Bypassing bypass surgery by growing new arteries

18 Aug

by Carolyn Thomas  @HeartSisters

The human body is endlessly fascinating, isn’t it? Consider how humans get started in the first place – only after one tiny sperm, one of hundreds of millions, has somehow negotiated its way past the lethal acid coating the vagina and made its long journey up to the waiting egg.  The odds are stupefyingly against that one brave little sperm. 

And then, consider the heart.

Before my heart attack, I had never heard of the heart’s little collateral arteries. These are small, normally closed arteries that, in times of dire need (like a blocked coronary artery that leads to a heart attack) can wake up, open wide, and enlarge enough to form a kind of detour around the blockage, thus providing an alternate route of blood supply to feed the oxygen-starved heart muscle. Do-it-yourself bypass surgery!

Consider also the example of Juliet’s life-saving collateral arteries. At the age of 46, this young mother of two in London, England suffered a heart attack due to Spontaneous Coronary Artery Dissection (SCAD).

Like most SCAD patients, she had no cardiac risk factors, and was very healthy at the time. (Just the day before, she had gone on a 40-minute run). But her early heart attack symptoms were initially misdiagnosed, and she now suspects that the tear in her artery may have unravelled further by the time she underwent a diagnostic angiogram. Juliet ended up with five stainless steel stents implanted along the length of her torn Left Anterior Descending (LAD) coronary artery.

But then things went from bad to worse for Juliet, as over the next three months, her stents re-stenosed (blocked) due to scar tissue build-up. She explains:

“During the period of re-stenosis and for about a year after, I suffered angina pain on exertion and most particularly after eating. Unfortunately, the stents subsequently failed, and my LAD is now 100% occluded with scar tissue. But that part of my heart is now functioning on collateral circulation. The chest pain symptoms disappeared slowly as my collateral arteries developed.

“It was a happy surprise to discover how wonderfully a heart can adapt with collaterals, and although I would love to still have the use of my LAD, I am doing fine without it!

“My cardiologists said these collateral arteries would have started to develop as soon as my LAD started to re-stenose, especially as I went straight back to running, post-cardiac rehab. I am surprisingly well and happy to be alive.”

Some researchers suggest that, because Juliet was already a physically active runner, her own collateral arteries may have already started this important process called arteriogenesis, which is defined as the transformation of pre-existing collateral artery pathways into conducting vessels.

In 2004, Swiss researchers, for example, found that enhanced physical exertion (like running) may indeed cause those tiny collaterals to kick into action.(1)  Study authors explained in the journal, Heart:

“For the first time in a human being with entirely normal coronary arteries, we have shown evidence of enhanced coronary collateral flow in response to an endurance exercise programme.”

I’ve been told the same theory – that my 19 years of distance running contributed to that enhanced coronary collateral flow, which may have been the factor that helped to save me during my own heart attack, despite having a Left Anterior Descending coronary artery that was also fully occluded.

While every human has these amazing little sleeping arteries, not every collateral will work when it needs to – especially if you’re not training for a marathon.

Researchers at Tel Aviv University have recently developed a protein-based injection that, delivered straight to muscles in the body, may spark the regrowth of tiny new blood vessels, much like the body’s own collateral arteries. Their study was designed to discover a way to prevent leg amputations, but their preliminary tests have shown potential value to future heart patients whose arteries are fully occluded.

Currently, as in Juliet’s case, implanting a stainless steel stent into a coronary artery is accompanied by a risk of future blood clots within or near the stent itself, which necessitates the prolonged use of blood-thinning anti-platelet meds. When I had a stainless steel stent implanted after my own heart attack, I was prescribed a what’s known as duel anti-platelet therapy: a drug called Plavix (clopidogrel, a powerful anti-platelet drug) plus low-dose aspirin every day.

Find out more about this emerging research, or about collateral arteries, or about Spontaneous Coronary Artery Dissection (SCAD).

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(1)  R Zbinden, S Zbinden, S Windecker, B Meier, and C Seiler, “Direct demonstration of coronary collateral growth by physical endurance exercise in a healthy marathon runner”. Heart. 2004 November; 90(11): 1350–1351.

 

21 Responses to “Bypassing bypass surgery by growing new arteries”

  1. Maurice Bartlett October 14, 2016 at 11:02 pm #

    On May 16, 2016 I had a Cardio angiogram at Dartmouth, Lebanon, NH and the Doctors explained that I had a 100% blocked artery on the right side of my heart and I do not need bypass surgery or stents because I grew two large collateral arteries! I was amazed!

    Immediately I felt blessed (not lucky…there’s a difference) and went through a gamut of emotions. I thought, I have been rewarded for having been credited for saving two people’s lives on separate occasions (while seriously risking my own life) when I was about 20 years old and again when I was about 23 years old! Then, after some time to process such inexplicable news, I thought that for most of my life I was a positive person and I ran long distance competitively for over 20 years. My faith throughout my life kept me in prayer. My Mom always said, “Prayers work! ” 😀👍

    Liked by 1 person

    • Carolyn Thomas October 15, 2016 at 5:11 am #

      Thanks so much for sharing your story, Maurice. Those collaterals are indeed fabulous, aren’t they? And while your bravery, positive attitude, and prayers couldn’t have hurt, the reality is that there are many equally brave, positive, religious people who do not survive what you did. My bet is that your decades of running provided you with terrific collaterals to begin with, as many studies have found (here and here, for example). Keep it up!

      Liked by 1 person

  2. Al Schifano July 24, 2016 at 6:56 am #

    I am 78 years old. currently very obese but on a low carb weight loss program that should get me back under 200 by next spring. I have not had angina or heart attack but because of abnormal stress EKG’s over past 7 years and a few episodes of mild chest discomfort (possibly acid reflux) my cardiologist decided to perform an angiogram. It revealed major stenosis in three coronary arteries; all over 75%, one at 95%. I am now seeing a surgeon to plan for triple bypass.

    However, because of a lack of symptoms, successful weight loss and ability to exercise moderately without any symptoms, we have decided to wait and review the situation monthly. My heart recovery rate after exercise is excellent. (I have not pushed rigorous exercise because of my weight, but as recent as two years ago, I could go an hour on the eliptical at a moderate 3 MPH) The surgeon also made note of the fact that for about 25 years I ran about 3-5 miles a day and completed two marathons. I have been reading about collateral blood supply. This may be at work in my case. We are still focused on bypass surgery but going slow as long as free of symptoms.

    Liked by 1 person

    • Carolyn Thomas July 24, 2016 at 7:28 am #

      Al, I really admire what you are doing! I’m not a physician but I think the collaterals theory makes perfect sense (given you have no symptoms despite those blockages – the heart muscle must be getting its oxygenated blood supply from somewhere, and that ‘somewhere’ is typically via the collateral arteries. You can thank your strong athletic history for those. Good luck on your weight loss and exercise program – you can do this!

      Like

      • Al Schifano July 24, 2016 at 11:20 am #

        Thanks, Carolyn. I appreciate your affirming response and your excellent blog.
        Thanks,
        Al

        Like

  3. Beulah Bradshaw April 30, 2016 at 12:54 pm #

    Congratulation to all with their collaterals. I had stenosis in four of the arteries of the heart. LAD, RCA, 1 other 100%,and the other 90%. Ejection fraction went to 45. I am not an active person, so my praises have to go to God my maker. Cardiac bypass was the only option. EF now 65-70, B/P couldn’t be better. Thanking God for growing those collaterals with adequate functions. Was told that I should have had a massive heart attack, but God’s mercy I am here.

    Liked by 2 people

    • Carolyn Thomas April 30, 2016 at 3:09 pm #

      That’s a great improvement, Beulah – EF moving up from 45 to 70! Hope you continue feeling better each day.

      Like

  4. Norman March 14, 2016 at 2:43 pm #

    I had chest pain come on after a severe sneezing ‘attack’ and could not walk more then a few yards without pain and felt sick continually apart from when eating a meal with wine. Which amazingly took away the sickness & pain.

    After various tests showing no heart damage but mild aortic stenosis I decided to see if I could create a Collateral circulation.

    So I started on the rowing machine at the gym, first 5 mins and built up to 75 mins in about 4 months and slowly I found I could be almost pain free in my usual work and daily living.

    When it first came on, I could only walk about 20 feet without pain, today I walk over 500 yards. I am 71 years old [male] and am feeling really fit and well, plus I find after the session I feel a sense of euphoria for two to three days.

    Norman

    Liked by 1 person

    • Carolyn Thomas March 14, 2016 at 3:10 pm #

      What a great story, Norman! Thanks for sharing this. Chest pain after a “sneezing” attack reminds me of something else: Did your doctors consider costochondritis (an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone)? We know that the chest pain of costochondritis can be caused by many things, including a severe continuous cough, for example, as a result of rapid expansion/contraction of the rib cage. Not to take away from your collateral experiment – which is a fantastic thing to do at any time – no matter what the reason!

      Keep up the good work!

      Like

  5. Susan Masin April 23, 2013 at 8:08 pm #

    I just completed 40 EECP treatments (Enhanced External Counterpulsation therapy). I had debilitating angina and was unable to exercise. After these treatments, I can now power walk/run up to one hour with no chest discomfort. I have also been taken off three of my five antihypertensive medications from my BP decreasing dramatically from the treatments. I am a believer in EECP!!!

    Like

    • Carolyn Thomas April 23, 2013 at 8:35 pm #

      That’s fantastic news, Susan! For readers wanting more info on EECP, read this. Or see Sharon’s EECP story – and cool photos – here.

      Like

    • Lina July 31, 2013 at 5:15 pm #

      Susan, where did you go for the EECP treatment?
      I live in Vancouver B.C.
      Thank you indeed
      Lina

      Like

      • Carolyn Thomas July 31, 2013 at 6:08 pm #

        Lina, Dr. Rod Santos offers this treatment in his Burnaby clinic. You could call his office for more info.

        Like

        • Lina August 3, 2013 at 8:21 am #

          Thank you.
          But he’s not performing EECP any longer.
          Anybody else?
          Yours
          Lina

          Like

          • Carolyn Thomas August 3, 2013 at 8:23 am #

            He’s not?! His website still features EECP services – maybe contact him for more info?

            Like

            • Lina August 3, 2013 at 9:44 am #

              I did contact him.
              The answer is – NO, he doesn’t do it anymore
              Thanks again
              Lina

              Like

  6. rehabilitateyourheart April 1, 2013 at 5:23 am #

    Another way of growing collateral arteries for people who have too much angina to be able to physically exercise is go through EECP therapy, a non invasive use of cuffs on the legs and buttocks which synchronously squeeze/push the blood back into the heart during its relaxation phase, thus providing more blood to the heart wall and helps to open the small collateral arteries. You can see the improvement on subsequent catheterizations. Many patients get enough relief of angina that they can return to exercise.

    Like

  7. RRastani November 7, 2011 at 3:36 am #

    What a truly magical concept this is. Like white blood cells and platelets springing into action when a finger is cut, our bodies are indeed miraculous self-healing machines. Trouble is, not every patient will be as lucky as your U.K. example here, particularly if they are not physically active. This is a compelling reason for increasing our physical fitness – the more we can strengthen our muscles and thus help to build up those ‘collaterals’, the better.

    Like

  8. Ami Woo March 15, 2011 at 7:26 am #

    My cardiologist told me that this is likely what has happened to me, my blockage did not require treatment because of these collaterals. Thank you for helping to inform people of amazing phenomenon.

    Like

  9. Mika January 12, 2010 at 6:09 am #

    Fascinating.

    The human body is endlessly mysterious, isn’t it?

    Thank you for this interesting information, and also for being such a valuable resource for women’s heart health. I have subscribed to receive all of your future updates.

    Thanks again.
    Mika in Tokyo

    Like

    • Daniel Jones February 1, 2014 at 8:28 pm #

      My heart grew its own bypass as well…I still smoke and am not physically active just very fortunate indeed.
      very sincerely Daniel Jones

      Like

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