@frankad, I am following up with an article from the National Library of Medicine on questions about CT and MRI imaging of coronary arteries -- not to provide conclusive answers, but to raise the questions that you may wish to put to your cardiologist (or another cardiologist if you pursue a second opinion). The article is available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259311/.

It was interesting to me because of my choices this year. Since January, I have had 3 MRIs -- one ordered by a cardiologist, one by a nephrologist, and one by a urologist. All three specialists understood my reluctance to endure the radiation of CT scans. However, my cardiologist mentioned that a CT scan might still be needed to get better images of my functioning heart.

One other thought tonight: I have not sensed that any of the issues about my a-fib, my bladder cancer, or my kidney tumor held a threat to my life -- or that the imaging in each case would hasten the end for me in my 81st year (beginning next month). Like you, I insist on getting all of the facts and expert opinions -- good news or bad -- and that has armed me with confidence in my doctors (or their successors) and in my own ability to manage my medical situation.

Best wishes for a comprehensive picture of your coronary arteries and a lot more sleep after you get it.

your last sentence is very important. as to me, i' am in the same situation, shall I go on with the oral anticoagulation (Xarelto) and have a risk for internal bleeding (mostly gastrointestinal), or shall I stop? several cardiologists said to me, why do you bother? you are with Xarelto on the safe side.you can travel everywhere, A-Fibs can't cause a cerebral thrombosis anymore.that was one of the reason,why I decided to have a mitralvalve repair (my A-Fibs started after a deterioration of the mitral regurgitation,from stage I to II).the underlying disease was a mitral valve prolaps.I thought ,wenn the repair and the ablation are successful, and the heart function goes back to normal, there is no need for medication like b-blocking agents and oral anticoagulation anymore.but doctors don't care about the high prices, they simply don't want to be blamed, if the patient suffers from a stroke.
As to statins, as I wrote, I have been taking statins (simvastatin 20 mg) for a long time. nearly all my family members have a high cholesterol level and take statins. I'm lucky,as my cholesterol level is only slightly increased and my HDL is high (unusual).a medication with statins was not really necessary, but my younger sister had a heart attack,wenn she was 52 and got two stents in her coronary arteries.so in my case it is a profylactic administration.and I will continue it. I have no problems, no muscle aching for example. my younger brother needs 40 mg simvastatin and he goes jogging. to avoid any muscle problems he skips the statin every sunday.(he is a biochemist).
I shouldn't worry about possible side effects.niacin was used a long time ago, the introduction of the statins changed everything.
I think that eating habits are very important, especially which oil you use. I never use butter or margarine, for baking olive oil. we are lucky, as we can buy olive oil directly from the producer in greece. there is no possibility for the owner to manipulate the oil, as we stand beside..

@yoanne, your analysis and the information you have collected make it clear that you're a whiz at managing your own medical condition, and your use of multiple cardiologists at one time or another shows that you are double-checking what you are told by medical professionals. Kudos to you!

As to Xarelto versus Coumadin, note that emergency rooms stock a Coumadin antidote (vitamin K solution) that cancels the anticoagulation effect of Coumadin in 10-20 minutes. An antidote for Xarelto is in development, but isn't yet ready for distribution beyond its research laboratory. My cardiologists recommended and prescribed Coumadin to ensure immediate availability of an antidote. However, I don't have a gastro problem like yours, which could bring different advice from my medical team.

As to statins, am I correct in assuming that you are taking a relatively low dose once a day? If so, you are not likely to notice any recent forgetfulness or clumsiness which a statin may provoke. That was a problem for me, so my primary physician looked at my diet and exercise regimen and suggested that it is good enough -- in light of good lab results -- to warrant dropping the statin medication.

Hi predictable,

Actually, I've not started taking any statins at this point. My cardio guy here in Las Vegas is not happy with me about that, but I don't believe that doctor's look at individual cases as compared to the large statistical profiles that they're informed about. Thanks again for the comeback. Also, I'm getting a little confused about recognizing exactly who's talking to me as there seem to be multiple conversations going on at this site, so please send any comments to, Frankad, so that I'm sure it's me that's being addressed. Thanks

@frankad, I try to include the name of the member I'm addressing in my message, as you do. Sometimes I forget. There are others who never do that, and that confuses me no end. But eventually the truth prevails. Waiting for it can be painful, though.

@predictable, of course, we should mention the name. I got irritated as well, but did not correct my mistake, sorry!
I know about the failing antidote for Xarelto, but the doctors here, especially in the emergency department, know what to do. 5 years ago my cardiologist said to me, because of your age you need an oral antigoalation in stead of 100 mg aspirin. he asked me, what do you want, Coumadin or one of the new OAG's,like Xarelto.? I said, I prefer the new one, because I didn't want the monitoring, necessary for Coumadin, as you know. so he gave me a perscription. He informed my general practitioner.but she did not agree, because this medicine is very expensive (98 tablets Xarelto 320 Euro) and she would have problems with the insurance company. (in germany every doctor has a medicine budget for 3 months, in total for all the patients she sees. the budget is lower for a family doctor, higher for a cardiologist. she would only perscribe Coumadin, which I refused. we got an unpleasant quarrel, and I had to find another family doctor, I tolerate Xarelto very good, no gastrointestinal bleeding so far.the only problem is , that I easily bleed. Januar last year I had an accident with the bicycle, my small finger was injured (no open injuries, but a big swelling around , definitely blood).6 months later a X-ray showed a fracture, too late for a treatment. and the other disadvantage of Xarelto is that I cannot take all kinds of pain drugs, only paracetamol is allowed, no aspirin etc.
My daily dosage for simvastatin is low, 20 mg (sometimes only 10 mg, alternating).

@yoanne, I have been on Coumadin for over two years. My HMO has a pharmacist tracking me regularly to check on my anticoagulation rating. He schedules a monthly laboratory test to keep on top of it; I drop in on the way to or from the bowling alley on Tuesday. He reminds me how lifestyle and diet choices could change it. So far, no problem. An 83-year-old friend has been on Coumadin for 10 years. His dose is small (compared with mine) and he monitors his coagulation level at home with an inexpensive device. You may need a similarly small dose of Coumadin, given your doctor's advice to move up from aspirin.

A year ago, a neighbor and friend fell off a step-ladder in his garage. I found him bleeding on the floor and got an ambulance to take him to the emergency room a mile away. The ER had no antidote for his anticoagulation drug, so they helicoptered him to a hospital 30 miles and 45 minutes away. He never recovered from the brain bleed, dying within hours, fortunately with family around him although they couldn't get a response from him.

I resolved to stay with Coumadin so long as it's the only anticoagulant for which there is a stock antidote (an antidote for Xarelto is in development, but is not yet released to put in stock). Saves me a lot of anxiety as well as a lot of money!

@predictable hello!
you did not mention,which anticoagulation drug your neighbour took. but probably one of the new ones. any person in the ER should know what to do,,especially since there is no antidote. (information about the treatment of bleeding has been included in the patient leaflet, for example bayer/xarelto.(I cannot send it to you, as it is written in german) . yesterday I read an article (very recently) about Vit.K antagonists and the new Anticoagulation drugs.
https://www.drugwatch.com/xarelto/vs-warfarin/
bleeding is a problem for both ,cerebral bleeding a big problem., with warfarin even bigger than with Xarelto. most people do not survive. I' m aware of this problem, it means risk or benefit, I have to believe the cardiologists.
concerning warfarin/coumadin I'm not positive. the reason is the medical history of my oldest brother. he was suffering form heart failure. since 10 years he took coumadin, and he was monitored by a special service in amsterdam (a nurse visited him at home).2009 he needed a cardioverter. the implantation was done in the university hospital of amsterdam.24 hours later he left the hospital, 12 hours later he died. - cause of death:cerebral bleeding and lung embolism. obviously the warfarin monitoring was not correct during and after his stay in the hospital. you can imagine that we were very shocked. since then I'm not keen on taking Vit.K antagonists.

I regret that the cardiac surgeon did not perform the left atrial appendage closure. this is up to now not a standard procedure, but my cardiac surgeon told me, that it will soon be done by all patients, who have preoperative A-Fib. ,like me. I'm quite sure,that this item will be discussed by the american and european societies of cardiology. Had it be done, I would not need any anticoagulation.

@yoanne, I didn't mention the anticoagulant involved, because that wasn't the point of my comment. In fact, it was Coumadin. It's not that the ER staff didn't know what to do. They said they didn't have any of the Vitamin K antidote on hand, so they called for a helicopter to take my friend to another hospital. For me, the ER oversight in a neighborhood full of senior citizens was unforgiveable.

From my research over the past year, I have become convinced that the criticism of Coumadin is deliberate degradation of its record and usefulness by pharmaceutical companies that manufacture the "new" anticoagulants. In the article you attached, for example, the great shortcomings of Coumadin are 1) the coagulation index (INR) of a patient's blood is checked regularly in a laboratory (although a friend of mine has a home testing device to keep track of his 10-year use of Coumadin) and 2) "Patients taking warfarin must be monitored every two to four weeks," the Drugwatch article complains. I read a less subjective report on anticoagulants last month; it declared that the standard Coumadin antidote returns the blood to normal in 10-20 minutes on the vast majority of cases.

In contrast, there is no antidote available now for any of the "new" anticoagulants. There is one in controlled clinical testing for the makers of Pradaxa, but we'll wait perhaps another year before that will be ready. I'll stick with Coumadin, thank you!

I'm sorry to hear that your brother's medical treatment team failed to keep him alive. I know from your postings here that you are too well informed and too prepared to manage your own circumstances to let that happen to you. I think the chances of you being victimized by a-fib are very small to zero, as they are with me.