34 year old Son - had CABG (4 vessels @ 26 years)

[Arkie]

34 year old son is having angina, shortness of breath, with minimal exertion.  Nitro patches help some, but render him unable to complete his daily job.  Other medication protocol appears to be standard.  Since age 26, he has had one CABG, and three stent procedures.  In 2003 and 2004, he presented to ER with HA symptoms, but catheterizations and chemical stress test did not identify additional occlusion.  At son's last ER presentation about two months ago, Carodiologist requested consult with gastro doc to rule out gastric symptoms.  (My son knows what Heart pain is!)  EGD ruled it out. His physician, a cardiologist, says the cath shows there is a graft of the original by-pass that is non-functioning, but the vessel is so small that it should not be a problem, and stress test indicate additional heart muscle ischemia is not occurring.  Is it possible that a vessel could be occluded and stent or by-pass be needed and it is just not being seen?    Physicians are recommending EECP, but I understand this procedure is still experimental, and son lives about two and a half hours from any facility that could provide this.  Is there any data that supports the efficacy of this procedure?  Are there additional diagnostic tools that could more clearly define the etiology of the current symptoms?  Any recommendations appreciated, son is active in his profession and raising family, and wants to continue doing so.

[Cleveland Clinic]

Arkie,

Sorry to hear about your sons ordeal.  The most important thing is for your son to maintain aggressive risk factor modification and control.

1) Is it possible that a vessel could be occluded and stent or by-pass be needed and it is just not being seen?

Most likely not, although I havent seen his catheterization.  However, if the arteries appears open and there is no ischemia on the stress then a bypass or stent will probably not be useful. There are small vessels which might not be getting blood which are not readily apparent which could be causing his symptoms. In these cases increasing meds or other therapies such as eecp may be of some benefit.  Also remember that there are other causes of chest pain. Even though an egd didnt show anything, GI pain or something non cardiac could still be contributing.  In these situations I often empirically treat other causes to see if there is any benefit.  
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2) EECP. Is there any data that supports the efficacy of this procedure?

Yes. Definitely. Many people have experienced dramatic benefit from this therapy.

3) Are there additional diagnostic tools that could more clearly define the etiology of the current symptoms?

Not really.  Sometimes a second opinion from a large referal center can be a help.  A fresh set of eyes might have some options for medical therapies or catch something new.

good luck

[knicks30]

26 years old and having coronary artery disease?? My what were his risk factors? Is there are family history of early heart disease??

Sorry to hear for your sons problems at such an early age. Wish him the best of luck.

[Arkie]

Son is and has been a none smoker and non-drinker, athletic, played high school and college basketball, and was a state winner in track and field during high school.  Since high school has played church league basketball and softball.  Eating habits are those expected of a young man.  His family history and genes is his problem.  His father had by-pass surgery @ 40, and, again, at 55.  Just a strong history.  Thanks for asking.