Additional Imaging of Benefit?

At age 51 or 52 after years of negative results on all testing, I was fortunately cathed 3 to 4 years ago at Stanford and diagnosed with moderate endothelial dysfunction via actylcholine challenges with no visible occlusion and elevated LP(a).  I take an array of meds (Coreg, Nitro, Nitro-Quick, Pravastatin, Niacin, Fish Oil and Vit D and small dose Xanax.  Lipids are good overall, but HDL could be higher and 1000 Slo-Niacin has not pushed down LP(a).  Possibly adding Diltiazem and have recently read about Eplenerone which I understand suppresses cortisol/physiological stress response.  I have breakthrough pain almost daily, particularly with emotion - I have always had an exaggerated physical stress response.  Have been resistant to taking SSRIs as vaso-constriction is a potential side effect.

Some medical centers do cath-MRI with challenges and are able to better image smaller vessel and see more detail on occlusion and or progression.  Is there a case to be made to re-check my status and get a more in depth analysis? I'm considering pursuing this a little further.  My insurance is HSA/PPO but will not love it. Thank you.

[Bromley]

Hi.  This is probably a question for a medical person, or scientist.  You could get lucky and get an answer, but not normally in the heart disease community.  You might try the expert forum.

I know what it is like and can appreciate the difficulty in getting answers to questions like this.  I hope you find your answer.

[MaryLG]

Thanks, Bromley - I thought I was submitting to the experts...I'll try again.  Best, Mary

[joanincarolina]

Hi again; the best additional imaging is a functional MRI to see if there is any wall damage done BUT after 5 years of  this MVD I show NO wall damage even with a dx of severe MVD.There is nothing else to look at these small vessels but I am of the opinion that this spider web of microvessels CAN be individually damaged but you'd have to have a very gross number to show wall damage.Therefore it is of utmost importance to have great control of lipids to prevent any placque clogging up these one cell thick micros. Consider low dose elavil at night to help with the pain/stress component. Joan.

[MaryLG]

Thanks, Joan.  

Well, the thoughts that have crossed my mind...maybe in 3-4 yrs I've had more occlusion and/or since menopausal, it could have calcified.  Another thought - it could show the level of tiny vessel "health" (or small vessel death) more clearly, since they're now looking at the nano level. With the level of pain I've had, I could have had multiple infarcts and never distinguished them from my normal pain.

Considered the Elavil, but don't want weight gain, and that is a strong potential with Elavil.  I need loss, not gain!  For now, I use Xanax for the emotional component, since I retired from the "glass of wine" when I started nitro.  Just as well.  I wish there were a vasodialating anti-depressant to try.  I tried Buspirone, but the CP didn't disappear.
Best, Mary

[MaryLG]

Just to be clear, I'm talking about a cardiac MRI with challenges, a la, Bairey-Merz style.