Angina, CAD et al.

Posted By Dan Moore on February 18, 1998 at 06:13:28:









First angina episode was in 1991 in Atlanta while away from home on business.  I experienced a dull chest pain for hours & assumed indigestion or other cause.  Ultrasound and cath showed no problem, although cardiolite test in late 1997 showed very small damaged area at bottom of heart.
Started on procardia 30 mg/day at that time.
Second angina episode was in 1994--pain episodes were more severe but much shorter (2-3 minutes).  Cath showed no problem, doctor took chest xray and prescribed some sort of inhalant under premise this was lung-related rather than heart-related.
Started pravachol to lower cholesterol.
Third episode was August 97.  Pain very severe, three nitros did not affect it.  EKG in emergency room showed distress, cardiologist administered TPA. Cath showed serious blockage (90%) in right coronary assumed to be cause of problem and some less serious blockage (40%) in circumflex.
Note: had been pack-a-day smoker for close to 30 years, approx 20 lb overweight, moderate physical exercise but not sedentary.
Referred to interventional cardiologist in Indianapolis, who performed atherectomy (rotablator), angioplasty, and inserted two stents in right coronary in early September.
Unpredictable chest pains started the day I came back from hospital 4 days after procedure and have been constant companion since.  I experienced no pains while in hospital.  Pains are sharp, below sternum, and do not spread to arms or neck, but most painful episodes will cause sweating.  tried numerous combination of drugs -- toprol, posicor, procardia, aspirin, with no real relief.  I had a cath 2 weeks after procedure and doctors found nothing but mentioned "unstable angina."  A month later I had the cardiolite test.  Doctor says I am not at risk of major heart attack but offers no answer to the pain.
Predictable pains due to exertion, cold, or even heavy meal have gotten worse; it is now difficult to exercise without chest pain starting fairly quickly.
I am scheduled for another cath in a week by Dr. who performed procedure in September 97.  The cardiologist tells me that there are many cases of chest pains where doctors are unable to diagnose the cause.  He also mentioned that at some point he may refer me to specialists with more experience in dealing with difficult cases (e.g., Mayo or Cleveland).
The angina is no fun, but nitro makes it go away fairly quickly. On bad days, however, quality of life stinks.  Throughout this ordeal, though, one thought keeps haunting me: these pains started so soon after the procedure that it is difficult not to think that there is some cause and effect relationship.  
I want to get this fixed -- any opinion / advice will be appreciated.