Angina vs Atypical Angina or Musculoskeletal

[Cody]

Dear Physicians at Cleveland Health Clinic,
Just over two years ago I had angioplasty performed on my LAD because of a 90% blockage.  Since then I have had annual thallium stress tests and regular stress tests each year all with normal and similar results.  My present daily medication dosages consist of: tenormin(50mg), imdur(30mg), vasotec(20mg), hydrodiuril(25mg) and an aspirin(325mg).  I jog each day for 30 minutes without any difficulties and maintain a low fat diet which keeps my cholesteral levels in check: 165 total cholesterol, 78 LDL, and 50 HDL.  On occassion I experience mild chest discomfort which can last for two or three days at a time.  I have brought this to the attention of my cardiologist and he believes because of the normal thallium and regular stress tests results it is probably atypical angina or musculoskeletal related.  Are yearly thallium and regular stress tests each at six month intervals good indicators of angioplasty progress?  Are other tests advisable (PET Scans, etc.)?  And finally what are some causes of atypical angina?  Could it possibly be psychological?
Thanks - HM

[Cleveland Clinic, MD]

Dear  HM,

Thank you for your question.  Some of your concerns deal with medical management of your particular situation and must be addressed by your doctor.  I have answered the remaining questions as follows.  Angina is due to a lack of blood flow (ischemia) to the heart muscle.  It is typically pressure like and in the center of the chest.  It may radiate to the left arm or jaw.  It is often accompanied by shortness of breath and a cold sweat (diaphoresis).  It is often precipitated by exertion or cold but may occur at rest. It may last for as short as 10 to 15 minutes or longer than several hours.  It is usually relieved by sublingual nitroglycerin.  Pain that lasts only a few seconds or continuously for days on end is almost never angina.

Atypical angina is pain due to coronary artery disease that is different from that described above.  It is a diagnosis of exclusion, which means that other causes of the chest pain (e.g. musculoskeletal, psychological, GI source, lung source, etc.) must be ruled out first.

Patients are commonly followed with yearly thallium tests and occasionally PET scans if available in their area.  These scans can demonstrate the recurrence of blockages.  Symptoms are also a good indicator of recurrence.

[HM]

Followup Question for Physicians at Cleveland Health Clinic -
What is the difference between a thallium stress test and a PET Scan and what are their accuracies?  Is one more accurate and/or preferable than the other to check the progress of angioplasty patients?
Thanks - HM

[FG]

Dear Cleveland Clinic Heart Center:

For the past several months I have experienced a squeezing pressure in the center of my chest.  Sometimes it feels like a lump in my throat.  It's a very uncomfortable feeling.  I have been through numerous testing to rule out gastrointestinal disorders and had two stress tests.  The stress tests were positive, but did not indicate severe artery disease since I was able to complete the testing without pain.  I also have high blood pressure and am currently taking an ACE inhibitor. My HDL levels are unusual at 110 with a low LDL.  I am a normal weight. I exercise and follow a vegetarian low fat diet.  My doctor considered follow up for coronary spasms.  He tells me I should consider a cardiac cath., but I am reluctant to do so.  I feel this procedure is very invasive.  However, the chest pressure is becoming a problem.  My question is do you also recommend the cath. or are there other procedures I should consider.
FG

[FG]

I never received an answer to my question.  Unless the answer to HM's question was also an answer to me.  It was unclear to me why our comments would be together, since our problems were not the same.  My question was should I consider a cardic catherization. Or, are there other tests I should consider before going that route.
fg