Angina- what happens next?

[cuaco]

My mother, 68, life-time non smoker, healthy eater, daily exercise- 1hrs walking per day, has just been diagnosed with grade 2 angina after a stress test. She started to experience chest pain 6 weeks ago, saw her GP last week and was fast tracked for a stress test on Tuesday.  After the test she was given the report and told to see her GP who put her on Bisoprolol 2.5 mgs and gave her some sort of spray.  Due to elevated colesterol she was already on a statin. The dotor wants to put her on aspirin and a stronger statin but she is reluctant because she thinks these drugs will aggravate her tinnitus.  My questions are 1. What is grade 2 angina, is that a serious grade? 2. Should she see a cardiologist? 3. How vital are the stronger statin and aspirin to her longterm prognosis?  4. Should she have further tests to find the extent of the narrowings?  5.  How long does it take for the beta- bockers to work, she is rather depressed as the chest pain is still occuring despite the bisoprolol?  5. Are there other combinations of drugs if the bisoprolol doesn't work.    
   Thankyou

[cuaco]

Well, good news!  My mother had an angiogram as she had suspected unstable angina and a possible heart attack.  The heart attack was ruled out due to blood test results but she was thought to be in danger of an imminent heart attack - but!!! - the angiogram showed completely clear arteries!! No angina!!  Thank heavens for a healthy lifestyle.  she will need to be investigated further for her chest pain, the cardiologist has ruled out her heart.

[cuaco]

Perhaps my mother will take her pills now- she has just been admitted to hostpital with a suspected heart attack.

[Cleveland Clinic]

cuaco,

Im assuming your from off the continental US.

1. What is grade 2 angina, is that a serious grade?

Angina refers to pain related to limitations of blood flow to the heart. There are classifications of angina based on the amount of effort it takes to precipitate the pain.  There are 4 grades of angina that somewhat coorelate with prognosis with 4 being the worse.  Angina is not routinely categorized based on stress testing, but on the amount of effort required to precipitate the pain so Im not sure how she was classified based on the stress.  In the states, she would probably next undergo a cardiac catheterization to assess and repair coronary blockages.

2. Should she see a cardiologist?

Most likely yes.

3. How vital are the stronger statin and aspirin to her longterm prognosis?

If her angina is from coronary disease aspirin and statin both have marked benefit in survival and outcomes. Im not sure which statin you are referring to so I cant comment specifically.

4. Should she have further tests to find the extent of the narrowings?

As I mentioned, if she has angina and a positive stress, then cardiac catheterization is usually the next step.

5. How long does it take for the beta- bockers to work, she is rather depressed as the chest pain is still occuring despite the bisoprolol?

Depends on a lot of factors. If her heart rate is in the 60s though and her blood pressure is controlled, then she probably wont get too much more benefit from it.

5. Are there other combinations of drugs if the bisoprolol doesn't work.

There are a lot of drugs. They are patient specific. I would probably discuss your case with a cardiologist.