Continued angina with medication

[tom3586]

Have had "atypical" chest pain for years. Recent cardio visit, exercise stress test & echo. No ischemic changes during exercise. Stress test terminated due to bp. Other results from echo include mild mitral and tricuspid regurgitation and incomplete RBBB. Treated for hypertension (metoprolol 25 mg daily). Also take isosorbide mononitrate 60 er daily and sublingual nitro (0.4 mg prn). Diagnosis was ?? with Prinzmetal "in the differential". Started these meds in July 09, was mostly pain free until Sept 09, but now having more  (same) symptoms (usually angina at night which wakes me, lasting from minutes to an hour). SL nitro sometimes works after one tab, sometimes three. Have angina occasionally in daytime, but still seems unrelated to exertion, although it sometimes occurs unpredictably. Am I getting worse or is my medication inadequate? Should I go for another check up? I'm not the type that wants to pursue invasive testing unless absolutely necessary. Any help would be greatly appreciated - at 58 I'm more than a little concerned since I have other risk factors as well (high cholesterol, overweight, high hs-crp, family history). I don't want to over react, just need some good advice. Thank you.

[Flycaster305]

It sounds like you have been through a lot of stress because of your chest pain.  Given that you have high cholesterol, weight issues, etc. I would strongly urge you to have an angiogram to determine if a blockage in one or more of your heart arteries is causing the problem.  It is the gold standard to determine if you have a blockage.  It is minimally invasive by today's medical standards as there are very few complications, and it gives health professionals and patients so much information.  Best wishes, keep us informed.

[ed34]

If your angina is not exercise related, then I would assume it is unstable angina. This is when a Coronary artery goes into spasm unexpectedly and for no known reason. You can be sitting down reading a book, relaxed or running around the block, it makes no difference. Most sufferers of this condition seem to get more symptoms in the morning.
Medications seem to work with some people but not with others. This type of angina is annoying and a real inconvenience because you have no control over its onset. With stable angina you know if you walk a certain distance it will start.
I will be very surprised if this is a stable angina problem due to an occlusion in the coronary arteries. You would get symptoms with exertion. An angiogram will not reveal anything if it's unstable angina, unless they are luck enough to see the culprit artery spasm.
I have often wondered if a section of coronary artery spasms, would a stent be strong enough to hold it open. however if it's a complete artery then there's no hope in stenting it anyway.

[kenkeith]

I have been taking coreg (beta blocker and isosorbide (10 mg as needed) for many years and manage heart failure and angina pectoris very well.  
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There is increasing evidence that beta-blockers are the drug of first choice in the management of angina. Beta blockers are at least as effective as the other two classes in controlling symptoms. Beta blockers have also been shown to decrease the risk of adverse cardiac events in patients with angina and silent ischemia. Nitrates and Ca channel blockers have not been shown to have this added beneficial effect.

I no longer take a nitrate (slow acting) daily but only prior to going to the gym for a workout 3 times a week.... YOU SHOULD BE AWARE If nitrates are administered around the clock, tolerance to their effects develops rapidly. Once tolerance has developed the drug is probably not having any beneficial effect. The drug must be taken such that therapeutic serum concentrations are only present for 12-14 hours of the day.

QUOTE: Diagnosis was ?? with Prinzmetal "in the differential".

>>>>>> What was the diagnosis?  Prinzmetal represents spams of the coronary vessel and the angina is unpredictable but dosing daily with a nitrate is not the solution.  I occasionally take a sub nitrate when there is unexpected exertion happens.   You should see your doctor for medfication adjustment or change because not controlling angina is depriving your heart cells of blood/oxygen and that can lead to heart failure or heart attack.

[cblmn7]

it is true that as said by ken keith about beta blockers. they may work for him but they dont work for all. you will have to get with you heart dr to find what works for you.coreg did not work for me or any other beta blocker so work with your cardioligst and find what works. i hope you get rid of the angina it *****