Continuing Chest Burning Following Angioplasties

  This is in regard to my wife who, since July, has had 4 catheterizations, including 2 angioplasties with stenting. The first angioplasty was done following the discovery of 95% blockage in the right coronary artery.  She continued to have pain, which led to 2 more catheterizations (the initial angio was at Crozer Chester Medical Center, with everything following at University of Pennsylvania). All of the procedures showed approximately 50%-60% blockage in the LAD and about 15% in a smaller artery, none of which suggested the need for further angioplasty.  She then underwent all test for reflux (also at Penn), which all proved negative.  When her chest pain continued, the only course of action was seen as the final cath/angio/stent on the 60% blocked artery, which was completed at the end of October.  Since that time, my wife has had continuing chest discomfort except for a day or so. Recently, she began a course of a timed release nitroglycerin type of medication, which she discontinued because of considerable side effects and no relief of symptoms.
  Which is where we are now--no apparent organic causes for the symptoms either in the heart or GI, but symptoms that are worse than they have been for a while.  Her chest "burning" does not necessarily happen with exertion; for instance it seems to happen noticeably when she is lying down at bedtime and at waking up.
  We are not dissatisfied with her treatment but would appreciate any thoughts you'd like to share with us.  Thank you

[Cleveland Clinic, MD]

Dear  Andy,
There are many causes of chest burning.  The one that doctors worry about the most is cardiac because it has the potential to be life-threatening.  Once this is ruled out (as it has in your wife's case) the work-up can proceed at a more leisurely pace.  
Amongst the cardiac causes of chest pain are: ischemia (due to blockages - including both stable and unstable angina and acute heart attack), pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.
Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.
Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.
Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).
Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.
As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause.  A good Internal Medicine doctor should be able to help work through the potential causes of the symptoms.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.