Continuing Chest Pressure/Discomfort

I wanted to post before I have a follow up w/ my cardiologist.  I have had 8 heart caths since MAR 06, and have 5 stents in my LAD.  I have had in-stent restenosis twice in my LAD in bare metal stents, but my doctor put a DES under the two bare stents, and the last two caths were clear.  But I still have chest pressure, pinching in my shoulder, discomfort in my back, and am very tired.  Also, when running, my left arm goes numb a little bit.  I have also had spells of dizziness and nausea lately, but could be my meds.  I take Plavix, Lisinipril, Zetia, Metaprolol, Isosorbide Mononitrate, Cilostazel (Pletal), Lipitor, Niacin, Fish Oil, and an aspirin.  What questions should I ask my cardiologist?  What could be causing the continuing symptoms?  The symptoms aren't as severe as earlier, but they are enough to cause me discomfort.  Is it safe to continue to exercise?  Are their any tests you recommend?  And finally, when should I go to the hospital and when should I just "drive on".  One of my biggest dilemmas is whether I need to go to the ER during strong bouts of symptoms.  Any info you could provide would be very helpful, as I'm 40 with two little girls and would really like to get back to leading a normal life again. I have a strong family history of CAD (my dad has 9 stents and has had 19 caths/angio's) and do not smoke.  I have already been tested for GERD and asthma, and both are negative. Thank you for supporting all of us through these posts.

[Forum-M.D.-MJM]

Hello,

What questions should I ask my cardiologist?
If your stents are open, you are on a good medical regimen, and you are doing your best to reduce your risk factors, I am not sure what else to ask.


What could be causing the continuing symptoms?

It could be microvascular ischemia -- blockages you cannot see on cath or non cardiac chest pain.


The symptoms aren't as severe as earlier, but they are enough to cause me discomfort. Is it safe to continue to exercise?

Cardiac rehab is a good way to assess what is safe.  I recommend it to patients for reconditioning as well as learning their limits.

Are their any tests you recommend?

An exercise stress test.  This is usually required to start cardiac rehab.


And finally, when should I go to the hospital and when should I just 'drive on'.

I never know how to answer this one, especially when I don't know the nuances of your case.  If you are concerned, it is always safer to be checked out.

One of my biggest dilemmas is whether I need to go to the ER during strong bouts of symptoms.

If the symptoms persist and are resistant to nitroglycerin, yes your should have it checked out.

Aggressive risk factor modification is key.  High dose statin mediations to reduce your LDL to less than 70 mg/dl, Mediterranean diet or equivalent, and exercise within limits.

I hope this helps and thanks for posting.

[chrisr]

Like yourself I have had several procedures including 2 CABGs (2000,2005), 3 stent implants and AVR with aortic repair during my first CABG but still persist with chest discomfort often accompanied by nausea. My symptoms are also not aas severe as pre-surgery but still worrying and often difficult to decide on ER or not. My meds include Coumadin, Diovan, Coreg, Niaspan, Glucotrol and Asp/Nitro patch. The Nitro patch seems to help most both with chest and nausea whenever the discomort occurs. Several tests for GERD, GB etc have also been negative.
I do not wish to interfere with your post but since our symptoms are so similar I would be eager to see the CCFMD's reply and see if there is anything new for this very common condition. Best wishes for recovery.
Chrisr

[jmike1_]

Well, guess the answer was that there's not much you can do about the continuing symptoms.  Was hoping for some advice on how to maybe overcome the continuing discomfort, but guess I'll have to live with it.