Options for Surgical Treatment of LAD MB w/Vessel Occlusion

[Sheila414]

I am a 62 year old female (an RN) with myocardial bridging of the mid portion of my LAD. I have a 45% occlusion just proximal to the bridge. My only symptoms are an insignificant shortness of breath when I walk too far or too fast and a fifteen year history of multifocal premature ventricular contractions at rest. The PVCs now come if I lie on my left side or bend forward for any length of time. After EKGs showed transient cardiac ischemia, T wave abnormalities and the arrhythmias, I underwent stress testing. The only notable information that came from that was a minor MVP. My last stress echo showed a narrowing in one of my vessels that was not detected before. I was given a left heart cath and diagnosed with the bridge in August, 2008. I was put on isosorbide DN. I was already on Atenolol (off label use for PVCs) and Digoxin (for a previous run of atrial fibrillation). Two things frighten me the most about the new problem: that I have had no cardiac pain--even with the ischemia--and that I have significant blockage in one coronary artery, with good control of my cholesterol since it first began to rise. My cardiologist indicates that had I not had good control of my cholesterol and not been a cardiac nurse early in my career, I would be a statistic--not the best news to hear.

In looking at future treatment options--particularly a stent procedure-- I am concerned that my options may be narrowed considerably due to a nickel allergy. I have read that there are currently no stent materials on the market that do not have any nickel in them. Are any other options open to me that don't involve something I already know I am allergic to?  
Sheila Kelly, Denton, Texas, USA,

[kenkeith]

Is the "bridge" collateral vessels?  I have a totally blocked LAD (at least 5 years) and collateral vessels.

If you don't have any symptoms (angina) and your lipid profile is under control, why are you planning ahead for a stent implant?  Medication may be all that is necessary.

You are aware that when used for long periods of time without a break, Isosorbide Dinitrate may not work as well. Be sure to have a "nitrate-free" period of time each day to help prevent this tolerance. I don't take a nitrate unless I go to the gym.

Also, some people who use Isosorbide Dinitrate for a long time without a break may develop a physical need to continue taking it. This is known as physical DEPENDENCE. If you take Isosorbide Dinitrate without a break and then suddenly stop taking it, you may get WITHDRAWAL symptoms. These may include chest pain, heart attack, or possibly sudden death. Be sure to have a "nitrate-free" period of time each day; this may help prevent dependence and withdrawal problems.