Possible angiplasty procedure

[Sunshine Steve]

I just had a stress EKG done, yesterday afternoon, that showed slight abnormalities.  I have been experiencing chest pressure and pain of varying degrees for some time.  I was given three options. (Last night)  1.  Do a stress/echo test tonight.  2:  Do the tred mill test that involves a nuclear injection and is followed up in 4 hours by more pictures.  (This cannot be scheduled for 10 days.)  3. Have an angioplasty procedure done Monday.  There is a concern that either procedure 1 or 2 would cause additional stress to the heart and only reconfirm the need for the angioplasty procedure.  I have a great concern about the angioplasty procedure.  At the same time, I am in almost constant discomfort.  My wife and I have just moved to a new city (San Diego) and it is tough not having physicians that you know.  Thanks for listening!

[CCF-M.D.-RCJ]

Steve,

I cannot give you good advice with the information provided, but I will try to provide some clarification.

If you have had "almost constant discomfort" for a long period of time, say months, then either a stress echo or a nuclear test would be fine.  If, on the other hand, the discomfort started just recently, then a catheterization procedure might make more sense.  However, your doctors should give you guidance in making this decision.  An internet consultation cannot substitute for a real doctor seeing you in person.

Angioplasty means that someone is planning to open up an artery with a balloon.  What the doctors are recommending to you is not angioplasty, but a cardiac catheterization ("cath" for short).  This procedure involves putting a small tube into your artery, usually in the right leg, and then threading a smaller tube up to the heart arteries to take pictures of them.  The risk of a major complication from this procedure is somewhere around 1 per 1,000, depending on where you have it done and under what circumstances.  If a blockage is found, then angioplasty might be one of the options available to help relieve the discomfort.

Good luck.

[Dr. Erik]

You should have the Cardiac Catheterization to look for the potential blockages and then procede with the Angioplasty if necessary. It is possible certain areas of your heart aren't getting enough blood resulting in your discomfort. As soon as blood flow is restored to your heart your discomfort should diminish as well as the chance for damage to the heart muscle from lack of blood flow. Good Luck.

[HealThySelf]

Just remember that stents are forever.  Once they put them in your artery they are never coming back out again.

If you suffer from restinosis further down the line, you will only have the option of further procedures or bypass surgery.

You should have clear guidelines as to when and where your cardiologist will place a stent before undergoing the procedure.

If you just have "abnormalities" or below 50% blockages, a regimen of aggressive lipid control, exercise, and lifestyle changes may be the best long term option.

With multiple lipid control drugs you can now control your lipids at any desired level.  By maintaining ultra-low ldl and triglyceride levels over a period of years and exercising you can stabilize and reverse coronary artery disease.

Just remember that there is no magic cure for CAD.  Stents have side effects and a high risk of restinosis possibly leading to further invasive treatments.

Good Luck.

[Sunshine Steve]

Additional Information.   I would like to add the following information.  I am a 62-year-old male who, until a horse riding accident two years ago, was in good shape.  I was in the gym four to six days a week, on the tred mill for 45 minutes to an hour, very active and felt wonderful.  The accident caused me to leave the gym and virtually stop all activity.  I have also moved from retirement back into a fulltime job with a significant amount of stress.  I moved from Tempe, Arizona to San Diego, California.  In two weeks we close on the sale of our home (of 36 years) in AZ and two days later close on our new house in CA.  I remarried two years ago after loosing my first wife in 1982 to a ten-year, 36 surgery battle with cancer.  (There were many unusually stressful events over the years including my home burning in 1985 and my daughter almost dying of toxic shock syndrome 1n 1986.)

I have an appointment on Monday to have Cardiac Catheterization.  The cardiologist that I have seen (who I feel very comfortable with) has indicated that the results of the treadmill stress ekg showed significant enough abnormalities that this direction was far more prudent than doing either the echo or nuclear tests as he did not want to put added stress on my heart. (The choice was obviously left to me.)

During the test my by BP went to 138/90.  I am usually at about 118/75.  My resting pulse is 60.  My discomfort is in three areas.  I feel heaviness in my chest.  I will have periods of pain in the area of my heart that will occasionally reach a perceived “4” on the pain scale but are more often at a”1” or “2”.  During the tredmill test I actually felt better until the very last part of the six minutes when the pain was about a “1.”  There has never been an extension of pain down my arm or any form of sweating.  (I have had the pain radiate into my left arm pit.)

Thanks to all for your responses

[RCC]

I saw the comments on Stent side effects. Can you elaborate?