Severe frequent angina w/2 prior mi's

[JP__0]

  I am living in fear. First the background info:  My husband (age 49) has had two confirmed, and probably one additional unconfirmed MI. (Our youngest child is 2 yrs old) He has had angioplasty 3 times, on the 2nd, the artery rebounded, and the 3rd they were unable to get through at all.  His MI's were in 92, 93, and most recently about 6 months ago.  The last 2 occurred after a stress thallium test.  He believes that the test caused the MI and I believe he is right.  How can you give a man a stress test that is having unstable angina, and not allow him to take nitro during the test, and expect it to have no effect on his heart?  After the last stress thallium they told him he needed immediate bypass surgery.  He declined to do that based on his own research and feelings (which I have no control over).  Since then, he has taken EDTA chelation therapy, which has given him more energy, but no less angina, and since his 1st MI he has taken various vitamin and mineral supplements. My problem and questions are:1.  How can he have a good day meaning normal activities and taking no nitro at all, followed by a bad day, where he pops nitros throughout the day, even at total rest, in bed, eating, sitting etc? 2.Isn't there a limit to the # of nitro you can take in a day?  (He never takes more than one or two at a time) 3.  Obviously I know that he is a walking heart attack...What is available that he may consent to that is non invasive?  Would he be a candidate for VEGF?  (He is already on procardia xl,atenelol,zestril,mevacor,aspirin) 4.  Sleeping is often a problem for him lately because of the angina; he already sleeps propped up. What else can he do about that?  5.  Has he possibly damaged his heart so much already that it is "unfixable"? 6.  Can you have congestive heart failure without swelling?  Thank you so much.  Sorry about the length and # of questions.
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Dear JP,

Thank you for your questions.  Most of them involve management of his disease and will need to be answered by his cardiologist.  We do have a VEGEF trial underway  here and the information is below.  In addition the NHLBI is considering a large scale chelation trial in the near future.
VEGEF trial
Primary investigator: Dr. Stephen Ellis
Purpose: Involves the direct application of DNA to diseased coronary arteries.  
The inclusion requirements are as follows:
1. At least 20% reversible ischemia on PET or thallium scan.
2.  Heart cath within the last 6 months.
3. No cancer.
4. No retinopathy (eye disorder).
5.  Ejection fraction of at least 25%.
If your husband meets these criteria or you have additional questions contact Cathy Comella at [phone].  The study is almost completed so if he is interested in participating you should call at once.  There may be additional studies in the future that he would qualify for if this one does not work out.
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.