"Small" blood vessels (coronary arteries) follow-up

[bzmed]

Follow-up of post of 7/3 on "small" blood vessels. Received the heart cath report-have a few questions (follow-up is not until July 23-dr on vacation). Am 45 year old woman with moderate mitral regurg - been having what dr calls angina. Subsequent to heart cath, dr changed med from beta blocker to nitro patch.  

1. If heart cath report is indicitive of "small coronary arteries" vs CAD isn't result the same..reduced blood flow to heart?  Would the treatment be the same?

2.  Angina generally comes on several hours after waking and last until I go to bed.  My heart rate generally goes up (usually 70s but goes to 90s/100s during episodes) and bp goes up (usually around 115/75 but goes to 130s/90s while resting)

3.  Under the impression that one should not stop a beta blocker without tapering off.  The cardiologist took me off it immediately. For the last several days I have spent the majority of the day with pretty bad angina..in fact, felt nauseous by the end of yesterday along with the angina. Could this be from stopping the beta blocker abruptly? Cath results follow in comments below..comments would be appreciated.

[CCF-M.D.-PPB]

1.  Small coronary arteries does not necessarily mean CAD.  Some people just have smaller arteries than others.  You may be talking here about small vessel CAD, meaning disease in the smaller diameter segments of the coronary arteries (further down into the heart muscle).  This means that stents and bypass surgery are unlikely to help with the symptoms becuase the obstruction to blood flow to the heart occurs further down the road where our current technology is unable to intevene on.  This then means that medical therapy is the only option.  Nitrates and beta blockers, as well as statins, are the mainstay of therapy.  

2.  From what you are describing, you angina sounds somewhat atypical, which can happen in women of course, but have you had an exercise stress test to confirm your symptoms.  If so, and the catheterization truely shows small vessel disease then you should most certainly be on beta blockers.  Whether or not you symptoms are related to cessation of beta blockers is often difficult to say but that is certainly possible.  I would stay on beta blockers and nitrates and add on statins if small vessel disease is suspected.  Most patients with small vessel disease are either diabetics, smokers or have long standing HTN.  Taking care of those modifiable factors/causes will also help controlling your symptoms.

3.  Where are the results of your catheterization?

[bzmed]

Cath results below...any comments would be appreciated....

Left ventriculography in the RAO projection showed an LVEF of 45% to 50% with mild midanterior to apical hypokinesis.

Left main coronary artery originates from the left coronary cusp in the usual fashion. The left main had diffuse plaquing in it to angiographically 30%.

It bifurcated into the LAD and circumflex coronary arteries.

The LAD had luminal plaquing probably to 20%. It was about a 3.25-mm vessel proximally and it became a 2.5-mm vessel very soon thereafter and wrapped the apex. It was a 2-mm vessel and it had luminal plaquing in the distal 3 cm to probably 50%.

The LAD gave off one proximal diagonal vessel of 2.25-mm size in diameter to 2.5-mm size in diameter with minor luminal disease to 10% to 20%.

The circumflex coronary artery gave off a 2.25-mm anterior margin, a 3-mm midmarginal, and a trifurcating posterior marginal. The anterior and midmarginals had luminal disease to 10% to 20% and the posterior marginal with luminal disease to 30%.

The right coronary artery originates from the right coronary cusp in the usual fashion. It was a 3.25-mm diameter vessel. It gave off a PDA and LV branch. The PDA and the right coronary was esssentially normal, may be with minor luminal disease to 10%. The LV branch actually retroflexed on itself and had luminal disease to 10%.

Goes on to say he is going to treat medically with a change in meds from Coreg to Imdur with follow-up in two weeks. I have also been diagnosed with MVP with moderate Mitral regurgitation.

[bzmed]

Sorry....they only give us so many characters so I had to post the results in the comments section...they  should appear above this comment but there they are again

Left ventriculography in the RAO projection showed an LVEF of 45% to 50% with mild midanterior to apical hypokinesis.

Left main coronary artery originates from the left coronary cusp in the usual fashion. The left main had diffuse plaquing in it to angiographically 30%.

It bifurcated into the LAD and circumflex coronary arteries.

The LAD had luminal plaquing probably to 20%. It was about a 3.25-mm vessel proximally and it became a 2.5-mm vessel very soon thereafter and wrapped the apex. It was a 2-mm vessel and it had luminal plaquing in the distal 3 cm to probably 50%.

The LAD gave off one proximal diagonal vessel of 2.25-mm size in diameter to 2.5-mm size in diameter with minor luminal disease to 10% to 20%.

The circumflex coronary artery gave off a 2.25-mm anterior margin, a 3-mm midmarginal, and a trifurcating posterior marginal. The anterior and midmarginals had luminal disease to 10% to 20% and the posterior marginal with luminal disease to 30%.

The right coronary artery originates from the right coronary cusp in the usual fashion. It was a 3.25-mm diameter vessel. It gave off a PDA and LV branch. The PDA and the right coronary was esssentially normal, may be with minor luminal disease to 10%. The LV branch actually retroflexed on itself and had luminal disease to 10%.

Goes on to say he is going to treat medically with a change in meds from Coreg to Imdur with follow-up in two weeks. I have also been diagnosed with MVP with moderate Mitral regurgitation.

[bzmed]

Also,  no history of diabetes, no HTN, no smoking...the only risk categories I fall into is obesity (by about 50 lbs.- 20 of that after I started beta blockers the first time), and sedentary (particularly the last year).