Small vessel disease/unstable angina

[jmike1_]

Any of you had or have experience w/ small vessel disease or unstable angina?  I have not really had a day for the past year+ without some level of chest pressure discomfort.  I have 5 stents, and have not had complete relief after any of the heart caths to put them in.  I've had 8 caths total over the past 15 or so months, but the last two came out clear.  So seems my main arteries are doing okay now (cholesterol levels are really doing well), but can't seem to shake the chest pressure/discomfort.  Doctors think I may have small vessel disease, but there's no proof - this is just an informed diagnosis.  I'm on Ranexa, and it seems to help as I now have some days that are better than I've had in the past, but would really like to have a completely good day and eventually a completely good week/month, etc.  Any hopes that this will just eventually fade away?  Thanks for any input!

[chrisr]

I am also having frequent chest discomfort even after CABG, AVR and 3 stent implants. Since it is often accompanied with nausea I have ruled out GI problems with GB, Gerd and stomach emptying tests which are all negative. Sometimes relief comes with Tylenol or Tylenol 3 but often complete relief only with Nitro-patch application. A recent CT scan indicated all bypasses are patent but cast doubt on the patency of the smaller vessels particularly those at the base of the heart.Before going for another angiogram, I have been prescibed Ranexa to try for about a month. Since this is a relatively new med and you have been using it for some time I would be grateful to know whether there are any notable side effects or contraindications with other meds. I am presently on Glucotrol, Coreg, Diovan, Vytorin 10/20, low dose Ativan and Nitro as needed. I also have periodic premature atrial beats or PACs but these are not a serious problem. My Rx calls for 500mg x2 a day. Is it OK to start with x1/day and move up to the x2 dosage?
Thanks for your comments or anyone else using Ranexa.
ChrisR

[jmike1_]

Sorry about the tough road you've had.  GERD has also been ruled out for me, as well as any respiritory problems as well, so guess that's how the doctors scientifically deduced that it must be small vessel disease.  Wish they could confirm that - at least I'd know for sure that's what it was.  I've only been taking Ranexa for about 3 weeks.  Tried to read up on it, but couldn't see that there were any bad side effects or complications w/ the meds I'm on.  They did list some meds that you wouldn't want to take it with, but can't remember what they were because they weren't on my list.  You can get a bit of info by google searching.  I seemed to feel a bit better for a few weeks, but still have chest pressure most days so not sure if the meds are working or if it was just "hoping" to feel better.  But seems to me that it sure may be worth a try unless you find any problems with the meds based on other meds you are taking.  Wish you luck, and hope someone else can post and provide you/us more info.  Thanks for the response.

[JB13]

Check with the Mayo Clinic.  They are studying small vessel angina and stem cell treatment for it.  JB

[texas2step]

Thanks for this information.  I will check on this. I have been diagnosed with small vessel disease and the culprit seems to be the distal LAD that causes horrific anginal spasms.  I was stented in the RCA in 2004 with absolutely no releif.  I had one stent 4 months later in the mid LAD with no relief.  (doctor scratched his balding head)  In 2005 after a bout of A-Fib and elevated enzymes, another DES was placed justr below the mid LAD and NO ANGINA for 16 months.  I was one happy camper.  But it is back!!!  Heart center here does not know what to do for it as they are afraid if they do a heart cath they will find several area's of blockages and they will not know which one  to stent and they do not want to stent just to stent.  I appreciate their honesty and concern. Thanks again JB.  I will alert my heart docs here and contact Mayo.  We all have too much living yet to do.  
NanaBanana

[Jim151]

I have been on Ranexa for about 8 months. Before I started it I was in constant pain from angina and had a hard time breathing. This stuff to me is a miracle drug. I no longer have angina as often and I can breathe normally. The prescription calls for 500mgm twice a day. I find that 500mgm once a day seems to work for meI also take Caduet, Plavix, Flomax, Prilosec.Lisinopril, and Metropolol.
It did take a few weeks before it kicked in completely.

[franners]

I also have small vessel disese (disease),large vessel disease and coronary artery spasm. I have been place on Ranexa andfor about four months all my chest discomfort went away. The one side effect I have experienced is loss of appetite and have lost another 5 pounds. Not a bad thing for some people but I am thin anyway. I can live with that. However recently I have started getting chest pain again and have to take nitro daily with exertion, I am a working nurse, 58 years old, and have had an Anterior Wall mi-the Lad- when  my stent occluded. They have restented it but is 50% occluded again. I am probably going to have to increase my Ranexa dose to 1000mg twice daily. I  guess my concern is what happens when the Ranexa stops working? Will bypass help ?
Thanks

[ed34]

What they need to be doing is a nuclear scan. For this test, the heart is put under stress, using drugs if you cannot handle a treadmill. A radioactive isotope is then injected which adheres to red blood vessels. A scan which takes around 20 minutes is then taken which reveals all the areas of heart tissue which have absorbed the radioactive
isotope. The higher the glow on the scan, the more blood is entering that section of heart tissue. This is a great clue for cardiologists to determine if small vessels are blocked or partially blocked. A second scan is taken an hour later with the heart totally relaxed.

[diva2007]

Well I Also have been diagnosis with Mircovascular small vessel disease. I have severe angina with exertion and with rest on a daily now. I take Coreg, Imdur, Cardizem, Nitrostat. I'm 37 years old and very afraid of having a Heart Attack I alredy had a TIA last year which was very scary. I'm a non smoker and non drinker I never did either in my life. My Cardiologist is worried about me I had a Blood Test Called hs- CRP done the first test came back 22.45 and two weeks later it came back 33.48 that's three times the normal which means my heart has lot's of inflammation as what I Was told. I also have LV Diastolic Dysfunction and my PCW preesure was Moderately High Which mean I have fluid backing up in my lungs. Well I hope everyone get some relief soon.

[ed34]

Have you been considered for a transplant?

[learnbydoing]

I am a 51 year old diabetic of 40+ years, Three years ago had CABGx5. Within two months 4 arteries failed and had 2 sets of stents. I also have CHF, CARD and small vessel disease. My Pharmaceutical cocktail over the past three years includes 1000mg of Ranexa twice a day, Plavix, Crestor, Zetia, Bydil, Bystolic, Trental, Lasix Nitro, Nexium, Fish oil and other vitamins. There have been numerous side effects to the combination of meds however, I have learned to live with it. I continue to have angina and breathing issues but I felt fortunate to be functional. Until recently I was progressing in that the CHF was getting better and my energy was adequate for my condition although I get tired easily. My CHF is now climbing the scale to near severe. I am currently on my second round of EECP therapy. I feel that the medication in combination with my medical team’s support as given me time that three years ago was thought to be minimal.  I dont believe that a transplant is an option for me. Does anone have a comment on that?

[ed34]

Having read that I am lost for words. Just this time last year I was offered a transplant, even though I had an EF of 70% and no tissue damage. My LAD was the main concern being 100% blocked at the top, diseased all the way down and fed by a few collaterals.
Cardiologists from 3 hospitals told me nothing could be done and my only chance would be a transplant. I refused this option, thank goodness, because a year later the blockage was removed.The only statistic they could give me was that 80% of people survive a transplant for the first year. I needed to know how long this heart would last compared to how long a transplanted one would last but there was no answers obviously.
Also, surely a heart with good coronary arteries put into my body and subjected to my lifestyle would suffer the same consequences in time.

[ireneo]

Have you noticed yet there's a group here for MVD? It's fairly new but the person who started it has quite a bit of information. Take a look, ask her some questions. Perhaps she has suggestions.

http://www.medhelp.org/forums/Cardiac-Syndrome-X--cardiac-microvascular-dysfunction/show/586?camp=msc