angina treatment

[jane-thompson]

  My mother is a 67 year old while female (5'3 108lbs).  Her history includes a MI in 1984 that was treated with medication due to the cardiac cath being negative for any occlusion. The past year she has had increased episodes of angina. These episodes occur at rest and when she attempts to walk-thus causing her to stop her exercise program of walking.  In Sept. she again had a cardiac cath that was neg for occlusion but a small aortic aneurysm was seen.  A thallium tredmill followed the cath with neg. results. Medication she is currently on includes: Imdur ER 60mg 1 tab daily, Verapamil 120 mg 1 tab daily, and nitroglycerin prn.  She is not hypertensive and has a negitive history of smoking and alcohol.  My question is, would you recommend a change in medication?  My dad is present when the angina occurs and is concerned the s/s are increasing in intensity.      

[CCF CARDIO MD APS]

_
Dear Jane,
I reccomend a second opinion, not a change in medicines.  Granted, your mother's
story is incomplete (i.e. I do not know the full medical history and physical exam
findings), but surely it is interesting and unsolved as I see it.  That is to say
that HOW DO YOU EXPLAIN HER ANGINA and prior heart damage(MI in '84)?
Sometimes stress tests can be falsely negative in women especially, thus I would not
rely on that one test result to make me feel comfortable to just treat with medicines.
For instance, questions that come to mind when hearing you speak of your mother are:
1. Is the aneurysm contributing in any way to the pain?
2. Why is there an aneurysm to begin with and how is it being followed?
3. Has your mother ever been evalutated for spasm of the coronary arteries which
could very well explain her symptoms (but not the aneurysm?) During the catheterization
the doctors can inject a special medicine to check for spasm, this is not done routinely.
4. Has your mother ever been evaluated for clotting disorders which can cause her problems.
As usual, the unusual cases like your mother's case are best evaluated at a major university
hospital/heart center.  Although we do not always find THE answer at such centers, we usually are
more familiar with such situations as well as more aggressive in the care of the patient (in this case
investigation and attempts at preventing further pain.)
I hope this has been useful. I wish you the best of luck.
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.