In sept 07, a very long blockage was removed in proximal LAD and around three quarters of the LAD was stented due to lots of disease. Grafted LIMA to proximal LAD was reopened due to the removal of the blockage. Since that time, my angina symptoms have worsened to the point where I now feel as I did before the procedure. Cardiologist has said a CT scan will not reveal if stents have a problem, and any further angio procedures are not really an option now because the risk is simply too high. Nitrates, CCB, have no effect but beta blockers recently restarted are helping a small amount. Any exertion is uncomfortable with throat and chest pains + shortness of breath. Cardiologist says there is no option but to remain on medication now. Would you concur with the opinion of my cardiologist? or say that quality of life requires an angiogram to establish whether a stent has a problem or restenosis? Would you consider a stent placed inside another stent (if this is the problem) to be too risky? I believe 5 long stents were used in the procedure on my LAD.
Surgeons have dismissed the possibility of transplant because thallium scans seem to contradict my symptoms, showing very good results and these were done with the 100% blockage in the LAD. I believe SOME collateral development had occurred. My echo shows no problems, EF 70% and a stress echo last month had me in agony with throat/chest/jaw pains and gasping for air with nausea, but showed no problems. My ECG looks great too, but I am finding it hard to put up with these symptoms now, I am 49 and used to be very energetic. I am in the UK and would appreciate your opinions and perhaps some advice on anything I can ask my cardiologist or suggest to her.
Unfortunately, a tiny little vessel can cause as much chest pain as the LAD, so just because the pain is there, it doesn't mean that it affects your previously placed stents. Also, keep in mind that collateral blood flow isn't as good as native flow and may cause you chest pain with exertion. The fact that your stress echo is normal and that your EF is normal is very encouraging. Your prognosis is excelllent. One thing I would consider trying is a medication called Ranolazine. It has been shown to decrease medical therapy refractory chest pain. I would try this first and if that doesn't work consider another angiogram. However, I do think that you stents are open. Placing another stent within a stent increases the risk of restenosis and I would definitely discourage that unless there truely is an indication for it.
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