intermitant chest pains

Question

i had a heart attack 2 months ago, i am 37 years old used to smoke heavily but have now totally quit, i was always in good health generally before my heart attack, 

since having my heart attack i had 1 stent put in and have been on prescribed medicines, I have been told i have high cholestrol but i am not over weight, i am 5"7 and weigh about 78 kilos, i am british of indian origins, 

my medicines are: 

ramipril 2.5mg 
bisoprolol 2.5 mg 
asprin 75mg 
clopidogrel 75mg 
lansoprazole 30mg 
atorvastatin 40mg 

i have been getting pain occasionally since maybe 4 or 5 times a week, 

the pain only lasts for minutes, like a sort of stabbing pain to then being a dull ache across my chest, i have used my nitro spray 4 times since i came out of hospital but i am unsure if i should of used it or not?? 

nobody is giving me a straight answer to how many times a day maybe could i use my nitro spray.?? 

or how long will it be before i am back to normal?? 

is there any other ways or practises that i can use to determine what is happening to me or what i should do?? 

i.e. check my blood pressure or some thing 

PLEASE HELP ME!!!!!

ed34 · Accepted Answer

Well, these are good questions. First of all, you need to get some more information from your Cardiologist. When having a heart attack, the blood supply to a section of heart muscle is cut off. So obviously, time is the essence here, you must get treated very quickly to save that heart muscle. The first line of defence would be paramedics who administer around 300mg of Aspirin to thin your blood and stop clotting. They then give you a Nitro pill to open the Arteries fully and this is far more powerful than the spray you use. In many cases, this stops or helps chest pain, allowing some blood to get through. This is because the blockage is likely 99-99.9% and not completely 100%. This reaction to the medication gives just enough blood passed the blockage to keep the muscle alive, but it will still be damaged, reversible damage if the treatment was within about 30-40 minutes. The cells have the ability to make repairs within that time frame. To survive that long they turn to anerobic metabolism rather than aerobic, meaning they burn sugars for energy rather than Oxygen, but this too will run out. In hospital they will perform an Angiogram, and insert Stents to open severely restricted vessels. If the blockage was 100%, there is no way to tell if any muscle will be saved, only time can tell. Cells can take a long time to fully recover because they are expected to work hard as well as make repairs, usually within 3 months. The larger the area of muscle affected, the longer it will take. Stents put in place are now of a pretty high risk of blocking within the first few weeks. This is not due to plaque or your diet, it is due to natural processes in the body. When you damage your body, you grow scar tissue to act as a framework, so new cells can grow underneath. This scar tissue in an artery just 2.5-3.5mm across will be a problem. Stents are coated with a special chemical to help inhibit scar tissue growth but it is very limited. A Stent is a mesh, so most of the Stent is empty space when expanded inside the Artery. All this space will not deliver the chemical to the Artery wall, and so only around 10% of the damaged artery actually gets coated to prevent scar tissue. Scar tissue grows from day 1 of the Stent up until about six weeks. If no problems occur in that time, they you have got away with it. If scar tissue becomes a problem, the Cardiologist can often insert a new stent inside the old one, which delivers more chemical. However, this often too ends up with re-blocking. This is the biggest problem with stents and one that still needs to be overcome. Your questions are good ones but there are other factors to understand. Very often when you have an Angiogram, it is all a visual thing. The Cardiologist will look at your Arteries on a monitor and look for 'obvious' blockages. This is not an accurate way to do things and different techniques are being adopted in the UK now. Imagine a fast flowing river with smooth banks. The water shoots along that river nice and smoothly and has a nice steady flow. Now imagine that there are many rocks bulging into the river. This causes the water to develop currents which cancel out the main one, and interrupt the flow, slowing it down. This is like your artery wall, it must be as smooth as possible. An artery can have lots of irregularities along the wall, causing flow to seriously slow down but may be far too small to see on an Angiogram. I had such a case over a year ago I was getting chest pains, but the Angiogram was clear. They put a special catheter into my arteries which had a tiny sensor on the end. This measured the flow of blood and gave the reading back to the Cardiologist. A bit like measuring how fast the water is flowing in that river. He measured the flow at the top of the artery to get a base reading and then passed it down to the bottom of the artery. About 2 thirds of the way down, the flow suddenly dropped by over a half. Obviously something was wrong in that spot so he stented it. The flow returned to normal but when he was passed that stent it dropped again. So he inserted a second stent. Now I had the same flow rate all the way down the artery. The cause could not be seen with the eye, yet it was there. If you felt no immediate difference when the stent was inserted, then I would strongly suggest there is yet another problem in one of the arteries. This sensor is referred to as FFR by Cardiologists, Fractional Flow Rate. ALL hospitals have them and yet most don't use it and it only takes 5 minutes to check the arteries. I know I said it can take three months for the cells to recover, BUT the ones closest to the blockage usually recover very quickly, almost immediately, giving some relief. If you did feel immediate relief when the stent was inserted, but discomfort came back a few days later, then it is likely that the stent is blocking again. After 2 months, there is no way you should be needing Nitro spray, not if they have treated blockages successfully. It simply wouldn't happen. I hope this gives you enough information so you can ask your Cardiologist the right questions. Usually if you have a basic knowledge, they tend to talk on the same level as you, rather than down to you. You can imagine treating thousands of patients every year and having to explain the same things over and over again, it would drive you crazy. So I can sympathise with them. If you learn the basics, it makes them happier being able to discuss your case with you.

hajibutch786 · Answer

thank you very much for all the advise you have given and also for all the information you have told me about it has helped me a great deal,

Nita2622 · Answer

I am not a doctor but the nitro spray max 3 times in 15 min. Every 5 min. If your chest pain is NOT going away in the last spray, go to er. I take nitro as well. There is another 24 hr nitro pill you take once a day for angina. Draw back is headaches.

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