Unstable angina, pain, event monitor

[Bev4848]

I've had stable angina for 15 years.  For the past 12 weeks I have had about 24 episodes of severe chest pain, bp raising to 240/140 and a pulse of 140.  These ease after about 25 minutes and 4 or 5 nitro sprays.  These are occuring at rest now, not on activity.  I'm on 4 bp meds and Imdur 30 mg and these keep my bp normal except for these break through episodes.  My cath, stress tests are normal - no blockages.   I've been instructed to just hold the course if the nitro spray stops the episodes; however, I'm very concerned.  At my request, I get a 30 day event monitor tomorrow.  I'm a 60 year old with diabetes and a history of idiopathic pancreatitis.  I do not feel my cardiologist is as concerned about this problem as me and my family.  Any suggestions or advice?

[dolfnlvr]

Bev,
     I would suggest that you stick to it with your doctor.  People who transition from stable angina to unstable angina are at a very high risk of suffering a heart attack within a few weeks of onset of symptoms.  Very often, the source of the transition is a blood clot that may partially or fully clog the affected arteries that are already sensitive to changes (spasmatic).  The goals of unstable angina treatment are to decrease the symptoms and prevent any more blood clots from forming. To accomplish this, a person with unstable angina will be hospitalized and given medicines through an IV.

In up to 85 percent of patients, this emergency treatment will stabilize the angina symptoms. The person can then have a cardiac catheterization, angioplasty, or heart bypass surgery (known as coronary artery bypass surgery or CABG for short) to look for and/or fix the causes of unstable angina. Emergency angioplasty or open heart surgery will be needed in those people for whom symptoms do not get better with IV medicines.

Please follow-up.  A simple "stay the course" will not suffice in this instance.