Stents failing?

[Cann22]

45 yr old female insulin dependent juvenile diabetic, former smoker 20 yrs, high cholesterol (now 130 used to be 252), 10 lbs overweight but still losing, and a long cardiac history in short time.  Multiple stents to RCA followed by 4x CABG (LIMA & 3 vein grafts) 1 yr ago, MI 3 yrs ago (clot while on Plavix & aspirin).  Early January after EKG change 1 bms placed into 70% blocked branch off lcx.  3 days later it closed with a clot and balloon angioplasty was performed on branch and lcx.  Pressure intensified after that even though on heparin drip and nitro drip and enzymes went up.  2 Taxus 2 stents placed after that to lcx across the branch closing the branch off.  The heparin drip was stopped right before the new stents went in which I thought was weird because weren’t more clots a worry but I came home and have had pressure ever since.  First just pressure with exertion (steps mainly).  In the last week it is while lying down, sitting, etc.  It is the same indigestion burning pressure and sometimes squeezing pressure I had prior to the last stents going into this artery.  It is right between my breasts close to the sternum and at times very uncomfortable and those times relieved by nitro under the tongue.  Just a few times so far I have had jaw pain but today I was very winded going up the steps.  A healing leg (just out of cast) prohibits stress testing and the dr said he wouldn’t get the results he wanted anyway.  I take aspirin 325, plavix, 80mg lipitor, protonix (just to protect stomach), 10mg zetia, capoten 25mg 3x, imdur 60mg 2x.  I did have high blood pressure (150+/80+ p90)  but am now unexplainably low 80/60 p 60 while on same meds.  My question is – what do I do now?. Could these new stents possibly be failing?

[Douglas Bogart, MD]

Adding a beta blocker might be helpful to improve your symptoms and to protect your heart.  If the symptoms persist despite the meds you may need another cath.  The  chest pain can occasionally be due to the drug on the drug coated stent and if that is the case it will improve with time.

[Cann22]

CTA can't be done due to severe rotator cuff tear that cannot be repaired because it would mean coming of Plavix.  Heart vs shoulder - heart wins!