Unstable Angina

My wife was diagnosed w/ spasming arteries after a recent cath that showed patent new stents (5 wks) and patent LIMA & SVG grafts post CABG (1 yr 4 mos). She was put on 30mg Isosorbide 4x a day and still takes sublingual nitro but not as many as she usedto since being put on this new medicine.  She also takes Coreg 6.25mg 2x a day.  .  1) Because she gets and has been getting these spasms for the last 3 weeks, are spasming arteries unstable angina?  Her Dr said people with unstable angina don't continue walking around with it.  An MI would show up before this he said.  Is that true or can someone have continued unstable angina?  2) Should this medicine be used long term or will her body become tolerant?  3) She has blocked stents (for the last 3 years) within 3 mos each time and is on the highest doseage statins, takes all meds but is diabetic over30 yrs.  The cath lab knows her by name.  Should she be concerned about the frequent puncturing of her groin for this procedure?  She really doesn't have other options.  Severe orthopedic issues don't permit a CTA or a stress test (she used to pass the stress tests anyway).  Thank you for your help.

[Douglas Bogart, MD]

Your wife has a difficult problem.  Coronary spasm can be recurrent but is different from unstable angina (now called acute coronary syndrome) in its mechanism ie,spasm not a clot.  Calcium channel blockers can be of value for spasm.  People can become tolerant to nitrates and the doses have to be increased at times.  Generally the femoral artery can tolerate multiple punctures without a problem.