Other tests/treatments for angina

[Sharon]

Thanks for taking my question.  My father (age 59) has a 15 yr history of heart disease.  His quality of life was very good up until 7/99.  Since that date he has had regular chest pains after the least amt of exertion (e.g. walking 50 ft).  Nitroglycerin  stops the angina attacks, but gives him a severe headache.  He doesn't want to be dependent on this med, but would obviously prefer not to have the pain at all.  He is also fearful with each bout of what may happen next.  My father is willing to travel to your clinic if there is any hope for an improvement in his quality of life.  Are there other tests/meds your clinic performs/prescribes which may "get to the bottom" of what is wrong?  Following is a brief history of his condition:

2/85 MI followed by bypass surgery (3 grafts, 1 endarterectomy)
7/93 Bypass surgery,no MI (5 grafts)
6/99 Cardiolite GXT showed heart emptying 47-48% blood vol      per beat
7/99 Chest pains.  Cardiac cath 9/99, angioplasty, insertion of 1      stent
9/99 MI apparently due to clot around stent
6/00 Cardiolite GXT - intense chest pain on treadmill; "something      different" from 6/99 test
6/00 Cardiac cath showed "good flow in all vessels" even where first coronary occurred (collateral flow from newly formed vessels).  "Grafts and stents look good."  Cardiologist isn't concerned pain is coming from blockage.  Says my father must "work through the pain."

Current Daily Medications:  aspirin, Coreg, Imdur, Avapro, Niaspan, Pravachol and Coumadin.

Thank you in advance for any advice you offer.

[CGTMHI]

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[EP__]

An important first step is to diagnose the type of angina your father has.  It is possible that, if indeed he has no blockages in the main coronary artery, he suffers from microvascular angina instead of the more common angina pectoris.  However, regardless of which condition he has, there are several treatments that are commonly recomended.  Nitroglycerin is known to cause discomfort in many patients.  Alternative medicines include Beta-Blockers nad Calcium Channel blockers.  In addition to medical treatment, it is important to keep an eye on risk factors such as weight, cholesterol, hypertension, and amount of exercise.

[CCF CARDIO MD - DLB]

We would be happy to see your father here if he would like a second opinion. If the cardiologist's interpretation of the last angiogram is correct, then your father has no good reason to have so much pain form his heart, so the pain must be from something else. If the catheterization in fact shoed that there was insufficient blood flow to some part of the heart, then he may benefit from another angioplasty. Without reviewing the actual catheterization film, it is difficult for me to say. But if he would like to come here, he should bring all his records, including a copy of te catheterization film and the stress test results.