When will I know if I need a Stent?

[gburg]

I'm a 51 year old female and I was diagnosed with CAD 2 months ago. I have an 80% blockage and a 50%. I'm on 50mg. Atenolol daily and Prevastatin. My chest pain has improved some since starting the Atenolol but I still have chest pain after being on my feet and/or walking for long periods which is what I do at work. I have only used my Nitro twice but for fear of chest pain I don't push my limits. I'm following all the doctor's orders, I've quit smoking (6mos now) although I wasn't overweight I've lost about 8lbs, and I've lowered my fat immensly. My combined cholesterol was 220 and my good a bit low at 48. I'm having it re-checked next week. My concern is that my chest pain isn't being controlled by the atenolol. It has already been increased from 25mg. daily. Should I have a stent?

[gburg]

I appreciate the answers I have gotten here, but no one has really addressed my problem, nor has everyone that has responded seemed to have read all of my posts. Put simply, I had chest pains, went to the ER- I was admitted, they did a heart cath. I have an 80% blockage and a 50%. I was put on 25mg. Atenolol daily- I still had chest pain. It was increased to 50mg daily. No change I still have pain when doing the same activities that sent me to the ER in the first place. The cardiologist then told me to start seeing my regular GP for treatment. I don't have a regular GP and I don't have insurance. So after a two day hospital stay and a $13,000 medical bill that they want half of my monthly salary as montly payments, I'm medically the same as when I went to the hospital in the first place. Not one person during my care has told me what to expect next, or what my prognosis is. We are told these days to take charge of our healhcare, so totally trusting my caregiver is not an option.

[kenkeith]

Some people do not have any chest pains that alerts them to significant blockage.  It is medically referred to as silent ischemia.  You will have to trust your caregiver on the subject because (s)he has your health history, medication, concomitant health issues, etc. Providing an insight and perspective is not meant to be any analysis of your specific health issues.  I have a totally blocked LAD and 70% blocked ICX and get along well with just medication for the past 7 years.

If you had a cath procedure, it seems the implant would have been done for the convienence at that time. (S)he would send you to a doctor that would then send you back to the cardiologist?!  Has the chest pain been successfully treated? No insurance may be factor, but no one would/should be denied appropriate medical care.  If it is a matter of cost, the doctor would turn you away inviting and subjecting you to a bypass?!

Do as the doctor suggested see another doctor for treatment may help you . Take care.

[gburg]

My blockages were detected by cardiologist during a heart cath. I have read that more doctors are trying medication for chest pain before other invasive procedures but I've also found that most people with an 80% blockage seem to tell me they received a stent on diagnosis. To complicate my problem I don't have insurance and I want to manage my health care the best I can. After a follow-up visit from my heart cath and hospital stay my cardiologist told me to see my regular doctor for continuing care and a lipid test. I don't have a regular doctor and a trip to the doctor means I might not pay my electric bill. I don't qualify for medicaid. I'm just wanting to know what I might do to find out if I really should have had a stent put in but because of my financial situation it wasn't done.

[kenkeith]

I agree with Ed, but it may or may not be for different reasons.  If medication is not preventing angina (chest pains), it may be time for intervention. My opinion is based on the fact that angina pectoris (chest pain) is an indication the heart is not receiving a sufficient flow of blood/oxygen and that deficit can cause hypoxia (cells with low oxygen level).  Untreated the hypoxia can impair contractility of the left ventricle and reduce the cardiac output.

The AHA/AAC guidelines are not to stent any coronary vessel occlution with less than 50%.  If medication does not provide relief for any occlusions, then a stent.  Sometimes due to location, size of occlusion it is not a appropriate then a bypass.

Seven years ago, with congested heart failure, I had tests that showed an RCA 98% blocked and was stented, circumflex 70% blocked and no intervention, and a totally blocked LAD (no intervention as it has collateral vessel flow that helps feed the area formally by the LAD.  I have been on medication for all these years, and only take a nitrate for visits to the gym to workout. I have felt fine for the 7 years without any day of symptoms, or even a common cold!

Notwithstanding the degree of an occluded vessel seen is not the criterion as to whether or not to intervene (of course there are exceptions).  The COURAGE study concludes there is no extention of a life span with meds, stents, or bypass.  The objective is to treat the symptoms.

After about 10000 responses to medical questions regarding heart issues, it appears to be a differing opinions of an interventional cardiologist (does stents), and non-interventional cardiologist (treats with medication when applicable).  My first doc wanted to do a stent implant of the 70% blockage (I had no symptoms and before I could provide permission the doctor left the area (a few weeks subsequent).  My new cardiologist (for 6 years) and non-inverventional has been treating my condition with medication and never a mention of angioplasty.  

A cardiovascular surgeon may have a different opinion which indicates to me any opinion of someone with time worked in specific environment may not be properly informed based on their exposure that may be biased by their environment.  Therefore, I believe the best information that is not biased are objective studies.

Thanks for your question, and if you have any followup questions or comments you are welcome to respond.  Hope we have given you some insight and a perspective that can help you research for further information and better discuss the issues with your doctor.  Take care and thanks for chosing HD forum for your question and we are able to give you different viewpoints...but you and your doctor has the last word.  .

[ed34]

It's becoming more common to try and control symptoms with medication as a first measure rather than just start fitting stents or doing bypass surgery. It would appear that the medication is not helping you as much as you would desire, so maybe it's time to discuss intervention with your cardiologist as the next step. Did your cardiologist say a stent procedure was possible? you could be looking at bypass.

[RNRita]

I think the important thing is WHO diagnosed you and how did they do it?  Was it a cardiologist and was it during a catheterization?  If the latter, they would have put the stent in at the time, if they thought you needed it right away.  Only your doctor can answer this question with any reasonable accuracy.  I have seen people get stents at 80% many times.  If you are having pain d/t the blockage, I would think that is a possibility.  Please see your cardio and keep us up to date on your progress.  Take care and good luck.