chest pain after heart attack

[balper]

I had a heart attack at the age of 37 in 1999. The stent collasped in 2006 & they put the new medicated stent in. I take metoprolol, isosorbide, metformin, aspirin, buspar, effexor, nexium, pravastatin. My problem is that I still have chest pains, shortness of breath, dizziness, light headedness It wasn't to bad right after the first one but after the 2nd one it has steadily gotten worse.. My doctor has ran all the test including stress test with dye, echo cardio& blood work. Everything has come back good. He said the blood flow is good. I have had a few bouts of periocarditus. I have recently been diagnosed with fybromyalgia.

[ed34]

Many people assume (including some cardiologists) that squeezing plaque into an artery wall and inserting a stent will resolve matters, but scientifically this isn't the case, not always. There are two things to consider in your artery that has been stented, the pressure and the flow. Both are equally important and rely on each other. When you have a stent, it is hoped that you will form a new layer of cells to line it, and no scar tissue. You need a lining in the artery that is VERY smooth to not interfere with the flow or pressure. Imagine pouring water down glass, and then down rocks, the difference in flow rate is affected. If you form any scar tissue in the stent, it will disrupt the flow, restrict it by causing turbulence. The scar tissue will also cause that section of the artery to be slightly narrower, causing a pressure difference. Flow is the volume of the blood passing a given point every time frame (e.g. seconds). The heart needs a good flow because it consumes a lot of oxygen to do its work. If flow is disrupted in any of the coronary arteries, then the muscle will not have sufficient oxygen. When you look at the images in an angiogram, the smoothness of the artery lining is only judged by the eye of the cardiologist, but he can't see what is happening at a microscopic level. There could be a huge amount of turbulence affecting the flow, yet not be seen by the eye. In Sept this year I was called into Hospital because my Consultant Cardiologist noticed something on my previous Angiogram. On arrival, one of his Registars was given the case and he said "i've looked at the images and can't see any problems, the artery in question is very good". In the Catheter suite, the images gave the same impression, blood flow looked really good. There were no humps or bumps along the vessel and it looked perfect. Being scared of missing something, he did an FFR (fractional flow rate) test. This is a tiny sensor on the end of a catheter which gives readings of flow/pressure. He entered it into the top of my Left Circumflex and took the base reading. He then slowly descended it down the vessel and watched the readings. Halfway down, it dropped dramatically but there was nothing to be seen causing it. He ballooned a 1cm section but still it dropped, so he ballooned a further 1cm. He had to balloon 3cm to get a reading with no drop out. This section was then stented. Now, if I form scar tissue in the 2 stents he inserted, then I will have flow problems again. The drop in flow that was seen would have caused a substantial lack of oxygen on exertion. Perhaps it might be a good idea to ask your Cardiologist to try this.
I have read papers that have been published, saying how FFR is changing the views of many professionals. It was taken for granted that blockages over 70% would cause issues, but this is proving even a 10% blockage or less can have huge implications. My irregularities in the artery lining were microscopic, yet the turbulence had a huge effect.

[balper]

No copd I have been tested. Thank you

[ChatterAlly]

Any reason to believe there might be COPD involved?  Just curious.