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unstable angina

Are there any new treatments for unstable angina? I am 5 years post CABAG w/ 3 bypasses. Since that time I have blocked off most of the bypasses, I have 4 stents and have had 15 heart caths in  5 years. I have to make an average of 1 to 2 trips to the ER for pain control when nitro s/l and nitro patches fail to work.I have had to retire because of the angina, can't garden or vacuum. My current meds are plavix, vytorin, ranexa ( max dose) , atenlol(75mg),norvasc (5mg), asa(325mg). I need to know if you are doing a study or have any suggestions because myself, my cardiologist, and the ER  doctors are at our witts end.
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Avatar universal
In Drugs.com, chest pain is listed as a possible side effect of norvasc.

Do you have HF?, if so I am not sure than a CCB is the best to take.

With all bypass and stents is your myocardium properly irrigated? Had you got a cardiac RMI to see problem areas?

Has ischemia due to vase spasms and micro ischemia ruled out?
After the bypass I guess that myocardium bridge is no longer a possibility.

What is your BP readings, too low ones can produce angina.

How well is your CVD controlled? Levels of LDL, Homocysteine and sCRP .

I might be wrong but if the pain does not lower with nitro, chances are that it is not angina.

Oh, last point, are you Afro American?  They do not respond to standard treatments like you have.

63984 tn?1385441539
Your doctors obviously are on top of your condition.  You might ask if Coreg would be a replacement for atenolol.  Could it be microvessel disease, where small vessels occlude causing pain?  Also, with that many stents, is it possible you are getting a harmonic effect of the arteries that causes a spasm?  I've got a chest full of stents and at one point I had an artery 'bridged' between stents with a longer stent to eliminate the spasm, and it worked, but I was miserable with continuous angina-like symptoms.  
976897 tn?1379171202
I am a bit confused. The poster says it's unstable angina, and I was wondering if microvascular disease is stable angina? If the cause of restricted flow is permanent then it will always give the same effect upon exertion, making it stable?
grah8755, have they diagnosed it as unstable? because it seems you are restricted due to exertion? Unstable angina really implies you can run a marathon, and not necessarily have an angina attack. It's hit and miss and can happen at any time, even when laying down. So, I am wondering if the diagnosis is correct. It would certainly imply stable angina if you have developed lots of blockages over the years and required further stenting.
Something else I would like to clarify, have they said whether or not you have any permanent heart damage due to the blockages you've suffered?

"I might be wrong but if the pain does not lower with nitro, chances are that it is not angina"
Yes I believe you are wrong. I had a totally blocked LAD (at the top), and the bottom was fed by a few collaterals. Nitro had no effect on the collaterals at all and the only result I had was severe headaches, but no relief to the angina. I tried patches for three days because they are not as abrupt as the spray, but still I had severe headaches but with lots of dizziness. Still the angina existed. The only relief I found was through beta blockers and they were like a miracle to me in really reducing the discomfort.
Avatar universal

Thanks for the nitro-angina explanation.

712042 tn?1254572809
I am entering year six with angina. I do not have coronary artery disease as in any vessels that could benefit from stenting or by-pass. I have what is called endothelial dysfunction of the very small vessels in the heart. It can also be called microvascular disease/dysfunction/angina or cardiac syndrome X...a not so used term these past couple of years. You probably are experiencing angina ( don't get hung up on the type) due to either involvment with the large or micro vessels. It really makes no difference at this point when you are just trying to get some relief from the angina pain. I should add that researchers who are looking at this role of micro dysfunction exclude known CAD patients as it is assumed that the placque in the large vessels are there in the very tee tiny ones.
It really doesn't matter as your signs and struggles with angina are the same as mine.
Drugs: the drug you may ask about is Bystolic. It is a beta blocker.It can be taken with a calcium channel blocker which I would not discontinue or exclude from angina treatment as it has been shown to reduce the angina (and spasms/narrowing that cause the ischemia which leads to pain). Bystolic interferes with adrenaline and that response on the heart demand. It has shown very favorable results.
Elavil:  I would also suggest that you try nighttime low dose( 25 mg)of this drug that helps the brain's response to pain.
Nitro: other than the drugs you state, I would try a better relationship with nitro along with controls on your exertion or heart demand. That includes controlling your emotional state. Right now I can read that you and your docs are frustrated.
Angina is pain. How to get the best control of this pain is the challenge. But it is manageable. And each drug trial is an attempt to find relief for you so don't get frustrated by any failures. I've had plenty since 2005.
My best suggestion is to recognize your triggers first: what are you doing and how fast are you doing something that triggers angina? Keep a note of it. Once you see a pattern, then common sense rules that you avoid that activity or you do it but much slower.
My second is your use of nitro: first, spray works very quickly but you must not be shy about using it and use it fast. The quicker you open up the heart vessels the slower the response to the brain in reducing release of hormones that increase the heart's reaction. The quicker you open them up, the lessor the pain. The goal is to stop that casade of events from angina.
Nitro patch: couldn't be without them! They are invaluable in the treatment of chronic angina. But there are many factors that reduce their effectiveness: body moisture creates a barrier, incorrect placement, chubby body fat area and a patch that is aging. If the edges are starting to curl, then take it off and put on a new one. Don't apply body lotions where the patch will go and be sure you are dry after a shower before placing.
Exertion: the biggest factor in angina is how we handle exertion that places a demand on the heart. And the quicker that demand, the more likely that angina can occur. And that demand include the emotional part of angina.
Anti-anxiety meds: No, this angina is not in your head but it is in your brain and it does affect your heart's response to events. When you feel an angina attack coming, stop activity and use nitro first, then quickly follow the nitro spray ( 5 minutes interval) with an anti-anxiety med. It helps reduce that brain casade of events. And if you have never taken that med before, I'd strongly suggest you do it, and until you stabilize this merry-go-round of anginal events that you are in, I'd be taking a regular daily dose.The nice thing about these class of meds is that you can take them on a regular basis, or you just take them as needed. I use xanax in my control of angina.
Side Effects with meds: You have to decide on what you can tolerate and what you can't, but give any meds a chance with time to see it they will relieve your main complaint of angina.
Chronic angina is a life altering event not only in daily management but in accepting that the next angina event might 'get you'. But time is on your side if you learn to watch the exertion, physical and emotional, and treat angina signs quickly. You must stop, take control of the event, and use the best medications available to help you...and nitro is high on that list. You may not like what you need to do, but it really will help your heart and your mind.
Angina treatment is trial and error; what works for one person may not have the same desired effect in another. The one thing we can control is voluntary cardiac demand. I'll answer specific questions. Best Wishes Joan.
367994 tn?1304957193
QUOTE: "Elavil:  I would also suggest that you try nighttime low dose( 25 mg)of this drug that helps the brain's response to pain."

>>>>I've been taking 25 mg elavil for 20 years.  I sleep like a rock, deep rim sleep, etc. refreshed in the morning.  Didn't know it had a positve effect on pain :)
I have a totally blocked LAD and circumflex 70% blocked, and I take a slow acting nitrate 3x a week prior to a aerobic workout for going on 7 years and no problems...one can develop a tolerance so there should be a break at times.  .  Fast acting nitro relieves chest pain, if the pain is due to narrow coronary arteries and/or micro vessels as the med dilates vessels increasing coronary blood flow. The stable angina develops when the demand for blood/oxygen increases and the narrow vessels stems good and effective blood supply. Dilated vessels Increase blood flow, and it is well known that this medication can supplement for a stent.  

Also, a doctor my have patient take a nitro pill, to help dx whether or not the chest pain is angina or not.  
976897 tn?1379171202
Is there a way that they can actually detect and diagnose MVD accurately?  I used to believe it was a diagnosis given if the cardiologist couldn't find any other problems. I know an angiogram has no chance of seeing such fine vessels, but does an MRI pick them up or any other type of scan? There must be millions of these vessels in the heart so I'm just wondering how they can see if it's the problem?  interesting stuff.
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