Recurrent angina after stenting

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Q:

Age 61, Past MI 2004,  May of 2010,  St elevation and myocardial infarction,  stent (2) right coronary artery and stenting (1) to left anterior descending.  4/2010, ABNORMAL NUCLEAR STRESS TEST.  2 stents  LAD and left circmlex.  Left ventricular with  inferior wall hypokinesis of old MI, mild apical hypokinesis.  EF-54%. Right coronary shows stent area with mild irregularity in the posterior descending and posterolateral vessels with a lesion of 30% in the distal right coronary just before the bifurcation.   Current: angina pectoris/prinzmetal, dyspnea, HBP  150/80, with  orthostatic hypotension  >25 point s systolic.  DX increasing HBP med’s.  Angina in chest and  right side neck.  Dr’s.  no comment on hypotension or angina, doesn’t think it’s the heart. IHD from 2000.

A:

Patients with 3 vessel disease (like you) do much better with a bypass operation than stenting and I am not at all sure  they have restored the blood flow to your heart back to normal as a coronary bypass operation (CABG) would have. A typical response after a procedure is often “we fixed you, so this can no longer be angina.”
You need to have your heart re-evaluated with a stress test at the very least.
You can read about this here:
http://www.cardiac-risk-assessment.com/heart-disease-diagnosis/exercise-stress-t
Here you can calculate whether your chest pain is more likely to be cardiac or something else:
http://www.cardiac-risk-assessment.com/app/chest-pain.php
Here you can calculate whether your treatment would have benefited from a different procedure:
http://www.cardiac-risk-assessment.com/app/
I have blogged about this before, because I think patients often are scared away from what is the gold standard in improving blood flow to your heart:
http://www.cardiac-risk-assessment.com/ca-blog/more-about-coronary-artery-bypass
http://www.cardiac-risk-assessment.com/ca-blog/point-counter-point/
Hope this helps,
Dr T
http://www.cardiac-risk-assessment.com/

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