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/