New bouts of angina

[LeBean]

Hi everyone.  It's been awhile since I've posted here.  I've got three stents.  There was an attempt to stent an artery that failed and he stopped.  I have problems because my LAD is too narrow and crooked to stent or bypass.  I got a stent last May that helped, and in early December I got some unstable angina and went back to the hospital for an angiogram.  Now on my third cardiologist (they keep retiring) I'm so confused and could really use some feedback.

This cardiologist said he didn't find any blockages.  I have inflammation of the upper stomach so he put me on Protonix.  I said I thought you couldn't mix that with Plavix and he says it's not true; you can.  Anyone know anything about that?

Secondly and most important, I continue to have angina.  Not really strong because I don't move fast or lift and walk at the same time, etc.  Sometimes I'll get excited and move fast and get it; other times I could just walk across the room and get it.  It's not severe.  So here's my question:  Since he's basically said there's nothing they can do, do I just live with it, and then, if it becomes unstable, should I just stay home and let things happen?  As in, bye bye?  Because they say I'm not a candidate for bypass, and they can't stent my LAD.  If there's nothing to be done I don't want to die in the hospital.  I hope that's not too morbid -- I just really want to do the right thing and enjoy what time I have left -- whether or not I am on my way out.  There's one thing I might be able to do, which is EECP, but the cardiologist won't see me for another three months and I'd have to get an order for it.  Any thoughts or ideas?  Has anyone been in this kind of situation?  Thank you in advance, Genie

[ed34]

Hi, don't start thinking too far ahead and getting yourself worked up, that's the first thing. Don't start thinking everything is all over, you are far from it. Everyone has the ability to open collateral vessels, there's a lot of misconception about this. It is far more likely you will open them if the restriction is in a major vessel, such as the LAD, LcX or RCA. If the blockage is in one of the branches from these vessels, the chances of opening collaterals is less. For example, Diagonal or Marginal vessels. There also has to be a substantial pressure difference across two major vessels, or across a blockage. For example, halfway down my main artery there is a 100% blockage, but natural bypasses have opened to bridge this, lots of them. My Left main artery is heavily blocked, but my LcX has bridged across to feed into the bottom of it. All my blockages are in the main vessels and none are in the branches. My arteries were discovered to be a mess at the age of 46 (2007) and since then I've had many procedures. 10 stents and a failed triple bypass are part of the list. Guess what? I'm still here. They always say there's nothing more they can do, but believe me, if you go to hospital having a heart attack, they will do something. Usually they say there is nothing they can do when the risks are a bit too high for the situation, but when having a heart attack that all changes. I remember my last meeting with my cardiologist. He said that there's nothing more they could offer so I replied with "ok, so if I have another heart attack then I'll stay at home". His response was "NO, you get here and we will do something, it's just that the risk is too high when you are stable". You should also realise that stenting has come a very long way over the last 3 decades. At first all stents were blocking and they brought out drug eluting stents to help prevent this. They couldn't stent a curve in a vessel, now they can, tight ones. They couldn't stent a bifurcation (where 2 vessels join), now they can. Research is continuing all the time with heart disease and other diseases too. Who knows what's around the corner.

[Flycaster305]

You and I have a similar history.  I'm not a health professional, but have had a lot of stents, about 10 I think, bypass surgery, a pacemaker.  

After I had bypass surgery, the veins used in the bypass failed.  I was a poor candidate I knew going in to the procedure, but opted to try it.  After it failed, I started experiencing angina like you describe and breathlessness that led to the diagnosis.  

Two attempts were made to open my native arteries without success, but was contacted by my Cardiologist that he felt he could open the artery with a stent with a 'new' procedure, and perhaps straighten the artery during the process.  I went for it, as I was frankly out of options and growing weaker, and it worked, the artery was opened that I have a better quality of life.

EECP works with people who have the ability to form collateral arteries.  I can't. Also, it is a long, expensive procedure.   I'd suggest to you to contact your University Teaching hospital and ask for your files to be reviewed by them.

As for the PPI blocker and Plavix, it is reported in a major study that Plavix can be 4% less effective when you take a PPI.  

I think you still have options.  You can contact me privately if you wish on this site.  Best wishes, keep us informed.