Stenosis in LAD

[Den57]

Hi been having Angina for over a year now and on 7.5mg Bisoprolol and asprin and statin as well as a GTN spray..I live in the UK and have been told I have microvascular angina and mild coronary disease...my cardiologist says he cant help unless I have pains that last more than 30 mins as I only have a 30% blockage. How long does it take for stenosis to get worse. Thanks

[Den57]

Thankyou all for the replies..I think I need to ask to see another cardiologist the one I seen was very dismissive of any of my symptons. I have now been diagnosed with ectopic beats which he says is caused by coffee etc I never used to have them. My GP wanted a monitor for 24hrs but my cardiologist said the beta blockers will help..I have never been made to feel such a waste of time.

Jesus,
Thank you for the reply I don't have a problem with my glucose and I certainly don't want the blockage to get any bigger. I had rather naively thought that stenosis would progress with time. I am doing eveything I can to make sure it doesn't. I had never heard of micro vascular angina and Im not convinced either so I am asking for a second opinion.

Ed
I am going to print out what you wrote so I dont forget what to ask. Its amazing to hear of the Angiogram when they use FFR, I take it they won't do further investigation routinely because of cost..I have been told that my Angina pain is not coming from the stenosis its to small. On my cardiac cath report all it said was no flow limiting in other vessels. I need to ask more questions I just accept what he says and leave. I have never felt confident of the diagnosis..but this man is very abrupt and to be honest Im just pleased to get out. To be honest the cardiac nurses help me more.

Flycaster
Thanks for the reply,The cardiologist did say I can have something for the pain but I need to go back to my GP to get them.. I dont want to go up another dose on beta blockers as I struggle with fatigue. The pain was terrible when I exercised. Now I use nitro it helps, but have to take it before I start now. Will let you know how things go.

Thanks again

[Flycaster305]

I was diagnosed with microvessel disease about four years ago.  I had eight open stents at the time, low blockages as you report, but certainly had chest pain.  I was prescribed two drugs, one being Ranexa and the other Isosorbide Mononitrate (Imdur) and the help was immediate.  Ranexa somehow maximizes the oxygen level to the heart, and it works with Imdur to accomplish this task.  It helped me greatly until I did get a large block that led to bypass, but thought I'd add this.  Let us know how you are doing.

[ed34]

Just bring up the points I raised with your GP and ask to be referred back to your Cardiologist. The only limit to the number of angiograms is radiation exposure, which is very low anyway.

[Den57]

Mostly a diagnosis of elimination had a cardiac cath with only 30% narrowing but a dobutamine stress test showed induced ischaemia..can I ask for another Angiogram on the NHS...thanks for the replies

[ed34]

Just as a matter of interest, how did they diagnose Microvascular disease?
Many times, if they are unable to see significant blockages in the major coronary arteries, they simply put you into this bracket because they have no other explanation. This disease cannot be seen on an angiogram, so I wonder why they have diagnosed it. I too am in the UK and recently had 2 stents for a blockage which was less than 2%. The irregularities along the artery lining caused a lot of turbulence, so much that it slowed blood flow. I would go to your GP and say you are not satisfied with the diagnosis because it has no foundation to it. I would ask for another Angiogram, one which they use FFR this time which is a tiny sensor on the end of the catheter. What this does is measure blood flow going past the sensor. They take a base reading on one side of your blockage, then pass it through, slowly, watching the flow rate. If it drops 2 points, then the blockage is causing a lot of disruption to the flow. The reason this device was invented was because it has always been assumed the bigger blockages are the cause of problems. This device is proving the complete opposite. My blockage wasn't visible on the screen and without the device, nobody would have known about it. If your Cardiologist gets funny, simply say "ok, I would like to see the evidence for your diagnosis, where are the Fractional Flow Rate readings which lead you to conclude my 30% blockage is not causing my Angina".
I'm not saying it is definitely your 30% blockage causing the discomforts, but I am saying it is certainly possible. It is also possible irregularities in another vessel lining are causing your angina.
Have you had a nuclear scan?

[jrbon]

Den,

If you have microvascular angina, then that pain has nothing to do with the small blockage in your LAD. And you do not want the blockage grows.

As far as I understand, ways to combat it are to low your glucose, and to take calcium channels blockers. There are also surgical options.

It is a disease that will not kill you but can be very invalidating because the pain. In the worst cases patients are referred to "Pain Management Units" where they have multiple ways to stop the pain.

What about asking for a second opinion?

Jesus

[Den57]

I am only slightly over weight go to cardio rehab 2 hours exercise twice a week and eat very healthy..Dont smoke or drink..It is a family problem..my brother has had two heart attacks he is 44 cause by heart disease he has five stents in and my dad had his first at 51 and died age 61 he also had serious CAD..so its not looking good then :(

[ff985]

The simple answer is that it is up to you.  Your life style is the most important factor.  With exercise and a healthy diet you could go the rest of your life without progression.  You are now in a position that you need to be cognizant of your health for the rest of your life, which is of course if you would like to be around for a long time.  I would suggest a minimum of 30 to 45 minutes of exercise 3 times a week.  Your goal of this exercise is to get your heart rate elevated to 110 to 130 for the length of your workout.  Start today on a low cholesterol diet.  If you are overweight, you need to start to lower your body fat percentage.  Now if lifestyle is not what got you into trouble and this is hereditary, you can gauge the progression with your family members that suffer or suffered from the same problem.