prinzmetal?

[Texheart]

Thank You for taking my question. For years I have suffered with severe "out of the blue" Severe chest spasms. Emotions and cold air (aircondition,weather) could trigger these attacks. Doctors did not have a clue.  I finally suffered two heart attacks.  Doctors here still do not know how to treat/diagnose this condition in women.  Five years after the fact, a Angiogram,Cath, showed LAD, 99% blockage with MI distal to that blockage, (apex.Septal scarred).  DES did not relieve the cardiac spasms. Doctor said "pains all in head" now.  Five months later had Acute Cardiac Event with elevated Trops and A-Fib.  New cath doctor placed another DES in the LAD and for 18 months I was pain free. (Thank you God)  Pains are back. Doctor will not do another cath even though I have 2 great insurances.  How would you treat this in a female of 58 years "young".  What is an IVUS and will this instrument be more sensitive in finding hidden areas of ischemia?  Thank You.

[Texheart]

Thank you for your most interesting reply. You have opened a door that was never explained to me by a cardiolgist that I had fired, 2 years ago.  I had an angiogram three months after first stents due to some "slight" pressures.  Interventional Cardio stated he saw no blockages but something about pressures being off and the number 75 and mine were 68 in the RCA so he added two more stents back to back to back(First RCA stent 3 months earlier)  After I saw your reply I googled FFR and there I was.  I had to learn about this from you (Thank You) almost 3 years later.   Have not felt well since this.  Almost immediately after this I had a ACE with another stent in the LAD.  I have small vessel disease, i.e. vaso-spasms.  
Article states that those having a pressure rate under 75, they usually by-pass this area.   My pressures were 68 but he never explained this to me.
Dr. VB. if you see this again, how safe is by=pass surgery in a 58 year old female.  
Again, my sincere thanks to you.  Live and learn and log into Medhelp.

[Douglas Bogart, MD]

I did not see your question and I am sorry for the delay as we try to answer the questions daily.  With your history it would seem appropriate to repeat your angiogram and if the angiogram does not show severe blockage a fractional  flow reserve (FFR) would be of value.  Again sorry for the delay.

[Momto3]

Sometimes it takes a few days for the doctors to respond.  This particular forum accepts more questions than the others, so it may take a little longer.  Hang in there.

[texas2step]

Have you overlooked this question?  I am not the only one who has not had their question answered.  Would it be better if we asked these on the Cleveland Clinic Heart Forum?  Thank You.