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Cardiology I have been having chest pain on exertion for a couple of years. After a stress test and a cardiac catheterization, the blockage is too small and behind the heart and hard to reach to place a stent. I am on plavix, zocor, (simvastatin) ecotrin,

9 doctors weighed in
Dr. Alec Moorman
Internal Medicine - Cardiology
3 doctors agree

In brief: Your

Your exertional chest pain (angina) is a result of poor blood flow to the region of your heart supplied by this small artery.
Based on your description, this sounds like a lower-risk lesion for serious complications like major heart attack or sudden cardiac death; and so would not warrant surgical bypass or higher-risk stenting. The good news for you is that a recent large clinical trial (courage study) has taught us that this type of blockage is treated very effectively with aggressive medical therapy. You are already on good drugs, but you may benefit from increased doses and/or the addition of newer anti-anginal therapy like Ranolazine (ranexa). If you have not already been referred to cardiac exercise rehab, this may also help relieve your angina.

In brief: Your

Your exertional chest pain (angina) is a result of poor blood flow to the region of your heart supplied by this small artery.
Based on your description, this sounds like a lower-risk lesion for serious complications like major heart attack or sudden cardiac death; and so would not warrant surgical bypass or higher-risk stenting. The good news for you is that a recent large clinical trial (courage study) has taught us that this type of blockage is treated very effectively with aggressive medical therapy. You are already on good drugs, but you may benefit from increased doses and/or the addition of newer anti-anginal therapy like Ranolazine (ranexa). If you have not already been referred to cardiac exercise rehab, this may also help relieve your angina.
Dr. Alec Moorman
Dr. Alec Moorman
Thank
1 comment
Dr. Thomas Heston
COURAGE trial is reassuring that in many patients it is safe and even recommended to treat stable angina with optimal medical therapy.
Dr. Rick Koch
Internal Medicine - Cardiology
2 doctors agree

In brief: Medication is likely

The answer to help eliminate or alleviate your symptoms when stents cannot be used.
Talk to your physician. Not exactly sure or question because it was cut off...

In brief: Medication is likely

The answer to help eliminate or alleviate your symptoms when stents cannot be used.
Talk to your physician. Not exactly sure or question because it was cut off...
Dr. Rick Koch
Dr. Rick Koch
Thank
1 comment
Dr. Atique Mirza
Make sure to keep your weight under control, control your HTN, cholesterol and do life style modification. Please stay in touch with your cardiologist and let him know about symptoms ASAP.
Dr. Francesco Rotatori
Internal Medicine
1 doctor agrees

In brief: Anti-anginal meds

From your question it appears that the appropriate work up was done.
Also, the medication that you are taking are appropriate to treat angina. Other medication for chest pain, such as Ranolaxine (Ranexa) , can be used, too. I would ask on next cardiology follow up.

In brief: Anti-anginal meds

From your question it appears that the appropriate work up was done.
Also, the medication that you are taking are appropriate to treat angina. Other medication for chest pain, such as Ranolaxine (Ranexa) , can be used, too. I would ask on next cardiology follow up.
Dr. Francesco Rotatori
Dr. Francesco Rotatori
Thank
Dr. Atique Mirza
Internal Medicine - Cardiology

In brief: Probably ok

You may need to add a beta blocker an acei if there is room in bp.
Please make sure that LDL is close to 70 mg/dl, bmi is less than 29 and BP is well controlled. Exercise on a regular basis.

In brief: Probably ok

You may need to add a beta blocker an acei if there is room in bp.
Please make sure that LDL is close to 70 mg/dl, bmi is less than 29 and BP is well controlled. Exercise on a regular basis.
Dr. Atique Mirza
Dr. Atique Mirza
Thank
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