Angina progressively getting worse

[MrDIY]

Just wondering if others have had similar experiences of Angina symptoms getting worse over 6-12months. Had a stent fitted in main left artery at the end of April20 instead of having a bypass because of Covid. They sent me home with the standard meds and I thought I was fixed, sadly I still got Angina when walking but to a lesser extent - a GTN pill stopped symptoms. Fast forward 8 months and I have to take a GTN spray 5mins before I go for my walk and take a GTN pill when the symptoms come on (as they always do) - so double the meds to keep the Angina at the same level.

I have been referred back to Cardiology and now need to wait again!

There is family history of Angina and my dad had a bypass at 68, I am currently 55. I have none of the lifestyle factors in play and my cholesterol has always been normal, there's not much I can change in my life other than increasing medication, which I am doing. I accept its hereditary and am less worried about dropping dead at any moment; I just hope they can do more to help me.

Currently on clopidogrel 75mg, aspirin 75mg, atorvastatin 80mg, bisoprolol 2.5mg, pantaprozol 20mg, monomil 60mg (now 120mg), ramipril 2.5mg, GTN spray and tablets as required. When I questioned all this after the procedure they said it was standard after stents and I could stop everything except the aspirin after 1 year. Tried 5mg of bisoprolol to reduce angina but my BP and HR would dip and I got dizzy so back to 2.5mg and double monomil.

[JennyRx]

If they were going to do a bypass then there are other arteries that are blocked, partially or otherwise. That would account for the single stent not ‘curing’ your angina. You don’t say if you got any rehab support even if just on the phone. So taking it slowly and building up exercise very gently is the way forward.

I would question what they said about your meds as normally clopidogrel would be stopped after a year but you may need to stay on the others, particularly as you still have a level of angina. You don’t mention what your BP or cholesterol is like. Those are risk factor for CAD and they may want you to continue with the meds to reduce the other cardiac risk factors.

Maybe talk to GP if possible and they can look at your discharge notes and get it all in perspective for you.

[MichaelJH Heart Star]

My angina did worsen before my bypass. This was handled by anti-anginals rather than frequent GTN applications. The more common ones are Isosorbide Mononitrate (another nitrate) and Diltazem (a CCI - calcium channel inhibitor). It may be worth discussing these with your GP.

[Milkfairy Heart Star]

bhf.org.uk/informationsuppo...

[Milkfairy Heart Star]

Hello MrDIY

I live with angina too.

Unfortunately my variety cannot be treated with stents or surgery because it's caused by a problem with vasospasms in my coronary blood vessels.

Unfortunately stents as you have discovered don't always ' fix' angina.

Which is so disappointing for you.

Whilst stents can help relieve the symptoms of angina and improve the blood flow to the heart muscle the underlying cause of coronary artery disease remains.

My husband had a stent inserted nearly 10 years ago and he's remained on a similar cocktail of medication to yours to reduce the cause of his CAD.

His clopidogrel was stopped after a year.

The results of a large study comparing surgery, stents and medications for angina due to blockages in the coronary arteries was published last year you may find the information helpful

medscape.com/viewarticle/92...

At the moment because of the Covid pandemic you are like many of us in limbo without a timely access to the Cardiology care we need.

I hope your wait to see a Cardiologist isn't too long.

In the meantime keep in touch with your GP and if your symptoms get worse tell them and ring 111 if you get chest pain at rest or not relieved by 3 sprays of GTN 5 minutes apart.

[MrDIY]

An update on my progress: the angina slowly got worse over the following months, my GP increased the bisoprolol but that didn't make much difference. Incidentally, after a week on 5mg bisoprolol I had a funny turn that lasted for hours and felt like hypoglycaemia (except a sugar dose didn't help). My GP immediatly took put me back down to 2.5mg - perhaps he should have listened to me when I said my heart rate is normally quiet low!

Next step was to double the dose of monomil which worked very well so angina during the day was under control. However, I still suffered angina walking in the morning (before monomil worked and the evening after monomil had declined). But angina continued getting worse so had an appointment with Cardiology Clinic at Addenbrookes who put me on Renaxa as well as everything else. This made no noticeable difference so they upped the dose to 750mg but still no help. Shortly afterwards they did a echocardiogram but it all looked normal. After this I was referred to another angiogram.

As well as rattling with pills the angina was still getting worse and started to appear at rest, waking me up at night a couple of times. My GP had recently written to the cardiology clinic so being alarmed at angina while asleep I phoned the clinic myself and had a long chat with a nurse who said she would pass on my concerns. Two or three weeks later I was back at Papworth for the angiogram when the same Doctor fitted another two stents - in the same place. Turns out I am in the 10% who get In Stent Restonosis (IST) as the stents had blocked considerably. They must have blocked more than the original arteries as the angina was noticeably worse than before.

The angina symptoms are now much improved, clopidogrel is changed for ticagrelor and I remain on all the other pills. However, I now get exercise angina sooner than I did after the first stents which is a bit concerning. At least I can do my normal daily activities again, GTN in the pocket at all times.

One thing to be thankful for - I didn't have a heart attack so no permanent damage.

I thought they had stented somewhere different this time and it wasn't until later I discovered they were re-stents. I was mentally ready for a bypass this time but was relieved they didn't suggest it. However, I did ask the nurse who said they are not doing many operation at the moment - because of covid!

Has anybody else been re-stented in LAD region?

How many times can re-stents by applied?

Are you more likely to have ISR again if you have had it before?