Persistent Angina/Palpitations Following Stent & Multi Vessel Atherosclerosis Diagnosis

[Torbjorn]

Hi everyone. Have had my RH artery stented following heart pain whilst exercising. RH artery 90% blocked and other vessels 50%-70% blocked. Have had persistent palpitations and/or mild angina every day now since the operation in March 2021. Now on 80mg Atorvastatin, 10mg Ramipril, 5mg Bisoprolol and aspirin. Due to persistent nature of angina/palpitations pressure wire study carried out with satisfactory blood flow. Eat low carb paleo, intermittent fasting, exercise every day, only a few glasses of red wine every week. Healthy. 52 3/4 years old. Feel that symptoms are worse around winter time and better summer. Also : never feel them when exercising which always reassures my cardiologist.My cardiologist wants to increase Bisoprolol dose by 2.5mg. Tried vasodilator but did not improve/contribute and I stopped taking due to head aches. Does anyone have any relevant advice and/or experience to share?

[andrew290171]

Funny not sure I have got any answers but get similar symptoms. Had lad stent a year ago. Get palpitations and quiet a lot of chest pain on and off. Been back to hospital twice but both times said nothing wrong. Almost made to feel like I was making it up !!!. Also pain happens when I am doing nothing and does not get worse during exercise. That is what seems to make Dr say nothing wrong. Got an exercise echocardiogram next week. See what happens

[Torbjorn in reply to andrew290171]

Hi Andrew, nice to know that others are in the same position. Would be grateful if you share any positive progress. All the best.

[Inspireblue]

Hi there, What you've put is almost identical to myself same medication similar age, I too went into A& E with typical heart attack symptoms ( this was 6 months after my single herat bypass) ..said everything fine probably caused by overdoing it at the gym ( muscular pain), Dr didn't really wanna know as she said same. I'm under the impression it's nerve damage??? It's been 12 months now and I still get symptoms but not as bad ...maybe time Will heal as they say.

[Milkfairy Heart Star]

Persistent chest pain following a stent being inserted is not uncommon. Some studies suggest the incidence is between 20-40%.

One possible cause of angina without blocked coronary arteries, ANOCA, is due to the blood vessels of the heart not working properly.

Microvascular dysfunction or coronary vasospasms.

Coronary vasospasms typically causes chest pain at rest, especially between midnight and 6am in the morning. The main triggers are the cold, emotional, mental and physical stress. Most people living with vasospastic angina are able to exercise.

Microvascular dysfunction tends to cause chest pain on exertion and can lead to breathlessness as well as chest pain.

acc.org/Latest-in-Cardiolog...

ahajournals.org/doi/10.1161...

Maybe keep a log of your symptoms and see if you can spot the triggers of your symptoms and how you respond to your medication.

When you see your Cardiologist perhaps ask whether they have considered whether microvascular dysfunction or coronary vasospasms are a possible cause of your ongoing symptoms.

[Torbjorn in reply to Milkfairy]

Milkfairy. I have seen your contributions/responses before here on the forum. Thank you for being an amazing contributor and responding to my post.

[Milkfairy Heart Star in reply to Torbjorn]

😊

[Sleesa]

Could you try a different vasodilator? Isosorbide gave me excruciating headaches. Currently take Nicorandil and Ranolazine alongside my statins etc. No headaches and no major side effects. I only use gtn if needed now and that's rare. It's possible you have microvascular angina too.

If your arteries needed stenting maybe the damage was also to the tiny vessels branching off from them.

I'd push for answers and maybe consider trying alternatives.

[Rosie0202]

Hello Tobjorn,

I was prescribed 5mgs of omeprozale as once per day at night. However I decided to split my 5 mgs of bisoprolol as follows:- 3.75mg in the morning and 1.25 mgs in the evening. I did this to cover the 'first thing in the morning' period when I would typically have atrial fibrilation issues; so giving me maximum cover in the day and a degree of cover overnight. It works well for me and as with all my other meds I also have checked out any interactions and changed them accordingly. You can google this and it is helpful in targeting your meds according to tolerable levels throughout the day.