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Forum Name: Ischemic Heart Disease

Question: ischemia


 r2d2 - Mon Jan 23, 2006 10:33 pm

64 old male non smoker, excercise regualrly complaned about burning in throat 6 years ago. Gi consult revealed slight evidence of GERD. Treated with Proton pump inhibitor- no help when doing aerobic excercise. Had Cardio consult- 1997 performed cath procedure-report all normal. continued to have throat pain on excercise. 4 years past using pepto bismal for releif during high excercise- not much help. returned for Cardio consult. New Dr. did thalium stress test. Normal! even with throat pain. returned to Dr. year later when friend had heart attack with similar symptoms. Dr. agreed to cath. Found 85% blockage of LAD and 80% blockage in RCA confirmed with IVUS. Stented LDA with complications- Diagonal Artery closed down during procedure- requiring 2 extra stents- one not coated due to small diameter of artery. Stented RCA- no problems. returned to normal activities-asprin 325mg;vytorin 10/10 and plavix 75mg. Burning in throat still occurring. Dr said he thought that might be from one of the smaller arteris that he could not stent. Reaccomplished angiogram- found diagnoal restenosed; balloned artery- looked ok. Dr. advised excersie under supvervision. 6 mos later; thershold for onset of angina much later in excercise routine. No more throat pain- pain more localized lower in the chest. Dr. suggests Angina caused by micro arteries. Did 6 weeks of Pulsation therapy (EECP)- no improvemet regarding symptoms. Dr. agreed to another stress thalium in 6 more weeks. Note: unable to take statin drugs due to muscle weakness and high enzymes (PK). Cholesterol 170: HDL 52; LDL78 Triglycerides 70,. Fasting Insulin 6. your thoughts please.
r2d2

 Dr. A. Madia - Fri Mar 24, 2006 9:10 am

User avatar Hi.

You have residual angina with microvascular component. You need optimal anti ischemic therapy. I suggest following:

Tab. GTN 6.5 mg twice daily
Tab. Aspirin 80 mg once daily at bedtime
Tab. Clopidogrel 75 mg once daily in the morning.
Tab. Metoprolol 50 mg twicw daily
Tab. Atorvastatin 10 mg at bedtime

As reserves Valsartan and Trimetazidine of the above combination is inadequate.

Statins are a must. You wont get the side effects at 10 mg dose. We in India have been using this low dose only with excellent results. I for one am not a strong believer of high dose satins.

Report back to me if you find this beneficial.

Dr. A. Madia

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