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How to reduce angina. Taking isosorbide and ranexa. Am I at risk of heart attack?

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Hello, I am seeking a 2nd opinion. My doctor has told me that other than medication (for which I get only minimal relief) nothing can be done to reduce my angina. Current meds are Isosorbide & Ranexa.

I am 73, 5'8" tall, and weigh 155 lbs. I do not have diabetes, high cholestrol or high blood pressure. I am physically active. I walk about 3.5 miles/day @ ~ 4 mph. During these walks I experience pain @ the entry point of the left & right armpit, and ocassionally pain in the middle of the chest, ~ level 3-4. Most daily routine activities cause no pain. Minor stress can also cause pain. I play golf 3-4 times/week. I walk 9 and ride 9, and have no pain from this activity

My blood pressure drops significantly after exercise. EXA: 1 hour after a 4 mile walk 104/68. I don't think this is normal

I have had 2 heart Catheterizations, a stress test, and some type of nuclear test. These tests have shown that the main arteries are clear, but (2) diagonal branches, D1 & D2 off of the LAD, are partially blocked @ 60% & 70% respectively.

My questions are:
1) am I @ risk of a heart attack
2) are there any surgical proceedures you would recommend
3) although I'm not overweight, my diet is not the best, is it possible that my excercise regimen can effect an improvement in my condition.
4) any other information that you can add that will help me deal with this condition

Thank you
Email address: YYYY@YYYY
Posted Mon, 8 Oct 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Anil Grover 3 hours later
Hi XXXXXX,
Thanks for writing in.
I am qualified and certified cardiologist and 70% I treat for coronary artery disease are diabetic. You are not. I read your mail with diligence.
First answer to the question you have not listed that is the fall of blood pressure with exercise normal. Answer is yes and no. Blood pressure ought to rise while you are doing exercise and it falls as you recover. So, you are right in a way fall in blood pressure while exercising is not normal.
Coming to your asked questions:
Your questions are:

1) am I @ risk of a heart attack
Yes you are at risk for having a heart attack and this risk is greater than a person of your age who does not have coronary artery disease which you have. In addition you have angina.

2) are there any surgical proceedures you would recommend

I have not seen your coronary angiography, however going by the report it looks technical possible to do coronary artery bypass grafting. A cardiac surgeon can see the angiography cine and tell you whether it is technically possible to do Minimally Invasive Coronary Artery Bypass (MIDCAB). This procedure has far lesser morbidity and quick recovery. If that is possible then it is strongly recommended.

3) although I'm not overweight, my diet is not the best, is it possible that my excercise regimen can effect an improvement in my condition.
Yes, nevertheless, you will have to take medicines in combination with exercise regimen and proper diet. I did not find any mention of cholesterol in your rather well written summary. Nor I found nuclear test report, you can mention in followup query.

4) any other information that you can add that will help me deal with this condition
If your nuclear study shows reversibility of ischemia then surgery is definitely indicated. If there is no reversible ischemia on nuclear test then your doctor is probably right in a way. However, I consider angina as a sign of reversible ischemia irrespective of nuclear study report. That leaves only technical feasibility of performing surgery. I am curious to know what prevents stent implantation probably the lesions are technically not suitable as judged on coronary angiography. Good Luck.
If you have any followup question, I will be most happy to answer. Regards.

With best wishes.
Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
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