What are the treatment options for variant angina?

Question

Hello doctor,

I ended up needing emergency angioplasty after experiencing two and a half hours of chest pain. The doctor found a completely occluded LAD and was able to open it to 50 percent with the angioplasty. He has recommended bypass surgery, and I am waiting to see a cardiac surgeon. I am concerned about the diagnosis, as it was nearly non-existent. I was discharged from the hospital with the following medications:

Before breakfast: Omeprazole and antacid.
After breakfast: Losartan, Angio II, Aspirin, Spironolactone, and Isosorbide mononitrate.
After dinner: Losartan, Angio II, and Isosorbide mononitrate.
8 PM: Tamsulosin and Senna glycoside.
Before bed: Simvastatin 140 mg, and Lorazepam.

I am concerned that the doctor did not include a beta-blocker or a calcium channel blocker in my treatment plan. I have variant angina, which can be quite severe at times. I am also unsure of my heart's ability to function properly and whether I am at risk for pulmonary edema or fluid accumulation around the heart. Since I will not be able to undergo surgery for another two to four weeks, I am wondering about my prognosis during this period and whether it is safe for me to engage in exercise, such as riding a bicycle. I have included copies of my angiogram and echocardiogram for your review and would appreciate your comments.

Answer 1

Hello,

Welcome to icliniq.com.

The diagnosis of variant angina and STEMI (ST-elevation myocardial infarction) due to total occlusion of a vessel is not typically seen together. The documents you provided also do not mention that you have variant angina (attachment removed to protect patient identity). Please clarify how you concluded that you have variant angina. If you do have variant angina, calcium channel blockers can still be prescribed. The tablet Isosorbide mononitrate is also effective in treating variant angina. If you do not have variant angina, beta-blockers may be prescribed, provided there are no contraindications such as heart failure.

Your condition may be managed with either bypass surgery or angioplasty to both vessels, assuming you are not diabetic. Whether your RCA (right coronary artery) can still be opened with angioplasty is a decision that needs to be made by the interventional cardiologist. Given your recent STEMI and an ejection fraction (EF) of 35 percent, you should avoid riding a bicycle or engaging in strenuous exercise. Pulmonary edema, recurrent angina, and another heart attack are potential risks that you are being treated for.

Please do not worry too much and try to stay relaxed. You should seek a second opinion from an interventional cardiologist to discuss both the risks and benefits of angioplasty and bypass surgery.

Thank you.