Case study ( 6258 views as of November 18, 2018 )
Wayne is a 52-year-old man with a history of high cholesterol and hypertension. He is referred to a cardiologist for the evaluation of exertional chest pain that has been worsening for 6 months. Walking only 2 blocks on the level reliably precipitated his chest pain. He had no symptoms at rest, and stopping exercise reliably relieved the discomfort.
A treadmill examination is arranged and is interpreted as being abnormal after 6 minutes of exercise. A trial of medical therapy with a beta blocker and a nitroglycerin patch is attempted, but it fails to relieve his symptoms satisfactorily. Therefore, Wayne is referred for coronary angiography to define his coronary anatomy and possibly perform a revascularization procedure. He is told that a stent may be implanted if a significant blockage is identified. He is concerned about the long-term implications of stent implantation and the need to take blood thinners for an extended period of time. He is also asking how long stents last and if they ever need to be removed.
Wayne may benefit his condition by further discussion with his cardiologist to address his hypertension and chest pain. A cardiovascular surgeon can discuss the options available to him, such as cardiac revascularization or the use of a stent. If surgery does ensue, a cardiac rehabilitation program will be needed. In the meantime, seeing a nutritionist regarding his cholesterol levels would be good, as well as searching for ways to control any stress he may be experiencing, such as yoga or massage.Author: Dr. Graham Wong, VGH