Heart & Cardiology/Unstable Angina?


Hi Dr. Richardson.

I tried to go through previous questions about this topic in the hope of finding something similar. I had no luck so I thought I'd see what you might suggest.

We live in a small town with limited medical expertise. We have a small hospital but half the time when you go in they ask the patient what they think they should do. I really wish I was making this up. I really wish what I'm about to say wouldn't sound as idiotic as it will but... This is what we deal with and why I'm turning to you.

My Father celebrated his 75th bday this February and, today, we returned from another trip to the city to see a specialist. My Father has told me he has given up now and will just wait to drop. Can't say I blame him but I have no intention of letting that happen if I can help it. The cardiologist is about 150mi away from us. I don't care if I have to drive him 500000 mi to see someone else if you think it might help.

In February 2010, my Dad started to experience, how he describes it, a crushing pain. He says it starts in his throat like it's closing on him and he can't breath. The pain goes into his jaw and down to his chest which then feels like it's being crushed. This pain is so intense that it has caused him to pass out on a few occasions. In 2010 I took him to our hospital as I thought it was his heart. An Internist came in and told him it was angina and there was nothing that could be done so to go home. A few days later it hit hard again and he passed out. I took him back and when I explained that these "attacks" were happening when he was at rest, the guy told us that it was unstable angina and he would probably have a stroke within two weeks so not to travel too far from the hospital. When I asked to be referred to a cardiologist I was told that there was no point wasting his/her time as there was nothing anyone could do so to leave and wait for the stroke (his words, not mine).

This didn't sit well so I drove him to another town and received my referral to the closest Cardiologist in the city (population of 150000 so still pretty small). This specialist first told us that there was nothing wrong with his heart so to go back to our doctor and explore other areas. We returned to our doctor who would not consider any other potential causes. He told us it was his heart and sent us right back to the specialist. This went on for a good year with nothing every happening other than the two of them passing the buck back and forth. A few times my Dad ended up in the hospital here and, was again told to go home.

Right or wrong, I finally pitched a fit with the Cardiologist because my Dad was on the strongest nitro patch and going through a bottle of spray in under two weeks. He finally agreed to do an angioplasty but he was not happy with me.  When Dad came out of surgery the only thing the specialist said was "No wonder you were in so much pain. You had 99% blockage in your artery so I put two stents in".

We took him home and nothing changed. He is still experiencing the same difficulties and pain etc. He is being worn down by the pain and his quality of life is severely diminished by this. These issues occur only at rest.

Twice since the stents we took him to the hospital because we thought he was dying on us. Both times they called his specialist to ask what they should do. The specialist said he wasn't concerned so to let him go home.  Both times the hospital did not want to let him go but had no idea what to do with him so they let him out.  This is causing serious stress to both my Dad and the rest of us.

I pitched another fit to the specialist a couple weeks ago and he agreed to do an angiogram dye test.  Two days ago I took him to the city for the angiogram. The doctor was in and out before I had a chance to talk to him. All he told my Dad was that there was no blockage and the stents were fine. When Dad asked what was going on the specialist said he didn't know but he'd make him an appointment for a year from now.

When they were releasing him, Dad had had one of his attacks so they kept him while they tried to get the doctor. They asked the specialist what to do and he said to release him to me as he wasn't concerned.  We stayed the night at a nearby hotel and he sucked back a quarter bottle of nitro during the night. I went to the Cardiologist's office this morning but he is now on vacation and won't be in until the end of the month. I brought my Dad home...

Until this, my Dad has always been in pretty good health. He was a farmer and trucker right up until retirement and has never had any serious health issues. About 10 yrs ago he was diagnosed with early prostate cancer but because it was caught so early it was dealt with quickly and easily. Other than that, he's still in better health than most people half his age.  

I'm just not sure what to do with him now? Should I drive him to an emergency room in an actual city with a heart clinic? Should we just sit back and wait for a stroke? I just find it hard to believe that there isn't anything that can be done other than wait for that? I'm not even sure it is unstable angina as the only time we were told that was from the Internist that told us to go wait for the stroke. His Cardiologist doesn't seem to care and his family physician isn't much help either as he just keeps sending us back there.

Do you have any suggestions at all? Anything would be helpful even if I have to go specifically request certain tests... I'll do it if I know what to ask for.  I'm about ready to plan a "vacation" and get him to a heart centre in a big city but I don't want to put him through that if it will be a waste.

Thank you.


Hello Tammy,

We can presume that the latest angiogram showed no fixed narrowings.. Coronary arteries can have spasms that narrow them enough to cause pain.  Ask your doc for some isosorbide, a long-acting form of nitroglycerine, and for nitroglycerine patches to put on his skin, above the waistline.   Use both the patch and the isosorbide during the day, remembering that one needs a 1232-hour holiday from all nitroglycerine every 23 hours or there is loss of efficacy.

Please write back if this note doesn't answer all your questions, and please let me know if this method of treatment helps.

David Richardson

Heart & Cardiology

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David Richardson


Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.


Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.

Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..

Circulation, American Heart Journal, Hypertension.

M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.

Awards and Honors
Gold Heartt Award from American Heart Association in 1995.

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