Question

I am a 51-year-old woman who had a stent placement in 1998. Since then I quit smoking, and have reduced my cholesterol (with the help of Lipitor). I also take Premphase and Synthyroid. I recently had chest pain lasting just a few moments which passed quickly, but with the pain a warm feeling spread from my lower abdomen upwards. Could this have been a "hot flash", or was it something caused by another cardiac problem?

Answer

In folks like yourself, I think the most important question is "does the discomfort remind you of what your angina felt like before the stent?" Usually, if someone is going to have a recurrence of angina, it will present in similar ways - perhaps not as intense, but the location and quality of the discomfort will be similar. This is the key question.

We know that if there is no recurrence of disease at the stent site by 6 months after placement, the likelihood of it recurring at that particular spot is very low. So it is likely that if the discomfort is truly angina, it is not coming from the previous stent site. If the discomfort is similar, then I would suggest a nuclear stress test. If it is different (and especially if it's not related to physical exertion), then I wouldn't worry about it as much, unless it becomes a recurring problem. I really cannot say if there is any relation to menopause.

As an aside, you should be congratulated on making such great progress in cutting down on the various risk factors for heart disease. Without question, quitting smoking was the most important decision you could have ever made in terms of impact on the rest of your life. Keep up the good work.