47 year old male. Past history of stents to LAD and Cx in 2005 for stable angina. Treated for hypertension and hyperlipidemia. Recurrent chest pain since the stents were placed, sounds anginal in nature. Between times he is fine, walks 1 mile on flat ground with no problem. Several hospital admissions with troponin negative events, without new ECG changes. Serial angiograms have shown no progression of his coronary artery disease; stents show minor degrees of in-stent stenosis only; not felt to be functionally significant.
Where next with this patient?
Echo during pain showed no regional wall motion abnormalities.
Could this be 'stent pain syndrome'? Small vessel disease?
What to do next?
Is this a scenario you have seen before?
Suggestions welcome in the comments!