Why do I get angina after stress/eating but not after exercise?
genesis2k12 posted:
Hello. I have extensive atherosclerosis. Part of my RCA is closed now and can't be reopened. I have 11 stents but haven't had a bypass. I often get angina after eating or when I get stressed, but never during or after exercise. Why is that? Shouldn't I get angina during physical exertion if I get it otherwise?

A cardiologist has told me that he can't help the blocked branch of my RCA. He said he can't bypass it either. Does anyone have advice please on how to live a less painful life? Should I increase my meds? I'm on a bunch: Toprol, Altace, Plavix, aspirin, Diltiazem, Trilipix, Welchol, Lovaza, and Niaspan.

Thank you,
cardiostarusa1 responded:

"Shouldn't I get angina during physical exertion if I get it otherwise?"

One would tend to think yes, but specific factors, as applicable to the patient, such as coronary artery collateral circulation, may make it otherwise.

It is well-known that in some individuals with known or undiagnosed coronary artery disease (CAD), after a large, full. or heavy meal, can experience symptoms such angina pectoris (classic chest pain or pressure) or even an irregular heartbeat (arrhythmia, such as palpitations or fast heartbeat), as some blood flow is diverted to the stomach and intestines to aid in the digestion process.

And, as applicable to the patient taking a beta-blocker, which lowers the heart rate and blood pressure by design, this class of cardiovascular drug tends to hold back or blunt the heart's response to vigorous exercise/physical activity, so no matter how hard the body is pushed so-to-speak, one might never reach the HR that one is trying to achieve.

One might end up overexerting, trying to reach an HR that beta-blockers will simply not allow. Those being on beta-blocker therapy doesn't mean that one can't exercise normally/vigorously (unless contraindicated by a doctor), it just means one can not rely on the HR to judge/gauge how hard one is working out.

"A cardiologist has told me that he can't help the blocked branch of my RCA. He said he can't bypass."

In general-only here, and beyond drug-therapy, if/when common procedures, first time or re-do, such as angioplasty, with or without stents, or coronary artery bypass graft (CABG) surgey are not deemed feasible, as applicable to the patient, there may/can be other options that includes non-invasive EECP, laser-based TMR or PMR/PMC, and gene therapy/transfer.

FDA approved non-invasive Enhanced External Counterpulsation (EECP) treatments.

Are You a Candidate for EECP Therapy?


Surgical-based transmyocardial revascularization (TMR, FDA approved) and catheter-based percutaneous myocardial revascularization or channeling (PMR/PMC, FDA approval still pending), laser therapy.

Holmium:YAG laser


Patient education site


CO2 Heart Laser


Growing your own so-called "bio-bypass" (collateral vessels) around blockages in the heart, and in the legs

It's known as gene therapy/gene transfer, which has been in experimental phases for quite some time now.

As reported, over the last 20 years, gene therapy has moved from pre-clinical animal investigations (animal models) to human clinical studies for many diseases ranging from single gene disorders, to much more complex, multi-factorial, multi-conditional diseases such as dreaded cancer and cardiovascular disorders.

Readers Digest Online - February 2008

An experimental treatment is giving desperately ill heart patients a new lease on life.

A process called angiogenesis. The experimental procedure had shown great promise in two German studies, and the FDA had approved the launch of the first American clinical trial.

The technique involves injecting the heart with a protein called fibroblast growth factor 1 (FGF-1).

"The protein is like a seed that causes new vessels to sprout, creating a network of capillaries and small arteries."

FGF-1 occurs naturally in the body.


Best of luck down the road of life.

Take care,


WebMD member (since 8/99)



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