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Heart Disease (Expert Forum)
Angina at night
Answered by
Cleveland - OH
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
Angina at night
by sillysally, Nov 08, 2003 12:00AM
A comment from someone about my last post prompted me to post again. 'Healthyself' commented about pushing yourself to the point of angina with exercise. Everything I can find to read about angina seems to refer to this 'stable' angina, but it does not seem to be what I am dealing with. My angina is at night, or before noon. It does not happen in response to stress, I am sleeping!
I am exercising about two hours a day, five days a week. 75 minutes yoga class, followed by 60 minutes on machines. I keep my heart rate at 110-125, and I am 42 yrs old. When I exercise, I have my nitro with me, but have never had to use it. No angina then.
I take Isosorbide before bedtime. A couple of times a week I still have angina, even with the Isosorbide. If in bed, laying on my left side is extremely uncomfortable, I can only lay on the right.
The other night I fell asleep on the couch and missed my bedtime medications. The pain I had throughout the night was intense. About once an hour, I took sublingual nitro each time, and the pain did recede. Once I was able to wake up enough to get up and take an Isosorbide, the pains stopped.
My questions - (1)could the Isosorbide be masking a greater problem in my case? (2) can you recommend anything to read on this type of angina, I can't find much.
It takes weeks to get into the cardiologist so I won't be able to ask my Dr for a while. Waking up in the middle of the night with chest pains in the middle of the night is not fun. Not only that, I would be in tough shape if my nitro got mislaid, or ran out on me!
Thanks!
I am exercising about two hours a day, five days a week. 75 minutes yoga class, followed by 60 minutes on machines. I keep my heart rate at 110-125, and I am 42 yrs old. When I exercise, I have my nitro with me, but have never had to use it. No angina then.
I take Isosorbide before bedtime. A couple of times a week I still have angina, even with the Isosorbide. If in bed, laying on my left side is extremely uncomfortable, I can only lay on the right.
The other night I fell asleep on the couch and missed my bedtime medications. The pain I had throughout the night was intense. About once an hour, I took sublingual nitro each time, and the pain did recede. Once I was able to wake up enough to get up and take an Isosorbide, the pains stopped.
My questions - (1)could the Isosorbide be masking a greater problem in my case? (2) can you recommend anything to read on this type of angina, I can't find much.
It takes weeks to get into the cardiologist so I won't be able to ask my Dr for a while. Waking up in the middle of the night with chest pains in the middle of the night is not fun. Not only that, I would be in tough shape if my nitro got mislaid, or ran out on me!
Thanks!
Doctor's Answer
by Cleveland Clinic, Nov 09, 2003 12:00AM
, Nov 09, 2003 12:00AM
sally, i've looked back at your post.
Its difficult to tell what is causing your symptoms, given you have coronary disease.
To simplify a angina classification to you:
Stable angina refers to people with set blockages that cause flow limitation of blood with increasing demands such as exercise. Rest or nitro can relieve the symptoms. The symptoms are reproducible and do not vary or increase over long periods of time.
Unstable angina refers to people with a plaque in the artery that has become unstable. These symptoms can feel the same as stable angina but are new in occurence, occur with increasing frequency, occur for longer periods of time, occur with less exertion or occur at rest. This type of angina can be a warning sign for a heart attack.
variant, prinzmetals or vasospasm refers to a hyperreactivity of the artery that cases spasm. this can occur in the setting of known coronary disease or normal arteries and typicall occurs in younger women. This presents as sporadic pain.
If the thought is you have vasospasm, the treatment would be increased doses of calcium channel and beta blockers in addition to nitrates.
If it is unclear where your angina is originating from then you need another catheterization to evaluate your stents. If everything is 'open' that might support vasospasm.
remember also alot of other things including GI and musculoskeletal pain can sometimes mimic angina, but these are diagnosis of exclusion.
hope this is a start
Its difficult to tell what is causing your symptoms, given you have coronary disease.
To simplify a angina classification to you:
Stable angina refers to people with set blockages that cause flow limitation of blood with increasing demands such as exercise. Rest or nitro can relieve the symptoms. The symptoms are reproducible and do not vary or increase over long periods of time.
Unstable angina refers to people with a plaque in the artery that has become unstable. These symptoms can feel the same as stable angina but are new in occurence, occur with increasing frequency, occur for longer periods of time, occur with less exertion or occur at rest. This type of angina can be a warning sign for a heart attack.
variant, prinzmetals or vasospasm refers to a hyperreactivity of the artery that cases spasm. this can occur in the setting of known coronary disease or normal arteries and typicall occurs in younger women. This presents as sporadic pain.
If the thought is you have vasospasm, the treatment would be increased doses of calcium channel and beta blockers in addition to nitrates.
If it is unclear where your angina is originating from then you need another catheterization to evaluate your stents. If everything is 'open' that might support vasospasm.
remember also alot of other things including GI and musculoskeletal pain can sometimes mimic angina, but these are diagnosis of exclusion.
hope this is a start
Some people get angioplasties, some get stents, some get bypasses, some get other treatments and many get no treatment at all. Is the triage decision based on need or the need/ability to pay quotient? It seems mighty easy to hand a person with angina a bottle of nitroglycerin tablets. That "treatment" must be over a hundred years old now.
If a person has angina and lots of money can that person buy themselves a bypass instead of gulping nitro and enduring less secure solutions such as stents-even if they would not "medically" be considered a candidate?
It seems to me that it is a very fine line that divides a night of recurrent and severe angina and a heart attack. Is the heart attack when the nitro fails to make the pain subside? Then the person goes to the ER with continuous pain. Is this continuous angina pain then a heart attack?
What are mortality expectations due to fatal heart attacks for a group of angina sufferers vs a similar aged group of non-sufferers?
How do angina patients manage what for some must be enormous difficulty with panic/anxiety attacks?
Just curious.
It's a little unnerving to live like JDM describes - the fine line comment about the difference between angina and heart attack. Which am I? Should I be making sure my affairs are in order in case I'm the walking time bomb, or will my adherence to my routines of yoga, meditation, prayer, stress relief, better diet, exercise, etc. etc. pay off? I don't have anxiety attacks, but I do sometimes worry that my kids will walk in the door from the bus someday and find me on the floor. For now, I just keep going day to day, keeping the faith, and making babysteps in the right direction.
There's a a couple of annoying things about life with CAD. One is - I can't see within my own body without my insurance company forking out $20K for an angiogram. If I go into the ER they slap the IV in and start injecting heparin, etc. and taking blood before I can say boo. I pass the stress tests, the ECGs are completely normal, but when they get to the cath they can finally see the blockages. There's just no way to definitively see without the cath, and I've now had three of those, and two stents in the LAD. The last inpatient visit, from 6:30 a.m. to 9:00 a.m. the next day was $40K!! (and they didn't even give me breakfast!)
Two - You can't get two cardiologists even in the same room to agree on anything. The last time I visited ER I had 3 of them, the last inpatient visit 3 more. All different partners from the same practice. One Dr said, do the cath, another said, don't do it. One Dr said, place the stent, another said, "I don't recommend it." And then they ask me for permission? I tell you what, I'm reading everything I possibly can find about this disease so that as I go through this with the docs I am informed to the best extent possible. They see me for 30 minutes in the office, but I live with my body 24/7. I am really listening to my body right now and trying to observe patterns, anything that can give the Drs more data.
The most depressing thing was waking up the morning after the 2nd stent was placed in my LAD 4 weeks ago and having the angina happening again just like before. They did an ECG just after each pain, but everything was normal. I wish they could have caught it when it was happening, instead of just after.
I guess had somewhat blindly assumed that an angiogram and stent would take care of it. Unfortunately, I am worse off than before - the angina is more frequent, more intense and now after I had that night off the Isosorbide accidentally - I know I can't live without the nitro at the moment, period. Perhaps it's temporary, perhaps it's just spasms of some sort, but how will I know? Another cath? Arrgggh!
I think I'm just venting now. I must remind myself to be patient and see if things get better, one day at a time....
I had insurance and was urged to have bypass surgery. After reading a lot about it and considering it, I decided that I would attempt to manage the disease with cholesterol and bp therapy, diet, exercise, and lifestyle changes. With an average life of 7 years, I just couldn't see having bypass at 49 years old and facing it again at 56 or so. Perhaps if they could have used the mammary artery it would be longer, but I would still be facing it again in the future.
3 years ago I agreed to an experimental angioplasty to open my occluded artery