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Heart Disease (Expert Forum)
MI, Prinzmetal Angina?
Answered by
Cleveland - OH
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MI, Prinzmetal Angina?
by janne, May 10, 2005 12:00AM
Hi, I'm back...
Brief review: 41 yr female, ex-smoker, no risk factors, had MI 2 yrs ago (mid LAD 90% blocked, stented). Symptoms continued shortly after, all tests negative. Angio Jan 2004, restenosis, 2 medicated stents. Felt good 'till April 2004, symptoms returned (fatigue, choking sensation, pressure off and on, not necesarily related to activity. , ecg negative, stress test negative, told to try maalox. G.P. felt maalox was not the answer and gave script for tiazac (180mg).
I had another MI last Sunday, ecg positive, troponin(?)elevated. Angio showed arteries clear. Diagnosed with MI caused by possible Prinzmetal Angina. Very rare I was told.
Meds: nitro patch, tiazac 240mg, plavix, novasen, lipitor, metoprolol (temporarily), ramipril.
I am still having symptoms off and on and wonder if this will ever end. How much can you tell me about Prinzmetal Syndrome?
I have reduced most stress in my life (seems to be a large trigger), I rest frequently (symptoms worse if I don't), and I do light activity (at this point). I feel like I'm 90 years old. Is there something else I should be doing or not doing? This is destroying my life because it has been so unpredictable. The only good thing that came out of the last MI is that the docs at the hospital now believe the symptoms are not in my head or from GI problems, although I couldn't blame them before because most of the tests were negative.
I had an MI taking good care of myself, what more can I do? I don't want to live like a cardiac cripple.
I'd appreciate any advice, info you can give.
Thank you.
Jann
Brief review: 41 yr female, ex-smoker, no risk factors, had MI 2 yrs ago (mid LAD 90% blocked, stented). Symptoms continued shortly after, all tests negative. Angio Jan 2004, restenosis, 2 medicated stents. Felt good 'till April 2004, symptoms returned (fatigue, choking sensation, pressure off and on, not necesarily related to activity. , ecg negative, stress test negative, told to try maalox. G.P. felt maalox was not the answer and gave script for tiazac (180mg).
I had another MI last Sunday, ecg positive, troponin(?)elevated. Angio showed arteries clear. Diagnosed with MI caused by possible Prinzmetal Angina. Very rare I was told.
Meds: nitro patch, tiazac 240mg, plavix, novasen, lipitor, metoprolol (temporarily), ramipril.
I am still having symptoms off and on and wonder if this will ever end. How much can you tell me about Prinzmetal Syndrome?
I have reduced most stress in my life (seems to be a large trigger), I rest frequently (symptoms worse if I don't), and I do light activity (at this point). I feel like I'm 90 years old. Is there something else I should be doing or not doing? This is destroying my life because it has been so unpredictable. The only good thing that came out of the last MI is that the docs at the hospital now believe the symptoms are not in my head or from GI problems, although I couldn't blame them before because most of the tests were negative.
I had an MI taking good care of myself, what more can I do? I don't want to live like a cardiac cripple.
I'd appreciate any advice, info you can give.
Thank you.
Jann
Doctor's Answer
by Cleveland Clinic, May 10, 2005 12:00AM
, May 10, 2005 12:00AM
janne,
thanks for the post. Sorry to hear of your events.
Some of the other calcium channel blockers such as nifedipine may help you a bit more if you truly have prinzmetal angina. Pushing the dose of this medication and your nitrates can often give pretty significant relief. You should also be on aspirin.
I would seek opinion with a preventive cardiologist to address all of your risk factors, as you are young to have had several events.
good luck
thanks for the post. Sorry to hear of your events.
Some of the other calcium channel blockers such as nifedipine may help you a bit more if you truly have prinzmetal angina. Pushing the dose of this medication and your nitrates can often give pretty significant relief. You should also be on aspirin.
I would seek opinion with a preventive cardiologist to address all of your risk factors, as you are young to have had several events.
good luck
I did not know there was such a thing as "preventive cardiologist". Would I just ask my regular cardiologist about it? (I live near Ottawa). I don't want to offend him, but I do wish to do more than just increase my medications. Surely I cannot continue to have small heart attacks. My poor husband is going crazy thinking I am a walking time bomb.
Is Prinzmetal Angina that rare , and if so, is it possible something else is going on? The only thing I know at this point is that I will be treated aggressively with medication and I am to reduce as much stress in my life as I possibly can(which I have).
Thanks very much again.
Jann
novasen is aspirin 325mg made by a company called novopharm in Canada. IT is a generic brand of aspirin.
Your story is very similar to mine. I have had on going severe angina type pains for almost 6 years and researched these (doctors did not have a clue) as Variant Angina (prinzmetal angina) and or Microvascular angina. My attacks would not be exercised induced but would appear out of the blue but mostly when I was mentally upset about something or scard by a bad driver. I had to beg for Nitro and they did work. I too was classed as a "real fruit cake" and this by top notch heart clinic.
I passed a Thallium stress test and passed a Cardiolite Adenosine test and kicked out the door to fend for myself. I was never given any meds, i.e. beta or ace inhibitors or calcium channel blockers as I was a "fruit cake"
Then my EKG's started showing an MI in the septal and I was still not believed. I could not get anyone to do a heart cath on me as I was a "fruit cake".
Last summer, I had to get mad and mouthy and would not leave this heart clinic until they did a cath. I too had a 90% blockage in the mid LAD and a 70% in the RCA. The Cath doctor was cocky as was the Fellow he was training as they had both told me that they would not find a &^%^% thing on me but would do a test called an Ergovine challenge test to see if I indeed had Microvascular angina...which cannot be seen by a regular heart cath.
They had waited so long before doing this heart cath (6 years)that when a person has the symptoms of Microvascular angina/Variant angina/Prinzmetal Angina, the way to check for this is by the Ergovine challenge test during a heart cath IF the main heart vessels are clear or pretty much cleared as this can be dangerous, I was told. Now it is too late to check this with me as there are/were blockages stented but it is not unheard of for a patient (especially a female) to have both conditions.
My MI never showed up in the heart cath and they did another one 4 months later but I had some real doozie cath doctors that needed glasses. I asked for a Cardiac MRI and had to fight for this and sure enough the MI in the distal septal/Apex showed up with regional wall abnormalities. I was never told by Jekyl and Hyde that there was an area they could not stent.(distal LAD)I found this all out by the Cardiac MRI.
I am now researching with top notch cardiologists around the country to see who is an expert in 1. trying the challenge test on me to see if indeed I have two problems and 2. to see who can stent and or remove the scarring in the distal LAD that may be causing angina type pains. My cardio doc is an Echo man and he knows only echo's and not much more. I had no idea either that there was a Preventive cardiologist. The Echo doc said he has never seen a patient like me and I must of been borm with small arteries in the dital. Duh!
I feel, had they done a cath on me 6 years earlier ..and the challenge test before I got so clogged and an MI. we would of had a better picture and an agressive treatemnt plan started. Variant/Prinzmetal angina..left untreated can cause an MI.
I am in my fifties and this can occur in our age group but also in younger women. My severe non exercised induced angina pains come in cycles...Several in a 3 month span and then quiet for months and then the cycle starts up again. It is so sad when Cardio docs do not recogonize these phenonomens.
Stay on top of this. It is your health and your life and no one loves you more than "you". Keep researching out for answers. I am trying to do this also. I am willing to fly anywhere for answers.
God Bless You.
take care all
cam
I'm 36 years old. In excellent health. Up until October 2004, I was running 5K three times per week, and weight training 3 times per week. I also rode my bicycle to work (about 3 miles) Monday through Friday. Never had any indication of heart issues.
I then went through some heavy stress beginning in October (I don't want to detail it all out, but it involves some physical injury and resulting legal issues).
Near the end of October, I experienced classic heart problem symptoms and went into the emergency room (left jaw pain, radiating left arm numbness and pain). Being 36 years old and having recent neck injury, they did some xrays and MRI of my head, found nothing, and sent me home (they thought it could have been an stoke) - the doctor even told me that my arteries looked "pristine".
Then 2 months later I woke up at 4am in the morning with chest