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Heart Disease (Expert Forum)
Coronary Artery Spasms
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Coronary Artery Spasms
by dmil241, Nov 19, 2005 12:00AM
I am female, 42, don't smoke or drink alcohol or take illegal drugs. I stay away from caffeine like the plague, eat pretty healthy and am not overweight. I walk for exercise but do not strength train. I have a history of premature heart beats but my heart is structurally sound and no blockages. However I get rather atypical chest pain-no breathlessness or real nausea. My cardiologist recently did an EKG which showed a change from the last one. He did an echo which was very good and a nuclear stress test. The test showed an ischemia at 160bpm which disappeared at 190bpm. He said I have coronary artery spasms. He said I have a good prognosis because of everything else. I HATE medicines. So he put me on OMACOR (Omega-3s). But now I am scared everytime I get any little chest pain which only lasts 30 seconds to less than 2 min, but usually comes back over the next 2-4 hrs when I have them-during the test I had NO CHEST PAIN or breathlessness! Is the spasm worse when I feel the pain or could the pain be totally unrelated? Do I really have nothing to worry about in regards to them? In what situation should I worry about it? Should I be doing something else or seek another opinion? He said nothing but coronary artery spasms would cause such a thing on the nuclear stress test. Other than that he said my stress test was great. I just want to know what to do from here. I get really worried at times even the premature heart beats will freak me out now. Is it more dangerous to have them if I have coronary artery spasms?
Doctor's Answer
by CCF-M.D.-MJM, Nov 19, 2005 12:00AM
Hi dmil,
You are not alone with this concern. Young women with atypical chest pain are notoriously difficult to diagnosis because women often present with atypical chest pain on one hand, but on the other represent a low risk group. It is true, however, that if this is spasm your prognosis is good.
Is the spasm worse when I feel the pain or could the pain be totally unrelated?
If it is spasm, you are probably only having significant coronary spasm when you feel the chest pain. Have you tried sublingual nitroglycerin with the pain to see if it gets better? Your pain may be so short lived that it would be difficult to tell, but is worth a try. Nitroglycerin should help relieve the spasm and symptoms of spasm. If this works, you should consider trying either a long acting calcium channel blocker or long acting nitrate.
I am not criticizing your choice to take omega 3 fatty acids, but what is the difference between taking a less well studied medication like omega-3's compared to proven safe medications like nitrates and calcium channel blockers that have been studied for this indications. I do not believe omega-3 FA's have been studied in spasm. There is some data that omega 3 fA's help reduce the incidence of arrhythmia in people without CAD. There is data showing that it does not help and may be detrimental to people with coronary disease.
I advice caution in using supplements other than those studied in large randomized trials for the indications they were studied.
(this should stir up some posts and debate)
Do I really have nothing to worry about in regards to them? In what situation should I worry about it?
You should worry about a change in the character of the pain, worse than normal or lasting longer than normal.
Should I be doing something else or seek another opinion?
You could seek a second opinion if you are uncertain of the diagnosis. If the second physician agrees with the first, it is probably worth at least trying medical therapy.
I hope this helps.
Good luck and thanks for posting.
You are not alone with this concern. Young women with atypical chest pain are notoriously difficult to diagnosis because women often present with atypical chest pain on one hand, but on the other represent a low risk group. It is true, however, that if this is spasm your prognosis is good.
Is the spasm worse when I feel the pain or could the pain be totally unrelated?
If it is spasm, you are probably only having significant coronary spasm when you feel the chest pain. Have you tried sublingual nitroglycerin with the pain to see if it gets better? Your pain may be so short lived that it would be difficult to tell, but is worth a try. Nitroglycerin should help relieve the spasm and symptoms of spasm. If this works, you should consider trying either a long acting calcium channel blocker or long acting nitrate.
I am not criticizing your choice to take omega 3 fatty acids, but what is the difference between taking a less well studied medication like omega-3's compared to proven safe medications like nitrates and calcium channel blockers that have been studied for this indications. I do not believe omega-3 FA's have been studied in spasm. There is some data that omega 3 fA's help reduce the incidence of arrhythmia in people without CAD. There is data showing that it does not help and may be detrimental to people with coronary disease.
I advice caution in using supplements other than those studied in large randomized trials for the indications they were studied.
(this should stir up some posts and debate)
Do I really have nothing to worry about in regards to them? In what situation should I worry about it?
You should worry about a change in the character of the pain, worse than normal or lasting longer than normal.
Should I be doing something else or seek another opinion?
You could seek a second opinion if you are uncertain of the diagnosis. If the second physician agrees with the first, it is probably worth at least trying medical therapy.
I hope this helps.
Good luck and thanks for posting.
My background is similar to yours, i.e, low risk factors for CAD and almost the same work-up.
I was diagnosed with "endothelial dysfunction" after an invasive cardiac cath. I do NOT recommend going down that path. My cardiologist put me in a NIH study on female-pattern ischemia. (You can Google "WISE study" and find more info).
A doctor from the Cleveland Clinic recommended nitrates and a calcium channel blocker. I tried the medications but felt significant side-effects and quit. You may be different, (if you get to the point of wanting to try medications).
I'm taking Inspra, (yes, a diuretic) and very low-dose Lisinopril, (an ACE-inhibitor or vasodilator). The change in my symptoms was remarkable. While a second test confirmed that the ED was still present, I feel less symptomatic and have moved on with my life. I don't even consider myself "sick" any more, and avoid doctors like the plague. (No offense CCF!)
If my symptoms change, however, and I feel sustained chest pain with pressure, you can bet that I'll page my doctor!
I hope this helps.
Carolina
Best Wishes
Konopka1955