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Heart Disease (Expert Forum)
Another question about coronary artery spasm
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Another question about coronary artery spasm
by dmil241, Jan 04, 2006 12:00AM
Yes this is my second and will be my last post as per the 6 month guideline.
My cardiologist diagnosised me with coronary artery spams. The pain was getting worse but not longe. It was disrupting my life, so I have gone on Norvasc 2.5mg. It has only been a couple of weeks but has dramatically reduced the stinging pains in my chest.
However from reading about this condition it suggests that 2/3 of the cases have clogged arteries even though intitial tests show that they do not and that the clogged arteries make the condition more dangerous.
My cardiologist has run all the test except a cath. There has been 3 nuclear stress tests in the past 5 years trying to determine what was causing the pain. Two echos which were good. I've worn a holter a couple of times and of course numerous EKGs. My EKG from the start has been abnormal. In fact the first time I saw my cardiologist he said it indicated that I had had a previous heart attack. After my first nuclear stress test he said my arteries were clear and that the EKG was abnormal only because of the way my heart was sitting in my chest cavity. However the last EKG when I was having lots of chest pains again indicated that there had been a change. Then came the last echo and nuclear stress test and the spasm diagnosis. He could not explain the change in my EKG but insists that my arteries are clear. My questions: Should I be more concerned that maybe my arteries are not clear? Do I need a cath done? Is a cath too dangerous because it would cause a spasm? Should I be on other medication to prevent a heart attack?
My cardiologist diagnosised me with coronary artery spams. The pain was getting worse but not longe. It was disrupting my life, so I have gone on Norvasc 2.5mg. It has only been a couple of weeks but has dramatically reduced the stinging pains in my chest.
However from reading about this condition it suggests that 2/3 of the cases have clogged arteries even though intitial tests show that they do not and that the clogged arteries make the condition more dangerous.
My cardiologist has run all the test except a cath. There has been 3 nuclear stress tests in the past 5 years trying to determine what was causing the pain. Two echos which were good. I've worn a holter a couple of times and of course numerous EKGs. My EKG from the start has been abnormal. In fact the first time I saw my cardiologist he said it indicated that I had had a previous heart attack. After my first nuclear stress test he said my arteries were clear and that the EKG was abnormal only because of the way my heart was sitting in my chest cavity. However the last EKG when I was having lots of chest pains again indicated that there had been a change. Then came the last echo and nuclear stress test and the spasm diagnosis. He could not explain the change in my EKG but insists that my arteries are clear. My questions: Should I be more concerned that maybe my arteries are not clear? Do I need a cath done? Is a cath too dangerous because it would cause a spasm? Should I be on other medication to prevent a heart attack?
Doctor's Answer
by CCF-M.D.-MJM, Jan 04, 2006 12:00AM
Hello,
Should I be more concerned that maybe my arteries are not clear?
It is true that people with spasm tend to have underlying CAD, although it may be more appropriate to call it endothelial dysfunction. The lining on the inside of the coronary arteries are called endothelial cells. The plan an active role in secreting hormones in response to stimuli. Endothelial cells may respond one way to a given stimulus under normal function and a different way when they function abnormally. For example, in the setting of coronary spasm, the stimulus that normal causes arteries to dilate may cause them to constrict.
Do I need a cath done?
That is a difficult question best left between you and your doctor. The answer often varies between institutions and sometimes even within the same institution.
Is a cath too dangerous because it would cause a spasm?
There are risks to cardiac caths, but in general they are very safe.
Should I be on other medication to prevent a heart attack?
When I have patients with coronary spasm, I usually will recommen a calcium channel blocker, nitrates, a statin and sometimes aspirin depending on their risk profile.
I hope this helps answer your questions and thanks for posting.
Should I be more concerned that maybe my arteries are not clear?
It is true that people with spasm tend to have underlying CAD, although it may be more appropriate to call it endothelial dysfunction. The lining on the inside of the coronary arteries are called endothelial cells. The plan an active role in secreting hormones in response to stimuli. Endothelial cells may respond one way to a given stimulus under normal function and a different way when they function abnormally. For example, in the setting of coronary spasm, the stimulus that normal causes arteries to dilate may cause them to constrict.
Do I need a cath done?
That is a difficult question best left between you and your doctor. The answer often varies between institutions and sometimes even within the same institution.
Is a cath too dangerous because it would cause a spasm?
There are risks to cardiac caths, but in general they are very safe.
Should I be on other medication to prevent a heart attack?
When I have patients with coronary spasm, I usually will recommen a calcium channel blocker, nitrates, a statin and sometimes aspirin depending on their risk profile.
I hope this helps answer your questions and thanks for posting.
Your question:
Should I be on other medication to prevent a heart attack?
Doctor responded:
When I have patients with coronary spasm, I usually will recommen a calcium channel blocker, nitrates, a statin and sometimes aspirin depending on their risk profile.
My doctor did virtually (except I don't tolerate calcium channel blockers - I take coreg) as the doctor on this board and I very seldom ever get spasms now.
I hope your able to get your concerns addressed fully to your satisfaction.
Konopka
Endothelial dysfunction can cause microvascular ischemia, limiting blood and oxygen to the heart, causing pain, not to mention anxiety. Anyone dealing with chronic angina (or pain) may want to consider an antidepressant to help cope.
Exercise is essential for promoting cardiovascular health. Consider food as medicine, too. The South Beach Diet is good for the heart. Or read Dean Ornish's books and see how simple lifestyle changes can remedy longterm health.
It all depends how motivated you are.
I avoid heavy carbs; take nitrates as needed; vasodilators; baby aspirin; a statin ... and I walk and do yoga almost every day.
Na ma ste,
C
If your doctor has his/her way and put statins in the water, then we'd all have to get our livers checked periodically to find out if there was any liver damage caused by the statin drug.
In my opinion the cholesterol numbers are way over-rated (unless extremely high). For goodness sake, our own bodies make cholesterol, we need it for life processes.
If your doctor was a good nutritionist (which most aren't) he/she would be recommending diet and lifestyle changes and simple things like anti-oxidants (vit.C & E and selenium for example)and garlic and fish oils to help protect your blood vessels and keep your blood "well lubricated". I think the biggest issue in the cholesterol debate is overlooked--that is if your vessel walls aren't healthy, the cholesterol has a better chance of sticking to the damaged parts. But NO doctor ever talks about that, or how to minimize the affect of free radicals in the body which cause the damage in the first place.