Angina, Exercise, and Blood Pressure

[Cody]

Dear Physicians at Cleveland Heart Clinic,
Is it unlikely to have angina like symptoms only at rest and never while jogging/running daily?  If so, what may be the causes of these at rest symptoms?  I always believed angina was escalated with exercise and/or cold.  Also, during an angina episode is one's blood pressure and heart rate likely to become elevated?
Thanks - CM

[Elva]

My physician has scheduled a thallium stress test using dobutamine.  I am being treated for hypertension and am concerned if this will raise my blood pressure uncontrollably.  Just what happens with this type of procedure when this drug is used instead of the treadmill?  Thank you.

[dah]

I have been taking atenolol for PACs, PVCs, and PAT episodes for almost a year.  I started on 50 mg/day and was too fatigued so my doctor cut the dose to 25 mg/day.  The fatique is barely noticable now.  I switched from taking it in the morning to taking it only at bedtime; that seems to work best.  I was getting mild headaches before switching to a nighttime dose  only.  And my arrythmias are quite a bit less now but I still get them.

Good luck.

[Cleveland Clinic, MD]

Dear CM,

Yes, I would say that it would be unusual to have angina at rest and not with exercise.  There are many different causes of chest pain.  Amongst the cardiac causes of chest pain are: ischemia (due to blockages - including both stable and unstable angina and acute heart attack and coronary artery spasm), pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.

Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.

Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.

Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).

Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.

I can't say that one of these would be more likely to cause symptoms only at rest.  Usually a good internist can work through the potential causes with you and work towards an effective treatment.