Angina Questions

[janne]

Hi, I have written before.  39yr old female, no risk factors other than I am (was) a smoker. I had a heart attack (LAD stented) a few months ago(diagnosed with CAD). Cardiologist is concerned about unstable angina. ECG and treadmill stress test abnormal (maybe false positives). Doc wanted another angio, but at my request, I have a nuclear stress test this Friday.  If it's positive another angiogram will be done.

I believe I understand about what unstable and stable angina are and that there is a lack of oxygen to the heart, but I am unsure of exactly why they occur.  How can I feel normal sometimes while exercising and for no reason have chest pressure while at rest?    What is physically happening at the time or why would this occur sometimes with exercise and sometimes not?  If there were another significant blockage or if the stent was occulding, would I not have more persistant or predicatable angina while being active?
Could you please tell me if it makes sense that angina often occurs "after" exercise as opposed to "during" exercise? I speed walk approx. 2.5 - 5km per day and often have no discomfort.  However, if I am tired or if I go for 2 walks per day, I often notice that evening I will have more chest discomfort while at rest.  Does this make sense? Is there a relationship between lack of sleep and angina? On a 12 lead stress test, 4 were showing ischemia.  Is this a high number of leads? Generally, how long after a heart attack does an ecg remain abnormal?
Thanks very much for your help.
Jan

[Cleveland Clinic]

Janne, Hello again.

Your symptoms are not neccessary typical for angina from exercise. That said often women can have atypical symptoms.

Angina refers to chest pain. We term unstable and stable base on the etiology. Unstable is named essentially because it often the precursor for a heart attack and should be a red flag telling you to high tail it to seek medical attention.  Unstable angina originates from an unstable plaque with damage to the lining of the blood vessel that predisposes you to a blood clot forming in the vessel.

Stable angina refers to pain that comes about from areas of the heart not reciving blood from fixed blockages in the heart. These symptoms are generally elicited by a fixed amount of blood getting through a stenosis as you increase your activity. the symptoms are reproducible with similar levels of exertion and dissipate with rest or a nitroglycerin.

Your symptoms are not perfectly typical so a stress is not out of order. Stress ecg can sometimes give false positive results in women, so combining it with nuclear imaging is a good idea. The amount of st deviation in total is slightly predicitive of stress testing.  You are young and if there are signs of blockages on your stress you should definitely proceed with angiography.  

The fact that your symptoms occur intermittantly may be caused by other causes like spasm of the blood vessels or even non cardiac sources. Those might be options to pursue if your workup is negative.

There is no specific relationship between lack of sleep and angina that is well recognized.

[BabsD]

Hi,

I am also a 39 year old woman who has had a heart attack.  I have no risk factors and the reason for my heart attack is unclear.  

I am curious as to how much damage you have to your heart.
Do you know what your EF (ejection fraction) is ?  How big was
the heart attack?  What heart medicines are you currently on?
Did your doctor's give you a long-term prognosis?

Babs

[janne]

Hi BabsD
I'm not sure how much damage was done or what my EF was.  But, I do know they said it was a small heart attack because I was given some sort of medication in the right amount of time.  They also said that I was to drastically change my lifestyle and reduce my stress load.
I have had a lot of family/personal issues to deal with the past 7 years as well as a very stressful job.  I'm not sure how much significance that really has, but they seem to think it was important.
I am taking metoprolol 50mg twice per day, ramipril 2.5 mg once per day, lipitor 10mg once per day, plavix 75mg once per day and coated aspirin once per day.  I use the nitro spray as needed and also have the nitro patch (.8mg?). The metoprolol was recently reduced from 75mg twice per day as I was always tired and my resting heart rate was 36bpm (it's still only 42 bpm, but I find my shortness of breath and energy level have improved some).  The lipitor was also recently reduced from 20mg because I was finding my muscles were really sore(I don't have high cholesterol anyway).
As far as my prognosis goes, I really don't know.  I am still experiencing angina most days, nothing major, but a nuisance.  I'm hoping that the test I have this Friday will show that the previous tests were false positives and then I can go on with my life and forget this happened.  
I had 2 blood tests done (lipoprotein and homocysteine??) but do not have the results yet.
By the way, did you find that your heart attack freaked everyone out around you more than yourself? I still find it difficult to believe I ever had a heart attack (my doc says it's denial haha).Yet a lot of my family and friends are now looking at their own health more closely.                  
Although a heart attack for a woman in our age group is uncommon (lucky us), I am grateful in that it has forced me to look closely at my life and helped me to get my priorities in order.
I hope I helped answer your questions.
Take care, Jann

[janne]

Hi!
Thanks for your advice.  Your analagy of chest discomfort and a baby's cries is excellent. Having four children of my own (and three step children), I could really relate to what you were saying.  
This forum has helped me a lot in that I have become more informed about my body.  But, you are correct in saying that you shouldn't over due or become obsessive with your health.

A few days ago I developed a sore throat that became a chest cold(it figures that I haven't had a cold in almost 5 years and I quit smoking and bam, I have a chest cold haha).  When I went for my daily walk, I could feel pressure in my chest and I was a little out of breath.  I had to think about it for a moment, but then realized it was not angina, but it was just from the cold.

I went to a wedding reception tonight and it was the first time I danced (fast)with my finance since my heart attack almost 3 months ago (the last reception I went to was the night before my heart attack and I had an extreme amount of chest pressure but kept igoring it figuring I was just out of shape).  So, tonight was a bit of a test for myself and my fiance. He was a little concerned at first when we first started dancing, but I asked him to please trust me to tell him if there was something wrong (mainly chest pain) and to not treat me like  a 90 year old when I'm only 39.  He agreed and the night went great.  It felt so good to be normal again and to be able to do what I would usually do without having people hover over me with worry.  I actually felt "normal".
Anyway, I had to write back because your post was really helpful.  It was nice tonight not to hear a "serious baby cry".
Thanks for the advice.
Jann

[fastsilicon]

wow, I never knew of anyone under the age of 40 having a classic heart attack. If you don't mind me asking, what was your lifestyle like? Were you overweight?

[LEEJ]

I am 64 years old and generally in good health.  I have been taking Beta Blockers for 15 years to keep hypertension under check. (Toprol 50mg morning only) For five or  six years I have been experiencing angina during the evening only ,usually during my walk with the dog, and sometimes when climbing the stairs to go to bed.  During the rest of the day I have no symptoms, even when exercising vigorously. I have tried to induce the symptoms by running up and down the stairs (15 to 20 times)(bringing my heart rate to 140 ) It makes for good exercise, but I can not duplicate the angina symptoms. It seems that after sitting in my recliner for an hour or so after eating, my system seems to slow down and change. I can eat a big dinner early in the day, and exercise will not be a problem.  I wonder if taking Beta Blockers for a long period of time can prevent the heart from speeding up when it needs to, thereby causing the symptoms.  I have recently been through all the tests including stress echo, and the findings are negative.  Does anyone out there have similar symptoms which only occur after resting in the evening.  I have never had it occur during rest or sleep , but only after getting up from my chair and becoming active in the later evening. I don't think it can be Prinzmetals angina because I never had an episode at rest.