Angina in 42 yr old female

[D-T-Stant]

Posted By  CCF CARDIO MD sc on October 20, 1997 at 17:13:34:

In Reply to: Angina in 42 yr old female posted by D T Stant on October 16, 1997 at 22:39:51:

: My wife has had 2 (3 days apart) recent episodes (August) of severe angina radiating to the jaw.  Her ekg's showed an inverted T wave..others subsequent to this were normal, as was the stress-echo.  She still complains of fatigue, occasional tachycardia and occasional low grade angina, sometimes radiating to the back.  Local cardiologist can confirm nothing, but says an ekg during the severe pain phase would be helpful--although he admits ekg's have limited diagnostic usefulness in women.  Not sure what to do at this point...Her physical profile and history is incongruous with her symptoms...yet her life is not normal...need help!

[CCF Cardio MD sc]

Dear Mr. Stant
I can understand the frustration you and your wife must be going through. Unfortunately this is not an uncommon problem especially in women. Chest pain may arise from the many organs and structures  that are present in the chest. Obviously it is cardiac pain that commands the most attention because of its potentially serious nature and the many different treatment  modalities that exist to prevent the potential complications. The other common causes of chest discomfort arise from the intestinal tract, more specifically the stomach and the esophagus and unfortunately it may mimic cardiac pain, and pain arising from the muscles lining the chest. In your wife’s case there are a few things that may need to be considered but I will concentrate on the heart as that is the scope of this forum. Angina implies that in certain condition there is inadequate blood supply to heart.  The commonest cause of this is narrowing of the coronary arteries due to atheroma or plaque. On rarer occasions the angina may be due to spasm of a “ normal “ coronary artery which gives the same kind of pain as that which is caused by blockages but has a different mechanism. There are a number of non invasive tests that may help in the diagnosis of coronary artery disease, however none of these tests are completely perfect and there could still be cases of  false positive test, that is tests that give a negative result even though a patient may have significant disease of the coronary arteries. one should always have a high index of suspicion to prevent this from happening and if the clinical scenario is such that the likelihood of coronary artery disease is high a different test may be considered. This may take the form of a different imaging modality such as nuclear stress test or else consideration should be given to obtaining  a cardiac cathetherization, whereby the coronary arteries may be visualized directly and even treated if a blockage is found. I hope that this information will be of help to you and your wife, and I wish all the best of luck in getting to the bottom of your problem. If you would like more information or would like to see one of our cardiologists at the Cleveland Clinic please feel free to call 1-800-CCF-CARE for an appointment.
Information in this Cardiology Forum is intended for general information only and should not be used for diagnostic purposes. Actual diagnosis may only be given by primary physicians involved directly in patient care.