Angina or Esophageal Spasm

[cheetoh15]

43 yom had cardiac cath 12 mos ago resulting in 5 stint placements. Another cath 6 months ago after reporting additional symptoms w/ no stints but additional narrowing of several cardiac arteries. Doc said it could be esophageal spasms but ordered stress test and follow-up every six months for two years. Stress test scheduled for next Weds with follow up appt in early December. Problem: Following last stress test, began walking 1.5 - 3 miles a day, 3-5 times/wk until early September, when I put it on hold due to other issues, although I maintained high level of activity. Last Sunday afternoon, I returned to walking track for first time, and in less than a quarter mile had to sit down and take a nitro because of chest pn. Returned home, but had additional attack later that evening. Following morning (Monday) had mild attack and that afternoon several minor-moderate. Tuesday morning had severe attack while showering that subsided after two nitro. One minor that evening. Several minor on Weds afternoon, as well as Thurs morning, all subsided after one nitro. On Thursday night very severe attack that did not clear up until after 3 nitro, with lingering pain in both hands, even after chest pain subsided. No problems Friday or Saturday, but one severe attack just after waking this a.m. that cleared with two nitro, and another moderate slightly more than one hour later, which cleared with one nitro. Symptoms are burning pressure that begins in center of chest and quickly radiates throughout the chest and down both arms with moderate to severe breathing difficulties, although I can't say for sure that the shortness of breath is caused by the pain or anxiety. Cannot determine precipitating factor - it is occurring with and without strenuous activity, but since I haven't had any problems for more than 6 months, I am unsure of how concerned I should be, especially with a stress test with my Cardiologist's ARNP next Weds. Any advice?

[Cleveland Clinic]

This sounds like cardiac chest pain and warrants further assessment.  The fact that it's so frequent would push me towards doing it sooner than later.  I would probably call your doctor or whoever is covering him today.  I would also advise you to limit your activities to the minimum, even though there isn't really a specific pattern of inciting events.  The fact that it responds to nitro is suggestive of either coronary artery disease (fixed stenosis) related pain or due to coronary vasospasm which isn't necessarily a fixed blockage.  If this is due to a fixed stenosis then placing another stent may help.  If coronary vasospasm is the cause of your symptoms, then you should be put an aggressive medical regimen with long acting nitrates (long acting imdur 30 to 60 mg daily) in addition to calcium channel blockers such as amlodipine or nifedipine.