Another question about coronary artery spasm

[dmil241]

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?

[CCF-M.D.-MJM]

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.

[Konopka1955]

Hi,  I just thought I would mention that I've had spasms on and off for years.  I had a prior heart attack and over the years I've had coronary spasms on and off..  I think my biggest blockage right now is the right side with a 60% occlusion.  So for me that is  nothing I would want to have stented at this time.. I get virtually no angina..  But this is my preference.  Stents can close up and cause problems to.  

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

[Carolina03]

My .02, too ...

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

[dmil241]

I have a question about statins. If my cholesterol levels are pretty good, I woulnd't need any would I? My total cholesterol is 206, HDL 50, LDL 142 and Triglycerides 68. My cardiologist keeps talking to me about them, but my PCP is against them. He says my levels just aren't high enough to justify the risks. By my cardiologists own admission he'd put them in the drinking water if he could. He thinks they are that good. I'm kinda on the fence about them right now. ??

[upbeat63]

My .02

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.

[Konopka1955]

Hi dmil1241,  You said:  Al Dente and Konopka I have a question about statins. If my cholesterol levels are pretty good, I woulnd't need any would I? My total cholesterol is 206, HDL 50, LDL 142 and Triglycerides 68. My cardiologist keeps talking to me about them, but my PCP is against them. He says my levels just aren't high enough to justify the risks. By my cardiologists own admission he'd put them in the drinking water if he could. He thinks they are that good. I'm kinda on the fence about them right now. ??

According to my cardiologist/electrophysciologist.  He recommends with my cardiac history that I have a 3 to 1 ratio and I don't have high cholesterol.  He said: statins are good for me regardless of my total cholestero so he recommended I go on cholesterol med just for the statin alone.  So I take Pravachol - its expensive - my insurance pays for it - but I would take it even if my insurance didn't pay for them as that's how confident I felt my doctor was that I should go on them even thought I don't have high cholesterol.  I had a prior heart attack 1992 (blood clot) and he said there is just enough good evidence for me to take statin.  I hate taking any more meds than necessary and I only take 7 "different meds" a day and my cardiac history is that - like I indicated - I had a heart attack, I have an ICD for sustained monomorphic VT and I have a St. Jude mechanical mitral valve for rheumatic fever.  So, if he says 'statins' are good for me - he must feel pretty confident because he knows any medication I take at all upsets my system as I am so sensitive to even the smallest doseage of med.

I'm just telling what I was told.  

Good Luck and Best Wishes
Konopka

[djpaj]

Hi All,

Sorry to hijack this post, but I was reading all the comments and wanted to chime in, er, well, ask my own question, but it sort of relates to one of the comments posted above.

I was diagnosed with MVP about 11 years ago, at age 16 - I haven't really had any pain associated with it (that I can remember - most of my memories are foggy...)  Anyway, recently I've started to have a best described as a quick stabbing pain in my chest - sometimes not always so quick, sometimes it lasts for about a minute or so, and worsens with deep breaths - but then boom it's gone.

Now I've had all the tests, noninvasive that is, 2 nuclear stress, echo, ekg, CT - all with my cardio telling me everything looks A OK - and that I'm "statistically" too young to have a blockage of any significant damage - but from reading the above comments, nuclear's arent' always 100% accurate - correct?  Should I be more worried now?  Should I request a cath?  He says he doesn't want to give me one because there are no signs of anything except MVP...  

He is such a busy guy that he doesn't really have time to sit with me and explain all the pains I would experience with MVP - I've gone to the ER twice and they've patted me on my back and told me there nothing wrong and I'm crazy for going in.

I would prefer to not drop dead from a heart attack, and I'm told these are normal - but are very scary.

Anyone have any advice?  You all seem very helpful and knowledgable here.

Thanks in advance for listening to my rambling and whining.

[upbeat63]

You are correct. If you go onto such an extreme diet to limit cholesterol and fat intake---YOUR own body, which NEEDS cholesterol will start to produce more of it. Hence your numbers will probably go up. It is actually a common occurence and very frustrating for people who are trying to control cholesterol through diet.

Keep in mind, there is a genetic factor in cholesterol numbers and a dietary one.

I just think that, (as with other drugs), there is a sudden jump on the band wagon by some doctors to get the numbers down. And for some doctors, that means prescribing statins to everyone they can. Why?

Also remember, it is your liver which processes cholesterol, and the reason you have to have your blood/liver enzymes checked periodically while on statins is to check for liver damage. hmm possible damage to the organ that processess cholesterol in the first place. Statins can be life saving for some people, I'm not suggesting that you shouldn't take them if you have been prescribed them. But there is discrepancy in the medical field about the numbers and what they really mean, and the use of statins. There is debate. That's all I'm saying

[MaryRoe]

Can I ask how many of you posters here are female?  I could of written all of these posts myself.  Yes, the heart cath is the gold standard and yes it is not without problems in itself BUT, you need to interview the Cath/Stent doctor before hand.  Many doctors can do a Cath OK but when it comes time to stent placement...that is another story.  If you are at a Teaching Hospital PLEASE be sure you sign a separate paper telling them you DO NOT WANT a Fellow (Kid in Training) doing the stents.  And, have them sign this paper that they have read your wishes.  Patient's have rights!  I was a guinia pig (unbeknownst to me) and suffered since becuz of a Cardiac Fellow!

It was a doctor at Brighman and Woman's that described my symptoms to a tee on the internet,4-5 years ago...More females have this than men.  It is called Prinzmetal/Variant Angina and yes normally there is an underlying CAD.  But, many tests do not show this.  Thalliums, Nuclear Cardiolits and Dobutermines did not show this in me.  I was led to believe I was a nutt case even at a top notch heart place. These attacks can be severe and can appear right out of the blue.  They do not have to be exercised induced.

Calcium Channel blockers and Nitrates are recommended and what I read 5-6 years ago, that with proper therapy, one can manage this condition well.  But, if it is not diagnosed and treated, it can lead to a heart attack.  This is what happened to me. I also was told that this is how my heart lays or the leads were placed on wrong, or I must of coughed during the EKG, yada yada yada, when it showed a heart attack on an EKG.  

I too am on Crestor and Zetia and this is working well for me.  I have stents but they could not stent the heart attack area. They could not by-pass it either. I am on Zebeta (worked better for me than Coreg)and an ace inhibitor.  They took me off all diuretics as an obstruction did show up on my Echo's and they felt a diuretic would cause dehydration and cause more problems.

Coronary spasms have been around a long time but many doctors are not familar with how to diagnose this correctly and the proper therapy for this and good follow up's are critcial in a person's care of this condition.  

I was told to limit my exercise.  I am wondering if some of you were told the same.  I am thinking of starting back at a low pace.

Wishing you all the very best of the New Year.  We deserve it.

[rayg]

i had sweats and no discomfort in my chest. i had all the test done ekg, sonagram, stress test all normal. went for a cath and had a 90% blockage in the lad. in 2 years i have had 5 stents, 2 angis and a double by pass. i now have a blockage in a small artery that gives me alot of discomfort and the docs do not want to open it. WHAT NEXT???????????????????

[phoenixrising]

Hello Everyone.  I am a 43 yo female, recently diagnosed with a heart attack caused by arterial spasms.  I don't smoke, have never smoked, don't have history or family history of heart disease, don't have diabetes, have low cholesterol, don't drink alcohol or caffeine and I don’t  take recreational drugs. I am pre-manopausal. I am ever so slightly overweight but I am in good health and under the guidelines for waist measurements.  I do have high blood pressure, a very stressful job and don't sleep well. I do also tend to have a nervous personality as well.  

On 1/20/06, I went to the hospitals' ER with atypical coronary symptoms.  My lower teeth were bothering me (I could feel every single nerve ending of each tooth), even though I did not experience pain, I felt slight to mid heaviness in my arms, neck and upper back as time progressed.  After a while,  I felt anxiety and goose pimples in my lower extremities but this was probably due to the fact to nerves when it dawned on me I might be having a heart attack and felt like having a bowel movement.   There was significant lag in getting help because the first hospital I went to made me sit in the waiting room for 4.5 hours even though several times during that period I told them I had suspicions I was undergoing a heart attack.  After 4.5 hours and progressively feeling worse.  

I drove myself to another hospital where they rushed me to an EKG which was abnormal.  The first set of blood work was normal, the second set of blood work done 6 hours later showed elevated levels of enzymes which indicate heart damage. I was placed in the ICU. Eventually, later blood tests showed the elevated levels had peaked and then they decreased which is good.  I was placed on aspirin, heavy duty blood thinners (heparin plus something intravenous), diltiazem, isosorbide and was given additional ekgs and an echo cardiogram (ultrasound).  The echo cardiogram was normal.  I was scheduled for a coronary cautherization early in the morning on day 3.  I live in the suburbs and the cautherization triggered angina but not before they saw an artery blockage of 95%, they gave me two oral nitros and shipped me to Boston for stenting.  In Boston, the cardiologist was suspicious given my low risks so he continued the cautherization and SAW my arteries in full spasm.  I was given liquid (nitro I think), directly into the arteries which caused them to open immediately---I HAD no blockages. I was very lucky since I went in there to have stents put in where the "blockage" was actually an artery blockage caused by the spasm.  

My current list of medication is as follows: Diltiazem SR 120mg (2X/day), isosorbide mononitrate 30mg (1X/day), baby aspirin 81mg (1X/day), nitroquick 0.4mg (as needed). In addition,  I requested Zoloft to help me cope. My spasms occur at rest, very late at night or early in the morning. The cardiologist told me that one of the medicines I had been taking to treat my high blood pressure (atenolol) can make spasms worse so that medicine was removed.

Questions: the oral nitro did not seem to help the episode when I was cautherization in the morning but the arteries opened right up when it was injected directly into my arteries in the afternoon, why is this so?  Does this mean that if I have another occurrence, the oral nitro might not work? The cardiologist suggested I exercise for .5hr every day up from my 1 to 2 times a week.  I am really hoping this will help, but is there any medical literature that links frequent high exercise to the minimizing of spasms?  Is it true that strenuous exercise can bring on spasms?  I had a heart attack that impacted 1-2% of my heart muscle, how significant is this %?  My diet is pretty healthy but what else can I do to lower my chances of a recurrence besides lowering stress, taking my meds and exercising every day?  My goal is to correct this problem by making life changes which will eradicate the spasms.  Is it possible to die from an arterial spasmic attack?  Thank you.

[phoenixrising]

For djpaj - I empathize with your statements.  I think getting a second opinion is always best. Specially with a cardiologist that is exposed to younger patients and works in a large city where the population is larger.  After sitting in an ER for 4.5 hours because the traige nurse thought I was having a panic attack because I was too young and didn't fit the profile where I was actually having a heart attack was really an eye opener.  Also,  I was in a hospital for 3 days and saw two cardiologists and two GPs before a 3rd cardiologist accurately diagnosed me-in Boston.  Even though I am new to this,  I've learned that some cardiac issues are difficult to diagnose and that being assertive, asking alot of questions and taking control of your medical situation goes a long way to getting answers.  Even if you are made to feel silly or others think it's in your head...  Listen to your body,  only you know what you feel.  It's better to be thought silly than to be dead.  :)