Arm and chest pain at rest, ruled out variant angina

[kbheart]

I’m 44 yrs. old and have had angina-like pain since November, a crushing pain in my chest and arms that lasts for 3 minutes and then is gone.  Last August I had an aneurysm repaired and my aortic valve replaced.  They said I had a connective tissue disease like Marfan’s Syndrome.  There was no plaque in my arteries, I’m thin, active, have never smoked, and eat healthy.  At first they thought my current chest pain was artery spasms (variant angina).  They started me on diltiazem. The chest and arm pain still occurs 3-4 times a day so now my cardiologist says it must not be cardiac related.  What else causes short bouts of crushing arm and chest pain?  They’ve tested me for ulcers, gallstones, GERD, aortic dissections, liver problems and everything comes up negative. Does diltiazem always stop artery spasms? The geneticist said I also have dural ectasia in my upper back.  Could that be causing the arm & chest pain?  Would I see a neurologist to treat that?  Whenever I mention it as a possibility to the cardiologists and primary care doctors they look at me like I’m from Mars.

[Forum-M.D.-MJM]

Hello,

Tough quesitions.

That is pretty good differential diagnosis for chest/arm pain.  Calcium channel blockers to not always stop vasospams.  It is difficult to prove that chest pains are or are not related to variant angina.  Other treatment options include trying different calcium channel blockers (amlodipine, nifedipine, verapamil) or long acting nitrates.  You could also have a left heart cath with medications given through the catheters (ergotamine) to try and stimulate spasm and confirm the diagnosis.  Sometimes only specialized centers will do this.  Dr. Stephen Ellis at the Cleveland Clinic has done this for some of my patients and I know the Mayo Clinic will do this as well.

I hope this helps.  Thanks for posting.

[Al Dente]

Variant angina can be difficult to diagnose.  Calcium channel blockers and nitrates are typically used to treat coronary spasm.

How exactly have they ruled out variant angina?  

Given the work that you've had done already, I'd gather my stuff and get another opinion at a large center.

[kbheart]

Thanks, Al Dente.
They ruled it out through several tests: ecg's, event monitor, CT scans, TEE, TTE, stress test, and the fact that the diltiazem & nitro doesn't help.  I saw a  Cleveland clinic cardiologist in December and have been following up with local physicians who have consulted with Cleveland.  I think I need to talk to someone who specializes in Marfan's Syndrome.
  

[Al Dente]

Thanks for the info.  The CCF docs are very good about coronary spasm and variant angina.  Usually nitro & calcium channels work--I have some vasospasm problems and it responds well to these meds.

Sounds like they've checked out your vascular system...some of the large vessels in the body can be tricky to evaluate.  Connective tissue problems aren't fun no doubt, and I hope they can shed some light.

Good luck!