Chest Pains in Cardiomyopaty

[collector]

I was diagnosed with Dilated Cardiomyopathy several months ago, that is thought to be caused by taking a new biologic injection for Psoriatic Arthritis.  I have chest pains daily, along with shortness of breath on exertion.  My angiogram showed all the heart arteries to be clear, so why am i still having chest pains? Also, all my cardiologist has treated me with is Altace 10mg once a day.  Is my cariologist being aggressive enough?  He seems to think my chest pains are not of concern since my angiogram showed clear arteries.  I've been off the biologic medicine since late September and have not seen any improvement in my chest pains and shortness of breath. Do you think my heart will return to normal size and function?  Thank you for your time.

[CCF-M.D.-MJM]

Collector,

Sorry to hear about your recent heart problems.  It is very difficult to say whether your heart function will return to normal.  Some dilated cardiomyopathies (DCM) recover completely, others improve but not back to normal, while it is also possible it could remain the same or worsen over time.  

Most people with DCM should be on a beta blocker as well as medication like Altace (ace inhibitor).

Regarding the chest pain, it is difficult to say what is causing them.  Fortunately you know it is not from coronary artery disease and that you aren't having a heart attack.  I would recommend trying a beta blocker and seeing if it helps improve your symptoms.  It is important to know that many people feel worse initially after starting a beta blocker, so don't be surprised if you are initially a bit more fatigued.  We know over the long term there is a clear benefit.

If you aren't sure about your treatment or your doctor, get a second opinion--it never hurts.

Also, if your ejection fraction is less than 30% and remains at that level for at least 9 months, an intracardiac defibrillator is proven to improve prognosis over the long term.

I hope this helps.  Thanks for posting and happy holidays.

[hankstar]

I am very intersted in what drug might have been responsible for your cardiomyopathy for the treatment of your Psoriatic Arthritis.

My brother has Reiter's syndrome(now called reactive arthritis). I have ankylosing spondylitis, we have both tested positive for the specific gene HLA-B27, it is often found in persons that have reiters syndrome and ankylosing spondylitis, sometimes many persons with a connective tissue disease will be found have an overlap of more than one, called mixed connective tissue disease. All I take is Aspirin 325mg and valium 5mg twice daily, it helps with the chest pains and spasm from costochondritis secondary to the AS. I avoid other dangerous drugs that can do more harm than good. These particular type of connective tissue disease are not life threatening , while powerful drugs used to treat them can have devastating effects.

May I ask have you been tested for the HLA-B 27 gene?

Altace is an ace inhibitor that has shown excellent results in increasing your EF, I know someone that it has brought their EF from 40% to 55% in just 6 months.

Good luck and Merry Christmas.

[rodtrade]

Being a 25 year sufferer of beneign PVC's I have been a reader of this forum for many months.  I am impressed with the concern and dedication of the doctors that answer the questions on this forum and sitting here reading a question and answer even on Christmas day is simply amazing to me.  In these days where many doctors show little concern and make most feel much like a number, the doctors at Cleveland Clinic take time out of what must be an incredibly hectic day to answer questions for free.  These doctors are nothing less than saints as far as I'm concerned and the time they take to do this is so very appreciated by so many.  Doctor's, thank you sincerely for your obvious hard work and dedication to people.  In my book, you are the best of the best.  Merry Christmas to all of you and may the new year bring health, happiness and prosperity to you and your families.

A grateful reader

[hankstar]

Rodtrade, I think you spoke for all of us here on the forum,Very well put and all the best for the Holidays and New Year to all the doctors and staff at CCF.

Warmest regards.

[Flycaster305]

Hank, I have enjoyed your posts.  I am a fellow-sufferer of AS, I also have the gene marker.  I always worried that the chest pain of AS would confuse the pain of a heart attack, and it did just that five years ago. Fortunately, my wife noticed a difference in my color and demeanor and drove me to the hospital.  Lifesytle changes, including losing 30 pounds, quiting tobacco, exercising has changed my life; great medications made the exercising possible.  I spend time now on the Northwest rivers flyfishing for trout, steelhead and salmon.  My reason for poking my head into this wonderful forum is to encourage anyone with Ankylosing Spondelitis to understand the difference between topical pain and the pain  of the famous elephant that sits on one's chest.
I had since childhood what all of my brothers and sisters called "a goofy heartrate".  Since the whole family, including my father had it, we didn't understand what it was, and simply didn't worry about it.  Since I had the heart attack, meds now control it, and as strange as it seems, a normal heart rate seems strange.
I would encourage anyone with Ankylosing Spondelitis to talk with a physician about the difference in topical pain and the pain of a heart attack. It could be a lifesaving conversation.
Cheers.

[hankstar]

Enjoy the fishing, I love to myself , but haven't been in awhile.
You are completely right the pain in the chest from AS is almost indistinguishable from the pain of a heart attack or aortic dissection for that matter, in fact persons with AS are at a slightly increased risk from aortic dissection though it be very low, as AS can affect the aortic valve in about 2-3% of all cases of AS.

  Trust me I been to the ER/hospital several times year this just to be on the safe side with severe chest pain, so far it has been diagnosed chronic costochondritis with severe flare ups, but I have been advised by all the doctors when the pain gets bad don't take chances and with your experience and much appreciated advice I will even be more cautious. There is no history of heart attacks or coronary disease in my family, even though some suffer from hypertension and diabetes, they all lived well into their late 80's and mid 90's ,.I myself have mild hypertension, well controlled with atenolol and cozaar. Palpitations , PVCs and tachycardia are few and far between for me these days, hope it keeps that way. Persons with any connective tissue disease are more prone to palpitations, though apparently it does not carry an adverse prognosis.

  Hope you did not suffer any significant damage caused by your heart attack and that you continue to do just fine.

  Happy fishing. Hope you had a Merry Christmas and all the best for the New Year.

  hank.

[shans 52]

I have tested pos for hla-b27. I was tested to rule out connective tissue disease and was in the end dx with fibromyalgia, I have had heart problems, well innapropriate sinus tach and now seem to be having more problems, is this gene have anything to do with heart disease?

[donray]

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