Coronary Artery Spasms

[dmil241]

I am female, 42, don't smoke or drink alcohol or take illegal drugs. I stay away from caffeine like the plague, eat pretty healthy and am not overweight. I walk for exercise but do not strength train. I have a history of premature heart beats but my heart is structurally sound and no blockages. However I get rather atypical chest pain-no breathlessness or real nausea. My cardiologist recently did an EKG which showed a change from the last one. He did an echo which was very good and a nuclear stress test. The test showed an ischemia at 160bpm which disappeared at 190bpm. He said I have coronary artery spasms. He said I have a good prognosis because of everything else. I HATE medicines. So he put me on OMACOR (Omega-3s). But now I am scared everytime I get any little chest pain which only lasts 30 seconds to less than 2 min, but usually comes back over the next 2-4 hrs when I have them-during the test I had NO CHEST PAIN or breathlessness! Is the spasm worse when I feel the pain or could the pain be totally unrelated? Do I really have nothing to worry about in regards to them? In what situation should I worry about it? Should I be doing something else or seek another opinion? He said nothing but coronary artery spasms would cause such a thing on the nuclear stress test. Other than that he said my stress test was great. I just want to know what to do from here. I get really worried at times even the premature heart beats will freak me out now. Is it more dangerous to have them if I have coronary artery spasms?

[CCF-M.D.-MJM]

Hi dmil,

You are not alone with this concern.  Young women with atypical chest pain are notoriously difficult to diagnosis because women often present with atypical chest pain on one hand, but on the other represent a low risk group.  It is true, however, that if this is spasm your prognosis is good.  

Is the spasm worse when I feel the pain or could the pain be totally unrelated?

If it is spasm, you are probably only having significant coronary spasm when you feel the chest pain.  Have you tried sublingual nitroglycerin with the pain to see if it gets better?  Your pain may be so short lived that it would be difficult to tell, but is worth a try.  Nitroglycerin should help relieve the spasm and symptoms of spasm.  If this works, you should consider trying either a long acting calcium channel blocker or long acting nitrate.

I am not criticizing your choice to take omega 3 fatty acids, but what is the difference between taking a less well studied medication like omega-3's compared to proven safe medications like nitrates and calcium channel blockers that have been studied for this indications.  I do not believe omega-3 FA's have been studied in spasm.  There is some data that omega 3 fA's help reduce the incidence of arrhythmia in people without CAD.  There is data showing that it does not help and may be detrimental to people with coronary disease.

I advice caution in using supplements other than those studied in large randomized trials for the indications they were studied.

(this should stir up some posts and debate)

Do I really have nothing to worry about in regards to them? In what situation should I worry about it?

You should worry about a change in the character of the pain, worse than normal or lasting longer than normal.

Should I be doing something else or seek another opinion?

You could seek a second opinion if you are uncertain of the diagnosis.  If the second physician agrees with the first, it is probably worth at least trying medical therapy.

I hope this helps.

Good luck and thanks for posting.

[Carolina03]

Dmil241,

My background is similar to yours, i.e, low risk factors for CAD and almost the same work-up.

I was diagnosed with "endothelial dysfunction" after an invasive cardiac cath. I do NOT recommend going down that path. My cardiologist put me in a NIH study on female-pattern ischemia. (You can Google "WISE study" and find more info).

A doctor from the Cleveland Clinic recommended nitrates and a calcium channel blocker. I tried the medications but felt significant side-effects and quit. You may be different, (if you get to the point of wanting to try medications).

I'm taking Inspra, (yes, a diuretic) and very low-dose Lisinopril, (an ACE-inhibitor or vasodilator). The change in my symptoms was remarkable. While a second test confirmed that the ED was still present, I feel less symptomatic and have moved on with my life. I don't even consider myself "sick" any more, and avoid doctors like the plague. (No offense CCF!)

If my symptoms change, however, and I feel sustained chest pain with pressure, you can bet that I'll page my doctor!

I hope this helps.

Carolina

[Konopka1955]

Hi,  I read your post and I myself have experienced coronary spasms -  since I've had a previous heart attack and I can attest that the spasms are quite painful for me - and nitro didn't take the pain away and ace inhibitors gave me awful side effects.  I found over the past 10 years that my coronary spasms just come and they go.  I can go years with none and then for 2 or 3 mos I'll get them occasionally.  No rhyme nor reason.  But they did pass for me..  To be quite honest - I hate them.  They hurt and I can't make them go away.  I tried breathing through my nose and out of my mouth when they come on.  That helps - but they still are still very painful.  My cardiac docs will run all the cardiac tests and everything will be fine.  If you get chest pains - you should never drive - call 911.  I don't get regular angina very often - but I have taken nitro for spasms as I indicated I found it to be useless for the pain.  But nitro may work work for you.  
Best Wishes
Konopka1955

[Richard_W]

I've not had these but my wife had and it became a very serious problem.  She is now doing well but her "cardiac event" lowered her EF to below 30% and she had to go on a year and a half of cardiac rehab.  In my opinion it has to do with stress closing those arteries up tight, or as the cardiologist put it, it was like someone stepped on a garden hose.  The heart was deprived of blood flow although there was no evidence of coronary blockage.  I would work on stress management but I'm no doctor but that's my $0.02 anyway.

[Carolina03]

Richard,

I agree with managing stress!!! While the chest pain I experience sometimes has no rhyme or reason, I have experienced significant episodes during stress.

As a result, I've taught myself a "non-reactive technique," borrowed from yoga. Here are a few books I recommend for anyone dealing with chronic anginal pain:

-- The Relaxation Response, Howard Benson, MD (takes the best of yoga without the religious dogma)

-- Meditation as Medicine, Dharma Singh Khalsa, MD (keep an open mind, jump through the New Ageisms and focus on the relaxation techniques)

-- Your Body is Your Subconscious Mind, Candace Pert, PhD (um, you have to read it to believe it)

BTW, be careful with the rebound effect of nitro.  

Peace,
Carolina

[dmil241]

The times I have had the most problems have been times of highest stress. My 9yr old recently had 2 incidents which sent her to the hospital and that is when my chest pain started on and off. I learned biofeedback a couple years back because my PCP thought I was having panic attakcs which brought on the feeling of my heart galloping or flip-flopping. My therapist disagreed. He said I was not having real panic attacks but did conceed that when my heart started doing its 'thing' it was probably causing a limited panic reaction due to not understanding or knowing what was going on. I have since learned that it is only  PACs and maybe some PVCs and have learned to usually cope with them although I DO HATE THEM when they are numerous! The biofeedback has been a TRUE Blessing!!!! However when my daughter was in the hospital I stopped the relaxation and WORRIED! It seems to have set things off-that and the lack of sleep in the hospital. I've got to get back into doing the relaxation technique daily. I think you are right that it is a key to keeping things together-at least for me.

As far as the Omega-3s, I am only taking 1 gram though the cardiologists said to take somewhere between 2-4 grams. They really make me feel sick and kind of funny. I am not sure they are going to work although I want them to because it seems easy. I do have cholesterol of 210. My cardiologist wants me on Lipitor. My PCP says it is not high enough for that because I am premenopausal and not on birth control. The cardiologist would be happy if I went on birth control so that he could put me on Lipitor. I think that is a bit much!!!  So  the cardiologist and the PCP seem happy if I am on the Omega-3s for the cholesterol and the spasms.

[MinnieM]

I am Ms. Cardiac Spasm Queen here. lol....Had these on and off for years and complained to deaf ears. It was not until I read an article by a Cardio at Brigham and Womans Hospital that described me to a tee. Variant Angina also known as Prinzmetal Angina and most people that have this do have some atherloscotic (sp) vessels.  These attacks can come right out of the blue.  Most do not start with exercise and most come in the morning hours and more often than not, attacks can come in the same places.  Weird. Mine would come mostly sitting at the computer, three at the post-office and several times shopping in stores.  Never laying in bed or sleeping or showering or cooking or driving the car. These attacks would be so severe that I could not talk or walk.  I finally got Nitro (without a diganosis) and Nitro DOES work for me.  These attacks can be well mananged if recognized and treated but can lead to a heart attack if not treated well.  This is what happened to me. I did suffer a heart attack becauz I was shunned.  Now, they listen to me. I have 4 stents now and the tiny vessel that many women have is closed completely due to the scarring of the MI.  I am researching stem cell therapy now for me.  Good Luck and God Bless Us all.....and make them listen to you.

[Tx_DreamWeaver]

I have Prinzemetal's and the same symptoms and problems for the past 5 years now while sitting at my computer, laying on the couch watching TV or reading. For the most part it truly is "at rest", but the pain can come on long exertion like shopping, or when in a stressful situation. Spasms tend to happen just above or below a blockage, which I have, but it isn't always that way with everyone. I take Procardia XL twice a day, and Nitro spray as needed for pain, but lately I am having alot of pain for long periods. Not bad pain (on a scale of 1-10 about a 3), but it's been nagging me, and has even woke me up a few times with a sharp pain.

It's been a year and a half since my confirmed Dx, so I guess it's about time for another round of tests. But I will say that the Procardia has helped tremendously (although not at the moment), and worked so much better than the Cardizem I took for 4 years, as it not only opens the arteries to more blood/oxygen flow but is geared more toward controlling spasms (so my Doc said). He also told me that in years past they used to do an angiogram and give you something to make you spasm during it to find the bad spot, and then stent that spot so it won't close up on you. But they later found out that A: making you spasm was very risky, and B: Spasms tend to travel and just set up residence somewhere else above or below the stent, and you can't just keep putting stents in there because, 1: it won't stop the spasms from traveling, and 2: there is always the risk of tearing the artery while inserting the stent. BOY don't this sound like fun boys & girls? LOL!  

Wishing you all God's blessings,
Sally

[MinnieM]

You made a lot od sense.  This is so true of the spasms finding another place to park.  I have had 3 Caths and 4 stents and YES...the Idiot Fellow that they were training on me (without my knowledge) 1.  could not deploy the stent correctly and I nearly ended up having by-pass surgery. Next Cath, I told them loud and clear...no Babies working on my heart.  I was assured that my wishes would be adhered to.  They had another cardio baby work on me and this baby nicked an artery placing in anotehr stent.  They kept quiet about this and sent me home in pain with no enzymes taken.  I ended up in the ER room 3 days later with high Troponin levels.  This is how I found out what happened.

Using a drug to produce a spasm during a heart cath can be very bad for a patient that has known plaque in the arteries.  They were going to do this on me during the first cath and after seeing blockages...they could not do it.  They finally did something right.

Good Luck to you and Happy Holidays.

[bygraceursaved]

I was diagnosed approx. 2 1/2 years ago after a stress treadmill, repeated twice and my ekg read to me by cardiology and the technician. I had infrequent problems with spasms to begin with. two week ago the spasms became frequent, and last friday, today being 1/6/06 i began having coronary artery spasms nonstop, should have sought medical attention two weeks ago, then by sunday 1/1/06 i was so bad that i knew if i let my husband go to work i would be found unconcious or even worse by his return, so he called 911 and when they arrived my blood pressure was 218/150 not good! my pulse was 168 and i was experiencing enough chest pain and pressure to received 4 aspirin, 5 sprays of nitro, and 5 injections of morphine all before arriving at the hospital E.R. i was in and out of consciousness and in significant distress, with breathing difficulties, within a half hour of arriving at E.R. i was admitted to the cardiac unit where i was given nitro patches, sublingual nitro and a calcium channel blocker, which was taken away the next day due to flushcing, and severe shoulder pain, i spent 2 days at the hospital was discharged only to pass out in the lobby while waiting for my husband to retrieve the car, and was experiencing spasms and chest pain, they did a re-admit and back went in the I.V. i stayed an additional 2 days being discharged with nitropatch and other meds, got home took a bath put my pj's on and layed down, got thee single worst headache of my life worse than normal migraines x's 10 vomiting severe chest pain radiating to my jaw and down my left arm, i was instructed to go to my local health clinic for a B.P. check which was 216/66 and i was having constant spasms and pain, was transferred from clinic by ambulance to return to original hospital when ambulance was diverted to another hospital because of lack of space, spent 4 hours in that E.R. and then transferred by ambulance to an entirely different hospital where i spent a day as inpatient and then was sent home again with transdermal nitro patches and am doing fair compared to the last several days. By Gods grace and my salvation through Christ I am still living and breathing.

[bygraceursaved]

I forgot to mention that the docs had put me on Imdur for a day which I experienced problems with and they took me back off of it, I read that they should not have been giving me Imdur with the nitro patch and the sublingual nitros and channel blockers all together. I am curious as to what other doctors think about my experience and my condition. I also have Myasthenia Gravis and wondered if there is any connection or research on a connection to coronary artery spasms and wondered if anyone out there has Myasthenia Gravis and coronary artery spasms? Thanks in advance

[coolkeepeer]

I to have corornary spasm.They found mine in 1979 and I still get chest pains at rest.No nitrates help me at all. My doc tells me they cannot confirm if spasmes are still there. The best thing that works for me is procardia xl. I know that stress, extreme joy can cause mine to start. the pain is so bad they have to put out to stop them. I now know that I have to demand what works for me. I hope any of you will not have as long a run of this pain as I have. By the way they did the ergonvine test on me to find out if had spasms and closed one artery 100%. The other artrey 95% and I went into v tac and had to be shocked back to life. Has anyone else had this test done?

[swimcheryl]

I have just been released from the hospital with an unclear diagnoses of coronary spasm. I am 37 I am wondering what your ages are?

[Tawanda]

Nov. 15th 2005 began my unknown illness. I am a single mother of 3 children. At that time was working 3 part time jobs and trying to get my masters. So stress was an issue. The nurse from work sent me to the hospital from extremly high blood preasure, severe crushing chest(felt like an elephant was sitting on my chest) very hard time breathing and left arm pain. I was treated for pluarsy then blood clots nothing fixed the chest pain. With every diagonis they gave treatment with no effectivew results. They state I had a flu bug and due to not resting the bug went into my heart from there I some how developted Coronary Spasms. I have lost all my jobs and finally am out of bed and doing normal house hold jobs, only cause I went to a HomeoPathic doctor who stated I was infested with parisites. She was somewhat correct cause I witnessed these worm like creature in my fecus (sp) after a month on the meds. My chest pain decreased, sinus problems occured then I developed athesma(never have had any lung problems in my life). Stoped taking meds and severe chest pain is back. I just want to go back to my normal like and back to work. I don't want to be on meds the rest of my life I am only 37. I have never been sick nor did I ever go to the doctor before all of this. The medical doctors also have stated that I am having anxiety attacks. Personally they have no idea what is wrong with me. I just want the chest pain and presure to go away. Yes I have been in and out of hosiptals lots of test done. I feel so alone and feel like some people and doctors don't believe me. My prayers to all of you!! Please reply with help or advice. Ps I have no insurance!!

[NU LIFE]

I just had my 1st cardio event,I am a 45 year old male who (until 9 days ago)smoked 1.5 packs a day, drank too much, and did not exercise. My problem started at 2:27AM and woke me out of a sound sleep,terriable burning in my left jaw, shoulder, and chest.
I went to trhe hospital (after going to work !)and they found an indication of a heart attack through blood testing, (I forget what enzyme the found,the enzyme was very low (1 I was told).
I had a cath. which showed no blockages, my blood pressure is high but I have been on Lisonapril, I now take Crestor for cholesterol and I have Nitro in my pocket just in case.
I am wondering...vascular spasm?
I have my first cardio follow-up this afternoon...hope to get more info.

[JetNote]

I just read all the post on Coronary Spasms.  I had a heart event in June and they placed a stent in my Right Coronary Artery.  Been on Plavix, Lasix, Inderal and Aspirin ever since.  My stomach was cutting flips even before the heart problem but it has been unbearable lately.  Two weeks ago something new started.  In addition to the almost constant pressure feeling in my chest( blaming reflux ), I have had several episodes that feel like my heart stops beating and justs contracts like a cramp in some other muscle. I can actually feel whatever it is tighten and then relaxing. Pain....but not as severe as last time.  Short of calling it some "Alien vs Predator" birth, would any of you think I should tell my Cardiologist?  
I hesitate because I can't find any description of coronary spasm like how I describe what is happening.  I had to go to an Urgent Care last week for bronchitis and because my BP was 214/109 they made me take Nitro, did an EKG and checked my enzymes. They were fine but they called my Cardiologist anyway.  When they called to give me an appointment, I told them I was sick and stressed out when I saw how many people were there.

Reading all of your posts....I really felt your pain and confusion.  You just don't know. My first episode started with pain in my jaw that radiated into a crescendo in my chest.  Nothing like this. It was a 99% blockage. I remember the nurses after the stent telling me....That is your pain.  If you feel it again..Get help.   This is different.

Any comments appreciated.
JetNote

[JetNote]

I just read all the post on Coronary Spasms.  I had a heart event in June and they placed a stent in my Right Coronary Artery.  Been on Plavix, Lasix, Inderal and Aspirin ever since.  My stomach was cutting flips even before the heart problem but it has been unbearable lately.  Two weeks ago something new started.  In addition to the almost constant pressure feeling in my chest( blaming reflux ), I have had several episodes that feel like my heart stops beating and justs contracts like a cramp in some other muscle. I can actually feel whatever it is tighten and then relaxing. Pain....but not as severe as last time.  Short of calling it some "Alien vs Predator" birth, would any of you think I should tell my Cardiologist?  
I hesitate because I can't find any description of coronary spasm like how I describe what is happening.  I had to go to an Urgent Care last week for bronchitis and because my BP was 214/109 they made me take Nitro, did an EKG and checked my enzymes. They were fine but they called my Cardiologist anyway.  When they called to give me an appointment, I told them I was sick and stressed out when I saw how many people were there.

Reading all of your posts....I really felt your pain and confusion.  You just don't know. My first episode started with pain in my jaw that radiated into a crescendo in my chest.  Nothing like this. It was a 99% blockage. I remember the nurses after the stent telling me....That is your pain.  If you feel it again..Get help.   This is different.

Any comments appreciated.
JetNote

[JetNote]

I just read all the post on Coronary Spasms.  I had a heart event in June and they placed a stent in my Right Coronary Artery.  Been on Plavix, Lasix, Inderal and Aspirin ever since.  My stomach was cutting flips even before the heart problem but it has been unbearable lately.  Two weeks ago something new started.  In addition to the almost constant pressure feeling in my chest( blaming reflux ), I have had several episodes that feel like my heart stops beating and justs contracts like a cramp in some other muscle. I can actually feel whatever it is tighten and then relaxing. Pain....but not as severe as last time.  Short of calling it some "Alien vs Predator" birth, would any of you think I should tell my Cardiologist?  
I hesitate because I can't find any description of coronary spasm like how I describe what is happening.  I had to go to an Urgent Care last week for bronchitis and because my BP was 214/109 they made me take Nitro, did an EKG and checked my enzymes. They were fine but they called my Cardiologist anyway.  When they called to give me an appointment, I told them I was sick and stressed out when I saw how many people were there.

Reading all of your posts....I really felt your pain and confusion.  You just don't know. My first episode started with pain in my jaw that radiated into a crescendo in my chest.  Nothing like this. It was a 99% blockage. I remember the nurses after the stent telling me....That is your pain.  If you feel it again..Get help.   This is different.

Any comments appreciated.
JetNote