Coronary Spasm Experience

[BillK3]

I am a 51 year-old male with low risk factors for heart disease.  3 weeks ago I got severe chest pain that went down my left arm.  On the way to the hospital, I was adminstered Nitro 3x in 5 minute intervals.  The chest pain stopped.

At the hospital, my first run on blood tests showed nothing.  The second test 3 hours later showed an elevation in that blood protein (I forget what it is...) that indicates probably heart attack.  This indicatation was very low, apparently just over the threshold for the docs to consider a heart attack.  I chose cardiac catherization and that was negative - 100% clear re: arterial passageways and heart function.  I was put on 2.5 mg Norvasc and once I adjusted to the med (tireness/coldness)I am fine - back at work and feeling well.

I had an Echo last week and the tech indicated that off-the-record, my heart does not show any indication of tissue damage/previous heart attack.  Colesterol has never been a problem for me.

I had an experience similar to this maybe 5-6 years ago after exhaustive swimming, but I "toughed-it-out" for 10 minutes and it was gone.  

Here are my quesitons:
- What is the probable cause of this?  Is it Prinzmetal?
- My last episode was in August-same week.  It's the same month that I begin to suffer from allergies every year.  Does this factor in?
- What can I do to avoid a recurrance?
- Do patients with these symptoms typically carry Nitro all the time - for the rest of their lives to manage spasms?

[Cleveland Clinic]

Bill,

Im assuming that probably your troponin (protein related to heart damage) may have been elevated, and that is why they thought you had a heart attack. However, there are other blood proteins such as myoglobin that are nonspecific for heart damage and may be elevated from other causes.  Without knowing which one, its impossible to say for sure.  We do see positive troponins with other conditions such as myocarditis or pulmonary embolism.  We have seen it some other times with normal arteries and no pure explanation.

Prinzmetal can cause this, but often its more likely seen in younger women, and spasm is usually associated with at least mild coronary disease. Empiric treatment with calcium channel blockers carry little risk so this is why it was probably done with you.

Allergies should have no effect with relation to cardiac causes of chest pain. They can trigger asthma which can sometimes present as chest pain.

What can I do to avoid a recurrance?

Live a healthy lifestyle, exercise and eat the right foods. Im still not 100% sure what the episode was though.

- Do patients with these symptoms typically carry Nitro all the time - for the rest of their lives to manage spasms?

There is little downside to carrying the nitro. I usually try to be 100% convinced that angina is causing the symptoms before prescribing a chronic medication.

good luck

[BillK3]

Thanks for your perspective Al.

I have my first visit with my Cardiologist since I was hospitalized later this week.  I hope to find out more about these symptoms in that visit.

While there might not any correlation between my episodes and my allergies, it's interesting that:
- Both of my episodes occured in the same week in August - about 5 years apart.
- August is the only month of the year that I have allergy problems.
- Research is showing promise for using a antihistime to treat coronary spasms.

Seems too coincidental to immediately dismiss.

On the practical front, do you (or other readers) keep Nitro in those little med containers on your keychain or necklace?  If so, does the Nitro need to be replaced every month or so?

[wildcat27]

Al...I have a question about these spasms since you have posted about them a couple of times recently.

I have had a myriad of tests done...all have come back negative. EKG, Stress, Echo, Stress Echo, blood work...the whole nine. I had PVCs pretty regularly back in Feb for a couple of weeks...then they went away. Then out of nowhere went into A-Fib for 11 hours in July. They cardioverted me and fine since, except for some PVCs again for a while in late July.

Now I feel a pretty constant ache in my left shoulder blade area, in my chest under my heart and in different places, and sometimes in my arm. Also, yesterday afternoon I came back from a run and was lying down next to my wife and she said, "hey is your heart palpatating"...it wasn't, but on the surface of my chest it looked like it was spasming very slightly. My heart felt fine and my pulse was normal.

I have a feeling that my chest and back ache is muscular since I am constantly holding my one year son on that side...but it scares me because the ache is localized...any thoughts...thanks Al.

[wildcat27]

Al...thanks for the feedback. I saw an EP about three weeks ago and he checked out all of my studies over the past 6 months and said the same thing all the other doctors did...I am fine...stay on the cardizem and keep them posted. I asked the EP if I should have an EP study and he said that he saw "zero" reason for me to have that done right now.

The aches I am having are pretty constant...so I do think it is my chest muscles/back muscles. Also, exercise doesn't seem to bother the symptoms at all. I don't know...I will call my doc and see what they think.

I think if these were heart pains they'd be sharper and come and go...thoughts?

[BillK3]

Al,
Check out the occurance of "cyproheptadine" (anti-histamine) and "Prinzmetal" on the 'net.  Interesting stuff.  Maybe there's no correlation between the efficacy of anti-hist treatment of Prinmetal and my allergies - it just seems curious I guess.

Thanks for the Nitro info.

[anacyde]

Did they re-check your Troponin level or was it only done once?  I had an elevated Troponin level a couple years ago after going to the ER with chest pain and palpitations while I was pregnant, but all of my other tests were normal...so they re-checked it in the morning.  It turns out there was no elevation.  I was told that as many as 1 in 20 can come back falsely elevated, so if everything else checks out normal, they often try to re-check the level within a short time period (since a true elevation will stay up for a while, it won't drop to normal overnight).

Sorry to hear you had to go through all of that, but I'm glad all your tests otherwise came back normal.

[BillK3]

anacyde:
I will check with my Cardiologist later this week to see if subsequent levels were elevated or not.  Thanks for the heads-up on this point.

[BillK3]

Thank you for your response.
"Im assuming that probably your troponin (protein related to heart damage) may have been elevated, and that is why they thought you had a heart attack."

Exactly - troponin is the protein that was elevated.  That elevation was the primary reason why the Docs recommended the cath, and I was told that I most likely had a heart attack.

So from what you say, I might be in a very small group that present chest/arm pain (sweating, shallow breathing, and elevated blood pressure), respond to Nitro, have elevated troponins sufficient to make an initial "heart attack" diagnosis, but since the cath and Echo are fine, the bottom line that that this was a probably transient occurance with no heart attack.  Is that right?

My personal GP Doc suspects that my troponins were a false positive, and that if there was anything significant going on here, it would have been detected by the cath and/or Echo.

I still have my Cardiologist visit later this week.  I really look forward to that appointment!!

[BillK3]

Visited with my Cardiologist today.  I learned that:

- My troponin levels were checked a number of times during my hospital stay.  The levels rose slightly and then trailed off in a characteristic manner.  However, the device used to measure troponins at that hospital was found to be faulty a few days after my hospital stay, which put measurements just prior to that date somewhat in question.  Many patients were affected by this faulty troponin measurment device according to my Doc.

- The Doc indicated today that:
  - My event was most probably a vasospasm.
  - The rash on my neck and back (just found this yesterday) is likely to be an allergic reaction to Norvasc, and she prescribed Diltiazem.  My GP looked at the rash in a separate appt later in the day and agreed with this determination.
  - All diagnostics since the elevated troponin test have been negative (cath, Echo, ECG's), so she doubts that a "heart attack" occured.
  - I need to keep Nitro handy if needed.

Just thought I'd report back.  Pretty good news IMO, considering some of the alternatives!

[suzzie1]

Hi Bill, Im delighted for you that your tests came back clear. Great news :)  Just wondering, what strength Diltiazem you are taking as I also take that medication, 90mg twice daily !!!

[BillK3]

I will taking Diltiazem 120mg, once daily starting tomorrow.

According to my Cardiologist and Pharmacist, I am not likely to feel any new side affects when I switch over, as the side affects I felt when I started Norvasc 3 weeks ago (feeling cold and tired at points during the day) where reportedly related to moving to "a blood pressure medicine".

I hope that my posting here might help others that get a rash or reaction to a BP med.

Thanks to everyone so far for a great dialog on my situation.

[BBPro]

Hi All,

I've only just discovered this site and am hoping this is the correct forum to be asking this.

Brief history.
I was first diagnosed with Coronary Artery Spasm about 4 years ago at age 25. This was a huge shock as I was and still am a very healthy active young man. I was initially treated with Verapamil, Amlodopine and Norvasc in rather large dosages.  All was good for a year, then the episodes returned - hospital again. After a period of 2 years with no symptoms, I had another major attack a couple of months ago. Treponin levels steadily increased over the next 3 days and lifted to around 54 (normal <.05) This was the biggest and longest episode I have had lasting a couple of days in extreme pain. My meds are now Adalat Oros 60mg, Verapamil 240mg and Imdur 60mg(reduced from 120mg due to massive headaches). Angiogram shows normal, Cardiogram shows absolutely no damage, cholesterol is normal.

The pain I feel when these spasms occur, even with the nitro spray, is a extreme weight almost like a crushing sensation in the centre of my chest that cannot be relieved by morphine. To treat this, the doctors have now confirmed that the only way to relieve the pain and stop the spasm is to have IV Verapamil administered by the Registrar or my Cardiologist.

My question is that in the past few days I have been experiencing a type of sensation that I can only describe as a 'Warm Rush', much like when you have the dye injected while having a angiogram. This is coupled with a shortness, more like a skiped breath and a rise in heart rate -lasting for only a couple of seconds at a time. This happens irregularly from 5 minutes to 1hr between sensations and has now almost ceased.
My cardiologist is currently o/seas and I am waiting on a call from another specialist to discuss.
In no way is this anything like I have felt prior to having spasms confirmed and there is no pain invlovled.

If anyone can share their experince of similar description, I would very much appreciate it - even if only to cure my curiosity.
Many kind rgds,
Michael

[suzzie1]

Hi bbpro,  I can understand everything you have described. I too experience the crushing/pressure pain in my chest usually,(but not always) in my case,brought on by exercise. I am 46 years old and have had to deal with this since I was a teenager. I find it comes in ''episodes'' which can last days or weeks, then eases off for some weeks, months or (when I was younger) years, and I (used to think) that it had gone,and I would hopefully never experience it again, but over the last few years I reasised it was NEVER going away. I think I may also experience what you described as a ''warm rush'', but I mostly get it when falling asleep. I wake up with the sensation you describe and 'gasping' for a breath and as though my heart had stopped and is kicking in again.(Im not sure if iv described it properly...its difficult to put some of these sensations into words). I find that also comes and goes, and when I have it 'bad' I actually dread going asleep. I know it happens at other times as well but not as severly as when I am asleep/falling asleep.   HAS ANYONE ELSE EXPERIENCED THIS.

Best of luck bbpro, I truly hope you get some answers and results.

[BBPro]

Hi Suzzie,
Thanks for your comments. My 'sensation' over the past few days have been interesting in the fact that it is a new experience. I mean this in a way that it is something I have not recognised before. I too have 'episodes' of pain that have lasted up to 4 days in duration, with sporadic bouts of extreme discomfort followed by calm and relaxation and then fear of the next one. I have had all of my episodes either at work in a meeting or in bed. My worst and most excrutiating pain occured whilst lying in hospital hooked up to IV lines of all my meds. I find this almost funny in the fact that I am an extremely active guy who has been stressed tested and also on occasions, enduranced tested to the point of making me physically sick (this was not part of my spasm testing)
I find that in the past few years that I have a hightened awareness of the 'sensations' that i feel within my body, especially my chest area and these are nothing that i have felt before. I guess that i am a little concerned but a lot more curious as to what is causing this. Hopefully after talking with the specialist tomorrow morning I will know more
Thanks for your input, it is nice to know i'm not alone.
Rgds
Michael

[Rosa49]

I am a 49 year old female.  I was born with a heart murmur, which never went away.  This murmur never affected me when I was younger, I played all sports and it never bothered me.  When I got to the age of 40 I started having problems with my blood pressure being high.  I was put on blood pressure pills, which made my asthema worse. I went through 2 years getting pills regulated to keep my blood pressure down.  I was finally put on 160/12.5 Diovan in the morning and 5/10 lotrel in the evening, and one baby aspirin a day, which was keeping my blood pressure down.  Then about 12 years ago I started having PSVT, having to go to the ER and getting the medicine put in my veins to slow it down, the beats per minute ranges from 200 to 250.  It is getting more frequent, to about 6 times a year now.   My doctor added a .25 Toprol XL in the morning and  .25 Toprol in the evening and that was keeping the tachycardia from happening.  I would feel the flip flop that happens right before it starts the fast heart beat, but it would stop it from happening.  I have been diagnosed with depression, also. Then last Thursday morning I got up to get ready for work, and was sitting in a chair and I got a very bad pain in my chest which I felt all the way through to my back, and then it radiated down my left arm, it was a burning kinda pain.  It only lasted about 5 minutes.  I took the day off of work, but kept feeling exhausted and eeky.  Monday I went to work, and was on my way to do some in home trainings, when I had 3 sharp pains, so I drove back to the hospital.  When they were putting in the IV, the machine went off, and I told the nurse, my heart just went off.  She looked at he machine and said yes, you are in PSVT.  They ran in some medicine to slow my heart rate.  Then they released me to go home, and told me to go to my regular Doctor in 3 to 4 days.  I made an appointment on Tuesday and my doctor ran an ECG which showed up abnormal, ST depression.  He put me on .02 mg of nitro patches until I can see the Cardiologist. He set me up an appointment with the cardiologist for tomorrow.  I hope they can figure out what is causing this.  My episodes usually happen when I am at rest.  Sometimes they wake me up happening.  But whatever it is causing them it is getting worse and more often.  I had one ER Doctor tell me when I felt the flip flop, my heart was actually skipping a beat and what I felt was an extra hard beat because of the skipped beat.  I had testing done about 5 years ago and he told me I did have some regurgitation, but he said most people my age had a leaky valve (Which I do not tend to believe) but he was a Cardiologist.  If anyone else have the same symtoms I would appreciate the insight.
Thanks, and good luck to all of you... :o)

[suzzie1]

Hi, I think you should probably get an echo done to re-evaluate the murmur you were born with. From what Iv read its seems that problems with heart valves (murmur) get worse with age, so I think if I were you the 1st thing I would do is get the echo done. Best of Luck. 8)

[LEarnest]

Hi, bbpro.  I'm curious to know if you have found out yet the cause of your 'warm rush' sensation accompanied by skipped breath.  My daughter, who is 21 and in good health as far as we know, recently had a very similar experience.  Sitting with family playing a quiet game of cards, waiting for someone to deal, when suddenly she felt her heart give a huge beat, and what felt like a surge of blood up to her face.  Accompanied by the feeling that her heart and breathing stopped for a second, and sort of a haze over her vision.  The others at the table with her reported that a strange look came over her face and that it turned tomato red during this brief episode.  It passed in seconds and she felt fine.  About a week later, she experienced a repeat of the sensation, this time while sleeping.  She has an appointment with her family practice Dr. tomorrow, but I expect they will be more mystified than enlightening.  So, wondering if you feel you've found the cause of your similar experiences.  Thanks!