Coronary spasm with arrhythmia

  I had 2 cardiac caths with showed coronary spasm.  I only seem to have problems in the fall through the spring.  Last fall I frequently had chest pain.  This started sometimes at rest or with activity such as raising my arms above my head.  It also comes on with cold temperatures or exertion such as climbing the stairs.  When I have the chest pain at times my heart is very irregular.  I am a Special Care Unit Nurse Manager and have put myself on the cardiac monitor.  Last fall I was admitted to the hospital for up to 10 beat runs of v-tach which was documented on the monitor.  I frequently feel PVC.  I had no trouble all summer, but the last week I have noticed PVC's several times daily.  I seem to be in and out of bigemey.  I have also been having chest pain up to 10 times daily.  I have been on several different medications but had no relief of the chest pain. Last fall my doctor tried a different medication each month, but none seemed to help.  Any ideas? I'm sick of trying different meds.  I am not on any medication at the present time.  Thank you

[CCF Cardio MD - MTR]

Dear Suzanne, thank you for your question.  Coronary spasm is a difficult disorder to diagnose and to treat.  The catheter used to do the cardiac cath can irritate the coronary artery and can cause spasm that is iatrogenic.  Then, there are patients with true coronary spasm who never have spasm during the cath.  However, I presume that you have no evident coronary artery stenoses on your cath.  Spasm is usually treated with calcium channel blockers (Diltiazem, Norvasc, etc.) and nitrates.   If these medications haven't worked for you, I'm not sure what else would.  If you are having frequent PVC's, then a beta blocker may help but you already may have tried that.  Also, common precipitants of PVC's (alcohol, tobacco, and caffeine) should be avoided.  It sounds like your condition is quite complicated so it might help for you to get a second opinion at a tertiary medical center.  Otherwise, it's difficult for me to comment on your condition in this forum since I'm unable to make diagnoses and we are only able to give general information.  Good luck!
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