Diffuse Coronary Spasm

[bryan56]

Hello and thanks in advance for this forum,
Two years ago I had a heart attack and since then I have had nothing but problems. I have since been tested for all sorts of problems (gerd and esophgeal spasm) , but two months ago I was found to have Coronary Spasms where my entire Coronary system spasms shut at one time. I have been on all kinds of medicines since my heart attack and I now take Imdur, Diltiazem, Arginine, Potassium, Folic Acid, Magnesium, Aspirin. I have taken Nifedipine, Atenolol, Verapamil and a host of other drugs to try and ease the chest pain I get when this happens. I am still having to take Nitro daily to help manage the pain. The Doctors tell me that my body isn't responding to the medications in the proper way and that the ones that should help keep it open aren't working. I am being seen at a teaching university medical center and they tell me that what I have is kind of unheard of. My questions are have you ever heard of this? If you have do you know what they did to help the person? Did the heart attack cause this? I am having an EP study done this week as they also think I have an arrythmia problem. Any help with medicine or combo of medicines would be appreciated. They also told me this last week that I may have to have surgery to remove my heart and reinstall it to kill all of the nerve endings which they think may help with the pain, they said they haven't used this surgery in about 10 years but said it might help to get rid of the chronic pain. I am 46 and was never sick before this. Thanks

[CCF-M.D.-KE]

Dear Bryan56,

Coronary Spasm occurs when the smooth muscle in the wall of the coronary artery contracts and narrows the lumen of the artery. This can occur and result in a heart attack. Heart attacks don't cause spasm. Usually the site of spasm has some underlying atherosclerosis or hardening of the artery.

The best treatments are calcium channel blockers, nitrates and probably folic acid. If spasm is definintely what you have, I would recommend  seeing how you respond off of beta blockers(atenolol).

Occassionally people may have a coronary stent placed at the site of spasm, but the spasm may recur in a different location from the stented area. Therefore, stenting is typically not recommended.

Thanks for your question,


CCF-MD-KE

[itsa4847]

HI,
i also have cornary artery spasms iam 43 female.  I have never had a heart attack, but in jan had eposide at work where it all started when in the ambulance had the heart cath etc etc.  that is when they found it they ran the test three times.  
since then i have been on toperal for heart paps which i was on prior.  and then added was nitro in the form on imdur and iam on cardizm.  my last vist he added a nitro patch cause i was having still at least once a week having to use my nitro spray and trying to avoide the er.  cause then they would have to give me morphine.  and its like magic.  i take my imdur in the am 140mgs and then i put on the patch at 11:30am and that takes over.  did they say how much your arterys close?  mine close to 50%  not enough to cause a heart attack but enough to cause the pain and pressure and shorteness of breath, he did this aug 3 and i have had only one minor attack and had to use my spray.  i do have some blockage in the artery's that close up but it is only 20% and 30%  so i don't need a stent.  Ask your dr.  my problem was they couldn't keep enough nitro in my system.

good luck to you  and my cardiologist told me this is a rare condition and that it would be the biggest pain in the butt i have ever had to deal with, cause you never know when or what triggers it!

it took them 8 months to get me under control, but i feel like we finally are there.

What you talked about seems kind of aggressive, I would get a second advise.

also i noticed that when  he took me off the toperal my paps when pretty much away and my eposides of been reduced.  
hope this helps

[bryan56]

Thanks for the comment itsa, I too have been told that we are sort of rare. My arteries close about 80 to 85 percent when I go into spasm, which seems like everyday. I take the same med's as you do except I take Imdur twice a day. I use Nitro under the tongue almost daily and as many as 12 a day, but on average of 6 a day. I am being seen at Stanford University and they say they will eventually have me back to normal....I hope so. You can reach me by email at ***@****. Thanks again for the comment.

Bryan

[joannar]

I to have just been diagnosed with Coronary Artery Spasms (Prinzmetal's Angina) I have not had a heart attack. Although I have had a few episodes that seemed like it. For years I have seen cardiologists who always said that I had nothing wrong. It appears that my heart is in good shape and I don't have high colesteral or any other risk factor for heart disease.

I believe that the most recent bout of Spasms was brought on by my being on Lupron which shut my natural hormones down to nothing and I started having the Angina with in 4 or 5 weeks of my first shot. I got progressively worse over 4 months to where I could do almost nothing without breaking into a cold sweat and getting nasea, chest pain, left arm pain, jaw pain, rapid heart beat, dificulty breathing, and dizziness. After having a cyst removed on my left ovary, I couldn't hardly breathe and after I was put through 4 days of testing was finally given an angiogram where it was discovered that I had spasms.

I have been given Norvasc 5mg up to three times per day and sub-lingual nitro when I need a little more boost. This takes care of the resting angina but I still have episodes if I exert myself or if I don't get my meds right on time, and some days are just worse than others. I have not yet gotten back to my normal hormonal production and I don't take any HRT.

My cardiologist said that it is very likely that hormones do play a big part in this, that is very "rare", and that he may have to give me "very high doses of calcium chanel blockers" (which I want to avoid). The Norvasc alone causes my feet to swell badly if I take 3 5mg pills per day. I have been able to get by with 2 most days if I take a good Magnesium supplement. He had me try to add 240mg pr day of Tiazac (diltiazem) wich at first seemed to help, but by the 4th day I was much worse (with almost constant angina in spite of all the meds) and had to discontinue it's use.

I am hoping to find some natural hormonal therapy that I can get both my cardiologist and my OBGYN to agree to let me try (Natual Progesterone Cream). The studies that I have seen say it is also good for men, in a different formulation. But I need to wait at least untill my own hormones get back into their natural cycle.

I would like to be kept informed as to what treatment is working for both of you and how you are doing.

I have one question. That is, does any one know the effect that prolonged angina can have on the heart? Should I try to completely eliminate the angina or is it safe to tolerate mild angina for long periods of time? Thank you. Joanna

[bryan56]

Heyya joannar,

Thanks for the comment. It looks as if there is a new member to the club. Sorry to hear about your demise, but at least you have good news in that your heart is OK and working properly.

I am like everyone else in that I really don't have a clue as to what causes our bodies to do this. As I posted I have been going through this for a little over 2 years now and to be honest there hasn't been a big combination of drugs that have worked for me. I was just back in the ER Sunday night/ Monday morning to get another Nitro IV that seems to keep my veins open for about a two weeks before I have to start taking Nitro under the tongue again. I now take Imdur and Diltiazem which seems to be fairly normal for the people with this condition. I took Norvasc and had no results at all with it along with every other mecicine that there is for hearts and as of yet they haven't hit the right combination. I do take L-Arginine that you may want to talk to your Cardiologist about. It is supposed to help keep your arteries open and you buy it at the Vitamin store. Do a search for it on the net and you can find more info.

According to all of the data I have read, if you continue to have spasm's for a long period of time, you could end up having a heart attack. I really don't know what a long period of time is but I haven't had another heart attack yet in 2 years so I guess it would have to be worse than what I have been. I have been admitted into the hospital more times than I can remember in 2 years and that's not counting the ER trips where they send you home without admitting you.

The best advice I can give you is to keep your spirits up and hang in there. I am positive that help is just right around the corner and all we have to do is find the corner...hehehe

Feel free to email me (my email is posted right above your post)and stay in touch and we will trade Doctor's secrets..hahaha

Bryan

[Mario38]

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