Heart Area Spasms

[Lauro]

Dear Doctor,

I thank you for answering these questions.

1.  Can a person have Angina Type attacks that just "come out of nowhere" (no exercise involved) and this not being considered
life threatening.?

I read soemwhere on this forum about "normal type spasms" posted by one of your CC physicians.

2. Does Nitro help other painful conditons that may mimic
pain like that of a heart attack.. (took one the other day
and within 30 seconds, the pain left)

3. If one had a Stress Thallium test and nothing shows up, is
the patient presumed to have Normal Heart type spasms.?
Is ending the Stress Thallium Test with a BP of 240/60 something to be concerned about.  The BP quickly went down to 130/60 right after getting off that threadmill.

4.  I see where a Stress test called Cardiolyte is mentioned on this forum with a 90% accuracy rate.  Is the Thallium Stress just as accurate?  Are these tests, the test of choice for women?
and are these the same as a Stress Echo.

I am in my late fifties.

Sorry for all these questions.  It has taken me 6 months to get into this forum.  

Thank You.  

[CCF CARDIO MD - DLB]

1. Angina (chest pain that is caused by insufficient blood flow to the heart muscle) is often provoked by exercise. However, angina can occur due to other factors, such as exposure to cold, emotional stress, eating, etc.
2. Nitro can relieve pain from the esophagus as well, due to spasm of the throat muscles.
3. With a normal thallium, angina due to heart disease is not very likely, though still possible. Your blood pressure response to exercise was a bit high, its worth keeping an eye on your blood pressure.
4. The thallium and cardiolite are very similar. The stress echo is a different technology that gets at the same clinical question. All are good in women (and men).

[Wendie]

I have a Hiatal Hernia and Gerd that I am
waiting for surgery soon....I get what they call
Esophageal Spasms , they feel like a heart attack
except they come anytime and usually at rest .....
they also treat this with nitro.....
do you have any digestive problems that could cause
the pain? I have been thru all the heart tests and all
normal,I have panic disorder also.....
This could be the type of pain you are having ....

[Lauro]

Thank You Wendi for this information.

These attacks have plaqued me now for almost 5 years, off and on.  Never with Exercise.

The last attack I had was last week walking into a Frame Shop.

This pain started seemingly in my right carotid area (first time in this area)  and quickly built up in the upper right chest area. (this is normally where it starts, the upper right Chest Area)  I quickly left the store and got to the car and took a Nitro.  From start to finish, the pain was gone in about 90 seconds. Last year, it lasted almost an hour and I drove home with this pain and laid down. This one started in the parking lot of the Mall <grin>

The jaw and teeth and ear can also get involved.  Can esophegeal disease cause these areas of pain distribution also?  This scares the jeebers out of me. This pain Cresendos.

I also had an attack  in the GP's office while talking to him 7 months ago. I had an EKG done one week prior to the pain in his office and this was Normal readings.  The EKG taken while in pain did have some very slight abnormalities but the doc said they were nothing.  

The frame shoppe did have a cold fan blowing on me and I am wondering if this had something to do with starting attacks.  Last Summer the same thing.  Car Airconditioner I believe started the attack in the Mall parking Lot.  

Hate to ask for another Stress Thallium Study? or the Cardiolyte Sress test as it has only been 15 months since the last one.  The Nuclear Doc said to come back in 3 years.

I had a Carotid Scan 3 months ago and the right side showed minimal calcification and the left side as normal. This was read by a Vascular Surgical Group.

Guess, I had better see a Gastroenterologist now.  

Thanks, Wendi.

[JENNY]

I have recently had an angiogram to make sure that the pain I was getting wasn't heart angina. I am female, in my mid thirties. I was getting pain in my chest, a crushing pain that radiated up into my throat.It was relieved by nitro medication. The pain came at any time, and was often started by being exposed to  cold air.
The pain was so bad one day that I ended up in hospital in coronary care. After that I decided to go ahead with the angiogram.
ECGs taken during pain were normal. I did not do a stress test because I have chronic fatigue.
My arteries turned out to be clear- but I am very glad that I had the angiogram. Getting the all clear has given me my life back- I was so sure that I was about to die of a heart attack that my life had ground to a halt. Life is good again and I can plan for the future again.
Good luck finding the answers to your problem!

Jenny

[concerned]

It is possible to have angina due to coronary artery spasm and still have clear arteries. It's rare but it does happen, and did happen to me. For unknown reasons, the coronary arteries can spasm and cause angina and if it's bad enough can cause a heart attack. I ended up in ICU for two days because of just that. After an angiogram that showed my arteries clear, it was concluded it was a spasm. Luckily I got the the hospital in time. Nitro will stop a spasm, and I keep that with me at all times. So if you do have angina like symptoms, use the nitro, but if it doesn't go away, get to a hospital, it could still be a heart attack. I don't mean to scare you, but just don't want you to assume that since your arteries are clear, you can't have a heart attack.

[JENNY]

Hi concerned,

My cardiologist ruled out Prinzmetal(artery spasm) angina because an ECG taken during a bout of severe pain in hospital was normal. Apparently artery spasm angina causes- I believe- higher ST waves on an ECG, whereas blocked artery angina causes depressed ST waves on an ECG. I had neither.
Did you ever have an ECG taken during pain? I am guessing you were found to have heart damage, and as your arteries are clear the only diagnosis left was artery spasm angina.

Jenny

[chris]

Thanks for your input "Concerned". I've had the same problems as the others above for the last 4 yrs. My chest pain are spasms that happen in the center of the chest usually at rest, though a few times I had them while jogging. They are always very sudden and intense under the breastbone, crushing-like, but only last seconds, like an electrical shock. I've had a high speed CAT scan that showed 0 calcium in all arteries, MRI of the chest (not the advanced MRI that takes pictures of the arteries), countless treadmills including a cardiolite with negative results, and holter monitors, all negative. I'm 34yr old male with 133 cholesterol (very low) HDL 58, LDL 62, but my homocysteine count is 11 which is high and worries me. All the cardio's (I've seen 5 or 6 not counting numerous ER visits) think I'm crazy and don't advise that I do an angiogram, but said I could try the new MRI test which is not invasive and apparently shows great pictures of the arteries. I think I'm having Coronary Artery Spasms or Prinzmetal's Angina but the dr's said the pain would last longer and not seconds like mine. I live in fear almost all the time, though I exercise and run 5 day's a week. I'm on a small dose of ZEBETA which is a beta-blocker because I also get pvc's and pat's and I have a history of panic attacks, though I think most were caused first by the chest pain or arrythmia's and I know the chest pain is not panic related because it only lasts for a few seconds and is not accompanied by other panic symptoms. I almost drove off the road last month when I had sudden chest pain in the car it was so intense, but again it didn't last. I'm posting this because I want the others to know they are not alone in their frustration. The dr's don't know what to do and I'm left with no answers, waiting until this happens again, hoping it's nothing that's going to kill me, and up to me ears in medical debt even though I have good health insurance. Maybe someone out there might have some advice. I wish you all well.

[chris]

Thanks for your input "Concerned". I've had the same problems as the others above for the last 4 yrs. My chest pain are spasms that happen in the center of the chest usually at rest, though a few times I had them while jogging. They are always very sudden and intense under the breastbone, crushing-like, but only last seconds, like an electrical shock. I've had a high speed CAT scan that showed 0 calcium in all arteries, MRI of the chest (not the advanced MRI that takes pictures of the arteries), countless treadmills including a cardiolite with negative results, and holter monitors, all negative. I'm 34yr old male with 133 cholesterol (very low) HDL 58, LDL 62, but my homocysteine count is 11 which is high and worries me. All the cardio's (I've seen 5 or 6 not counting numerous ER visits) think I'm crazy and don't advise that I do an angiogram, but said I could try the new MRI test which is not invasive and apparently shows great pictures of the arteries. I think I'm having Coronary Artery Spasms or Prinzmetal's Angina but the dr's said the pain would last longer and not seconds like mine. I live in fear almost all the time, though I exercise and run 5 day's a week. I'm on a small dose of ZEBETA which is a beta-blocker because I also get pvc's and pat's and I have a history of panic attacks, though I think most were caused first by the chest pain or arrythmia's and I know the chest pain is not panic related because it only lasts for a few seconds and is not accompanied by other panic symptoms. I almost drove off the road last month when I had sudden chest pain in the car it was so intense, but again it didn't last. I'm posting this because I want the others to know they are not alone in their frustration. The dr's don't know what to do and I'm left with no answers, waiting until this happens again, hoping it's nothing that's going to kill me, and up to me ears in medical debt even though I have good health insurance. Maybe someone out there might have some advice. I wish you all well.

[Christine]

Just wanted to add my experience to the list...  I have sharp intense chest pain, once it woke me up when I was asleep.  The duration is seconds only.  Also, I have lots of PVCs.  Cardiologist can't find anything wrong with my heart.  Interestingly enough, I only have these pains while resting AND just before I begin to menstruate.  I don't have these pains any other time.  I worry that I have angina, heart condition, etc...  Doctors say I don't.  <<<SIGH>>>>  I guess we have to live with this....

Christine

[concerned]

Yes, I did have an ECG during my attack, and all I know about the results were that I did indeed have a heart attack, and that was confirmed with an enzyme test. Heart damage was minimal, I had gotten to the hospital in time and it was called a very minor heart attack. Surprisingly, I never did have any chest pain, only pain in my right arm and was so faint I couldn't stand up. I knew something was wrong. That was a year and a half ago, but I'm doing well now. I do get pain in my heart area occasionally, but very quick pain, and my cardiologist also says it's nothing to be concerned about. I also get PVC's sometimes, but again, they're okay. I did find out that the spasms are more likely to happen in people who also have migraines which I get. It's the same mechanism, just different places. I can tell both are hormone related, only happening at that time of the month. If anyone wants to e-mail me, I'm at ***@****

[Lauro]

I posted a response this morning to Thank the doctor and everyone for their replies.  This message never appeared.

I am curious about the NEW MRI that does show the Heart Arteries.  Is this widely accepted now and how relaible is it.

Does anyone know.  I wish everyone a very long and happy life.  Thanks again.

[Xtian]

Macy,

The new MRI is VERY reliable and available in most major cities. I live in the Los Angeles area and my Cardio has done alot of these, especially with people who don't want the more invasive angiogram. He tells me he gets beautiful pictures of the arteries and can detect calcified plaque and soft plaque. However, this is not yet covered by health insurance and costs around $1000.00. But for piece of mind I'm considering it over the angiogram because I'm young and don't like the idea of invasive surgery if there is something else just as reliable. Many patients don't really know about the new MRI technique. I'm sure it's also available at the cleveland clinic.

Best,

Chris

[Lauro]

Thanks, Chris..

My cousin is a Cardiologist in the L.A. Area but
I do not discuss health with any of them.

Try to keep health problems from family, until..

I live in Houston and have talked with a Cardiologist
Office yesterday.  

The doctor is out of town but will return on Tuesday, of which
his nurse said, she knows he will want to see me.

I do not have to get permission for MRI's from my Insurance company but, if this is not FDA approved for usage of the heart and arteries, then they may squak.

I would much prefer this to an angiogram. I also saw advertised in our newspaper, The Heart Scan Place.  Wonder what this is.
They also indicated that they can scan one's lung at the same time.

Thanks, Chris...I will keep you posted and pls. do the same.

[dah]

I wanted to comment about the kind of chest pain Chris has experienced (plus some of the others who posted replies); I too have wierd chest pains - almost all episodes last only a few seconds!  I am in my early 40's; the pains usually don't happen when excercizing, just when I'm sitting around.  Some are very intense, but I am really just talking about a few short seconds.  Sometimes I get an extra beat with the pain, so that always makes me worry.  I keep complaining to my docs about this and of course they have no answers.  I do take 25 mg of Atenolol and it helps with the extra beats.

I have chronic arrythmias: PVCs, PACs, PATs, and occasional SVT.  I've had the King of Hearts monitor plus a bunch of other tests and the docs tell me there's nothing wrong.  It's comforting to hear that I am not alone with this nightmare.  We have to get on with life and that's hard to do with these nasty symptoms.  I keep telling myself that we're all going to die someday so we might as well enjoy life while we can.  I sympathize with all of you and wish you well.

[stevebu]

It is amazing how SVT, PAC's, PVC's were controlling my life for more years than I care to remember.  After having the RF ablation for SVT, I decided to go for broke.  I started running 6 months ago, now over 30 miles per week.  I am still alive and no longer care about the PAC's and PVC's, and few seconds of atrial fib I sometimes get.  With excercise all my other symptoms now seem to be less and less.  I will no longer let my heart worry me.  It's going to do what it is going to do:)

[patrica]

I loved your e-mail. I wish I could live like that as well.  I have let these horrible things control me for 10 years and I question sometimes how I am still alive with them.  I am too scared to do anything "just in case" I trigger them.  Not much of a quality of life (especially when you have two small children to worry about).  I am really going to take your message to heart (no pun intended).

[stevebu]

Thanks for your message.  The thing with me was I had all the tests EKG, stress test with dye, echo, and all showed a normal heart.  If they have missed something I can't worry about it anymore.  I have accepted that I will have PAC's and PVC's.  Some days I have had hundreds, and some days almost none. I think now my average is a dozen.  As I have increased my running I think they have become less and less.  Since I could have something done about the SVT I had the RF ablation.  I will just assume it was successful unless I have a fast heart rate again.  It feels so good being off the meds for the SVT.  I am not going to take them for the PAC's and PVC's.  Thanks.

[CLM]

I, too, suffer from pvcs, pacs and psvts and I detect a pattern with folks who are successfully living with these nasty things:  First, trememdous fear and confusion when they begin or when they intensify for the first time.  Second, tons of testing and the anxiety that accompanies that process.  Third, attempts to control them:  with diet, with mind games, therapies, or drugs.  Fourth, resignation and moving on.  I am finally to stage four.  I have accepted them as an ongoing part of my life and I no longer mourn the fact that they will never ever leave.  I have decided to take a low dose beta blocker so that I'm at least "doing something."  But my greatest accomplishment is in simply living my life despite them -- especially I am proud of those times when I do something even though they are really bad or when I keep the fear in check.  I'm like Ted, they vary but are nearly every day to some extent.  I have also chosen to begin exercizing and getting really fit.  In my case they don't seem to be letting up as a result, BUT as I get physically stronger, I just feel healthier and mentally stronger.  I recommend it to all fellow pvc/pac/svt sufferers who have been cleared to do so.  It just makes sense to get strong when you have been so beaten down by these things for so long.  If you get them while exercizing, just grit your teeth and reject them:  don't let them get you down ANY MORE!  Best of luck to all (we will probably live longer, healthier lives than many folks without these because we are "scared straight" by them!)  May you find peace with these things.

[Lauro]

Hello Chris, Ted and friends,

I am also "scard straight" and am now walking 2 miles per day.

It is very hot here so I am walking up my long driveway back and forth 7 times  = 2 miles.  Water jugs along the path.

I have cut out most of the fat and have quit drinking all soft drinks.  I noticed how high the calories and sugars is on colas.

I am trying to also do stress management and trying to keep my mind off these heart quirks and Angina? pains. I am aiming at getting my LDL down and my HDL up with hopefully diet and exercise.

I broke down and called the Texas Heart Institue and made an appointment to see someone in 3 weeks.  I want to have someone there just in case....

This took for "me" a lot of guts as I am petrified of doctors. But, as one of the posters stated, "we need peace of mind" and my mind has not been at peace lately.  

I saw Chris post "scard straight" and I am heeding this.

Wishing everyone "heart healthy body and minds"

[From James To Becca and Mary]

be

[ellie]

I started experiencing the short sharp chest pains when I was 16. When the doctor told me it was muscle spasms, I thought shucks nothing to worry about. I too just learned to "live with it". Then in my early 40's I experienced a heavy feeling in my chest. I had a doctor who was lucky enough to be watching the test as my blood flow to the heart shut down. They put me in cardiac care immediately and starting a nitro drip. I stabilized in 3 days. I had a cardiac cath and it showed no blockages. Diagnosis was Vasospasms. I was put on Cardizem CD and told to carry Nitro with me at all times. Twelve years have went by with no symptoms. Now suddenly I am having problems again. Stress test last week showed inverted T-Waves. Now I am suffering the pressure in the chest again.  See doc again this afternoon.  Don't be fooled people.  This can kill you. It is very hard to diagnose because the spasms don't happen on command. I am lucky in that I don't have any blockage yet.  However my stress tests that I do every 3 years keep showing little areas of ischemia caused by spasms I was not even aware of.  Good luck to you all. If you need someone to talk to email me at ***@****. If a doctor thinks you are crazy fire that doctor and find one to take you serious.  It may save your life.  For more on vasospasms check out the following sites.

http://medhlp.netusa/glossary/new/GLS_4357.HTM
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/cas.html

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