Prinzmetal / atypical chest pain ?

[tom3586]

Have had "atypical" chest pain for years. Recent cardio visit, exercise stress test & echo. No ischemic changes during exercise. Stress test terminated due to bp. Other results from echo include mild mitral and tricuspid regurgitation and incomplete RBBB. Treated for hypertension (metoprolol 25 mg daily). Also take isosorbide mononitrate 60 er daily and sublingual nitro (0.4 mg prn). Diagnosis was ?? with Prinzmetal "in the differential". Started these meds in July 09, was mostly pain free until Sept 09, but now having more  (same) symptoms (usually angina at night which wakes me, lasting from minutes to an hour). SL nitro sometimes works after one tab, sometimes three. Have angina occasionally in daytime, but still seems unrelated to exertion, although it sometimes occurs unpredictably. Am I getting worse or is my medication inadequate? Should I go for another check up? I'm not the type that wants to pursue invasive testing unless absolutely necessary. Any help would be greatly appreciated - at 58 I'm more than a little concerned since I have other risk factors as well (high cholesterol, overweight, high hs-crp, family history). I don't want to over react, just need some good advice. Thank you.

[kenkeith]

You can develop a tolerance for nitrate medication!  Talk to your doctor or nurse to establish effective control for your angina with the medication if possible.  Your condition does not give you any indication when angina will orccur as the angina is a result of spasms so something has to be worked out  in regard to effective treatment.

I take isosorbide for the past 5 years, 10 mg, before going to the gym 3 times a week for a workout as I know there could be an episode.  My angina is stable meaning the chest pain occurs with exertion, but yours occur without exertion (unless you had a stressful dream)apparently and that may be difficult to treat...but taking such a high dose daily of a nitrate is not going to help.