Prinzmetal's angina

[Mels22]

I am a 25 year old female with no fam history, low bp and cholesterol is 46 hdl and 55 ldl.  I have had chest pains for about 3 months now and have had EKGs, thallium stress test, echo, chest xray, ct scan...all negative.  I even had cardio blood work up in ER still negative.  I was wondering if I could have prinzmetal's angina.  I know that the tests I've had so far cannot test for that.  Lately, my pain is worse.  It is a squeezing pain under my left breast and it moves into my high chest on the left side.  It would last about a minute and then go away but return every like 10 minutes.  Today I woke up and it has hurt constantly for 3 hours now.  My cardiologist and regular MD assure me its not my heart but I've read lately that in women, heart disease is harder to diagnose, especially this kind of angina.  My questions are..
1. Could I have this with no fam history and at my age?
2. What tests can show this and should I press for more?
3. Is your blood pressure high when you are having a heart attack?
4. is aspirin good to take for this?
5.  Should I ask for calcium channel blockers?
6. Do you think this is what I have?
Lately I have been taking aspirin every day just b/c I'm scared of a heart attack.  Also I forgot to mention that I have been belching up a storm the last couple of months and can hardly eat anything without pain and burping.  I have upper endoscopy and he said gastritis...would that cause chest pain though?
Thank you!

[Cleveland Clinic]

els,

Thanks for the post.

From what you describe, I really wouldnt have any reason to believe that you have any type of cardiac etiology for your pain. Even with Prinzmetal's angina, typically we see this with people that have at least mild coronary disease. With your profile I would think this to be very unlikely. Your symptoms are also not really characteristic of this.

I wouldnt press for any more test related to cardiac etiology if the extensive workup you describe thus far has been unrevealing. I also wouldnt treat you for it empirically until I exaustively looked into other more likely causes such as musculoskeletal pain and GI disturbances.

Gastritis can definitely cause chest pain and with the documentation on edoscopy and the symptoms you describe I would focus your enegy in this direction for treatment.

I hope this helps and partially reassures you. I know it can be quite worrisome. It sounds like your doctors are on the right track, continue to keep them in the loop.

good luck

[Al Dente]

Hi Mels,

Sorry you are having a tough time.  Some of your diagnostic work that you've had done should shed some light on what's going on.  Gastritis will cause some chest discomfort, however chest pain from cardiac events and upper GI events do not feel the same in my opinion.

Prinzmetal's Angina or coronary artery spasm can happen to anyone, but if you have cardiac risk factors, you are more likely to have an event.  A coronary artery spasm will show an ST segment elevation or depression--you must capture this reading to make this diagnosis.  Otherwise, a provocative called an Ergonovine Challenge can be done in a cath lab.  I strongly recommend this be done by a major tertiary center.

Frederick Heupler, MD an invasive cardiologist at Cleveland Clinic is one of the most skilled cardiologists in the country at diagnosing coronary spasm.

It gets much more complex in diagnosing chest pain in my experience than standard echos or EKGs, and on the oppositte side, the upper GI endoscopy.  It does not sound like you have a real diagnosis.  A heart cath and uppper esophageal manometry can give the docs some concrete info.

I wish you and the forum a Happy New Year.

[ozark]

if you have gastritis, i would avoid aspirin for now.  good luck

[Mels22]

forgot to mention...several EKGs have shown inverted T-waves but my doc says that is normal...is it?

[finetilthree]

For what it's worth, I have inverted t waves too.  My cardiologist says alot of women do, something to do with the way our hearts recover from each beat.  I had a nuclear test done and I don't have any blockages, but I still  have inverted t waves.  I found a good explanation for it and I will post the link if I can find it.

[Mels22]

Thanks for the info..it helped.  I still worry but not as much.  I just don't understand the pain in my breastbone through to my back.  I guess gastritis can do taht.  I did have the pain yesterday at my regular doctor appt so he hooked up the EKG and we waited for the pain...I thought for sure it was a heart attack but he said it was exactly the same as the EKGs he did in September and October.  He said if I had artery spasms it would show ST on the EKG while in pain, is this true?  Also, are EKGs reliable?  I would appreciate any input.  Thanks for all on this site, it helps.
Happy New Year!

[dbvoicepa]

If you had the EKG during an episode the EKG would most liley have shown ST segment changes for the duration of the attack and then resolved when the pain was over.  EKG is a very reliable source of information for diagnosing all types of angina.  I would still go with the gastritis diagnosis especially with endoscopic evidence.  Avoid the aspirin. Good luck!