Reaction to adenosine? and a couple more q's

[tanns]

I had a stress MRI where I was injected with adenosine.  The nurse said I would feel midly flushed.  I had a complete seizing feeling after the first 45 seconds or so.  It felt like my stomach was caving in on me, my chest was tight and my head felt like it was in a vice.  I had a hard time breathing and was like this the entire time until a few minutes after the injection stopped. My heart has been "jumpy" since this time, often doing a weird quick squeeze-release thing.  

1.  Could I have had some type of reaction to the adenosine?  Have you heard of this happening before?  

I have seen so much info on heart disease and differing symptoms between men and women.  All my symptoms are there.  One of the most frequent (but not only) being unexplained heartburn,  gastro tests neg and tums and such don't relieve it.  It stays as long as it wants and eventually goes away.  Journalling has not put a cause to the symptom.  

2.  If my tests (EKG, Echo, Nuc. Stress, CT-A, Stress MRI, holter, event recorder) are negative, would you say this is purely coincidence?

I am 35F, family history of heart disease, diab. and HBP (at this time I don't have any of those).  I don't have a stressful job or home life.  Just concerned about out of the blue symptoms (left sided chest discomfort/weirdness)  that have increased over the past year.

[Forum-M.D.-MM]

Hello Tanns,

Your concerns are surprisingly common.

1. Could I have had some type of reaction to the adenosine? Have you heard of this happening before? I have seen so much info on heart disease and differing symptoms between men and women.

I tell people before they receive adenosine that they are going to feel like ****. A close friend of mine had VT at a young age and told me that when I give patients adenosine to make sure they know they feel like they are going to die but that they won't.  It impressed upon me that a minority of peole that receive adenosine have significant symptoms, while the majority feel a brief flushing.  Adenosine should cause no long term problems though.  It is incredibly quickly metabolized and is in  your heart as we speak as a native hormone/chemical that your body makes.

2. If my tests (EKG, Echo, Nuc. Stress, CT-A, Stress MRI, holter, event recorder) are negative, would you say this is purely coincidence?

I would say that in a 35 year old woman with the symptoms you describe, the tests are almost certainly correct.  Coronary disease in women presents atypically -- this is true -- usually MUCH later in life.  In the office we usually consider symptoms that you describe related to anxiety.  I am sure there is a biochemical reason for the symptoms but we just don't know what that is yet.  In general though, we see a lot of young women specifically with this atypical chest pain syndrome and no coronary disease.  As a whole, this group is very difficult to convince that they are OK.  Try not to fall into this trap because it can consume your life.

I hope this helps.  Thanks for posting.

[LukeL]

When I was having a panic attack (just normal sinus tach) the ER doc order two doses of adenosine over a brief period of time (about 2-5 minutes) right when the nurse pushed the med it felt like someone was reaching into my chest and squeezing my heart with all their might.

Because of this I no longer fear general chest pain as I now know what a deep seated cardiac pain feels like. But the odd thing is both the nurse and the doctor said I should not feel any severe symtpoms at all.

[CollegeGirl143]

ive had rapid pushes of adenosine on more than one occasion, and its terrifying... It feels absolutely horrible, and ive never met a person whos recieved in a rapid push not agree wholeheartedly.. you arent alone in your distaste for it :)

[tanns]

Thank you for responding.  I was in such a weird state afterwards and when I couldn't find any info about the same kind of reaction I was thinking maybe they gave me too much or my body rejected it or something.  Hopefully my pictures will be clear enough because I am certainly not going to repeat that test!!  

Thanks for helping to put my mind (and heart) at ease!!

[Carolina03]

Hi,

I would ask your cardiologist if your coronary flow reserve was normal. As long as it is, and all your other tests were normal, then you can put this behind you but continue managing your risks given your family history.

When you hear all the press about women presenting with different signs and symptoms of heart disease, it sometimes pertains to women like me with microvascular disease.

I have mild diabetes and changes in the smaller arterioles in my heart that create chest pain. My cardio discovered it via adenosine that recreated the chest pain AND revealed a coronary flow "deficit."

They attributed the reduction of blood flow to endothelial dysfunction born out of microvascular disease that couldn't be seen via normal diagnostics such as an angiogram.

Best,
C

[tanns]

Was the it diagnosed with the stress-MRI??  I have been curious about microvascular spasms and microvascular disease for awhile.  I don't know the flow reserve question yet.  I see the cardiologist next month.  I had the test done at the Mayo Clinic in Jacksonville and saw an internal medicine doc right after.  The test had been read and reported by a cardiologist but he didn't want to go through the results with me because he isn't a cardiologist and may not be able to answer any questions I might have.  He did, however, tell me that he felt comfortable letting me go because there wasn't anything serious on the report.

Do you still have chest pain?

[kucycoo]

I've had svt for 21 years now, so I have had plenty of visits to the E.R.  I have been given adenosine a few times, and I must say, I dread it almost as bad as the svt itself.  It gives me a feeling like no other....I can't breathe, my head gets a full feeling, and I feel like I could die at any moment.  It always does the trick though, and my reactions last only a few seconds.  Thank goodness my episodes are few and far between!

Just thought I would share.

[aloni]

A related discussion, adenosine reaction was started.