Small vessel disease induced chest pain?

[Samsgirl]

I am a 51 year old female with a two year history of chest pain,my Echos have shown EF > 65%,trace mitral regurg,mild tricuspid regurg,LV diastolic dysfunction, EKGs show sinus brady,non specific ST and T wave abnormality and left axis deviation. Increase in the frequency of the chest pain in January .He ordered Nitro tabs in January and they did relieve the pain. I had a Cardiac Cath 1/29/07 which showed no coronary artery disease. The origin of my Circumflex artery is from the right coronary artery.I continue to have chest pain most afternoons or evenings which is relieved by 1 or 2 nitro tabs. He is talking about it being microvascular disease and is considering use of a Beta Blocker type med. 20/12.5 for B/P
As an aside, I have hypothyroidism and am going to have that managed by an Endocrinologist for the first time since diagnosis by a PC 12 years ago starting next week.
Are there any long term effects from Nitroglycerin use?
Do you recommend finding out the path of the circumflex artery originating from the RCA by heart MRI?
Do you think this chest pain is arterial spasm from small vessel disease?I have a male cousin with microvascular disease, heriditary?Anything I should know about Circumflex artery originating from the right side?
What do you recommend to manage the chest pain in addition to the Nitro?Do you recommend another opinion,I live near UCDavis Heart center?I am a nurse and I would love not to have this chest pain !I appreciate any help you can offer.

[Samsgirl]

Thank you to all who have responded, this is a great site! I am happy to have some medication suggestions for my Cardiologist when I see him next week.I continue to have periods of chest pain and occ. difficulty catching my breath. I think that microvascular disease is a newer area. My cardiologist admits that they have overlooked many women's chest pain as "all in your head".
I had a headache two days after the cath and a difficult time making a sentence,I had a head CT and the results show an " old " infarct in the central sulcus. I am going for F/U to a Neurologist. I have no extremity weakness and no further headaches. I wonder if microvascular vessels play a role in that area? I will let you all know.

[guadamom]

I am 51 years old normally in good health. Since March of 2006 I began having shortness of breath and left chest pain along with left arm and shoulder pain.  I had a treadmill stress test that I failed so they did a Isotope Thallium Stress test and CT scan also Angiograham. All have come back normal.  I have been on Nitro patch, and now Norvasc. Along with several other medications.  I have 5 children, three have Mitral Valve proplasp and Bicuspid Regurgitation.  So last week they did and echo on me and my echo reads:

Left Artium is normal in size, Mitral Valve is Midly Thickened, Left Ventricle Normal in size & wall thickness. Ejection Fraction about 60%. Aorotic Root is Normal in size. Three Cusped Aortic Valve is Mildly Thickened. Right Atrium is normal in size. Tricuspid Valve is Normal in structure & opening. No Pericardial Effusion.

1. Normal Left Ventricular size & Systolic Function.
2. Moderate Mitral Regurgitation.
3. Mild to Moderate Tricuspid Regurgitation.
4. High Normal Right Ventricular Pressure.  
5.  Trace Pulmonic Regurgitation.  

I get shortness of breath daily and left chest pain.  Doctor tells me it has nothing to do with the valves in my heart. But that I have Microvascular Angina.  And that I don't have to worry about my heart, I should not need a Valve replacement for 30 years.  I'm not sure if I believe him.

Doctors have all but said that the pain and fatigue I feel is in my head.  Doctors now say I have small vessel disease that cause spasms.  I am now taking Nitroglycerin slocaps 2xdaily and Norvasc 1xday. this seems to finally be working for me.  the only problem I have now is a frozen left shoulder doctors said is related because I couldn't be mobile much. But my heart/chest pain has really decreased since I have been on the Nitroglycerin slocaps.

[EchoTech]

The circumflex coming of the the right coronary artery instead of the left anterior descending is a variant of normal. Sort of like blue eyes instead of brown, so to speak.  The normal cath results eliminates any question of the circumflex being the cause of the pain.    I would say you could have microvascular disease, but I think that is associated more with diabetes.  I'm stumped.

Good night and good luck.

[dee gee]

What about Costochondritis.  That is an ongoing "kick in the chest" feeling which will take years to cure.  Some days more severe than others.

[tanns]

Okay, it's the unexplained chest pain club!  I have had pains for about 15 months now.  All my tests have been normal and there is nothing cardiac related is ringing any bells.  I have been to the lung doc, gastro doc, ob/gyn and colon guy.  I am so very interested in the docs reply because I am at a loss.  Do either of you have any weirdness that goes along with it?  I mean, like sinking feeling or shortness of breath or panic?  My doctor (cardio) wants me to believe it is all anxiety related.  I am not willing to accept that.  Not feeling stressed or anxiety ridden.  I do, I believe, now have some anxiety symptoms as my health feels like it is going down hill and I have a mountain of medical bills---which I could accept if I had a diagnosis!!  But the chest pain started way before that.

I wish you both the best.  And thanks for the question, I'll be waiting the doc's reply!!

[Samsgirl]

Unexplained chest pain can surely bring on the stress..
My doctor has not offered that as the cause yet.
As far as Costochondritis, I have been taking 600 Mg of Ibuprofen twice daily at times for neck and back pain. I was off of it around the time of the heart cath and there was no noticable difference in the chest pain. It is also unrelated to eating. I take Prilosec and have had a negative UGI and gallbladder ultrasound. When the chest pain is gone,it is completely gone. Its a curious problem for sure.

[Samsgirl]

The pain I have is sharp at times,dull and aching other times,right side and left side,the sharpness is only for a moment,the dull pain lasts minutes to hours but is now relieved by nitroglycerian and tylenol,My doctor has ruled out coronary artery disease and another option is small vessel disease, I am happy to try medication as treatment to see if that helps,I am asking this forum to see if there is a connection to the circumflex anomaly,and if there is a way to diagnose small vessel disease. We have no other tests planned at this point.

[ltunes]

Sorry to hear about your ongoing problems.  I too seem to be suffering from these mysterious chest pains for about 3 years now and would like to know how your doctor arrived at small vessel disease as a possible diagnosis.  What symptoms are you feeling with your chest pains?  Are they sharp and brief or is it a dull centre chest pain that lasts for hours?  I'm trying to get a feel for whether they are similar to mine.  Also, were there any tests that your doctor performed to diagnose small vessel disease?

[Forum-M.D.-bkj]

samsgirl,

thanks for the post.

While there are some coronary anomalies associated with increased risk of sudden cardiac death, an isolated circumflex from the RCC is not though to be associated with increased risk.

There are no long term effects of NTG use but regular use leads to tolerance.  Strict control of weight, BP and cholesterol is a more effective treatment for microvascular disease. This term is often over used and more simple causes of chest pain such as musculoskeletal and GI causes can sometimes be overlooked.

I can't specifically comment on the origin of your disease without formally evaluating you.

A second opinion never hurts. If you are overly anxious with answers to your quesitons, then perhaps a second look could help alleviate your concerns, even if they agree with your current physicians.

good luck