Variant Angina

[000111]

I'll try and keep this brief, so here goes.
I had and MI in 2006 with stent placement (2), and they put me on the usual cardiac coctail, bet, ace, statin ect. Then a week later I had chest pain again but not as severe and they called this coronary spasms and put me on Norvac with eliminated the problem or so I thought.
In Aug. of 2007 I again had CP that took me to the ER, they transfered me to Anchorage (no easy feat considering where I live), and I once again was stented, now I have three. Then last weekend in the middle of the day doing nothing, I had the worst Chest Pain I have ever had, I thought I was dying. It took 10 mg of Morphine just to stop the hyperventilation from the CP. All I can say is it was bad.
Again they transfered me to Anchorage, another cath arteries are fine at the moment. Because I'm already on the Calcium Channel Blocker they put me on a low Dose Nitro patch. 0.2mg. They don't ant to start twieking my meds because I'm already on such a low doses becasue of my low B/P.
I know that eventually I'll build up a tolerance to the Nitro and this will eventually happen again.
I've been doing some research and everything I've read tells me I'm at increased risk for another MI because of this Angina. How much of an increase risk is there, or is it individual? Can this just go away with extra attention to controling risk factors, will it even help?

Thanks
gail

[Jack54]

Thanks for your reply. I know exactly what you mean. For me this feeling comes with the "loss of control" of whether or not you find yourself dialing 911. I have did it too many times. Each time has saved my life though.

LOSS OF CONTROL is best left in some far corner of your mind :)

My best,

Jack

[000111]

Jack
Thank you for responding, believe it or not I'm a MS candidate in nursing, so your questions make sense. I told my doctor last week that my brain just goes numb when I starting looking at all of the data and 6 years of college is doing me nothing :-) He laughed and told me to try and stop being a nurse and be a patient for a change. Let him worry about my test results and that he will answer each and every question, night or day just ask. This isn't the "your not competent to understand this infomation" it's "Stop streresing about it."
Anyways in response here goes
Primarily because of the meds, as you know we need the Beta Blockers, ACE, Calcium Channel Blockers, Statins to help protect the epithelial lining of the arteries.

No I am not a diabetic even borderline .

About 100/70 , 10 MCG of Nitro IV drops me to 70/ 30.

Do you limit caffeine and other stimulants?  1 – 2 cups of coffee a day, I don’t smoke, and don’t do illegal drugs. I walk about 1 to 1.5 miles a day.
My Triglyceride value is 120, HDL is 49 and LDL 80 I don’t know the value of
my VLDL.

Are you aware that being in extremely cold weather can cause coronary artery spasms? I am

Have you had an echocardiogram? Yes, no changes from 2006, and normal sinus rhythm.

Do you take Plavix or aspirin daily?  Yes and yes

What is your ejection fraction? 65%  8/07

Was your cardiac muscle enzymes high last weekend? (There are several enzymes that are released when heart cells are damaged.) I don’t know the values but they were all WNL along with the Troponin at 0.00 over 9 hours.

I’m probably not feeling a lot different than anyone else going thru the same thing. I just need to get beyond the “oh my God” I every time a break a sweat, or become the slightest bit short of breath. But I’m really mad, I've worked so hard the past two years to control the risk factors I can control.  It is just so irritating to see all the morbidly obese people smoking 2 pak. a day and the most exercise they get is walking to the refrigerator or moving the joy stick on their electric wheelchair, and eating these foods with tons of salt, and dripping in grease
I’m sure you and everyone else here know what I mean when I say “ I’ve still got a lot I want to do, like watch my grandchildren grow up, retire. I DON’T WANT TO BE SICK. I DON’T WANT TO BE ONE OF THOSE WHINNY PAIN IN THE BUTT FREQUENT FLYERS AT THE LOCAL ER.

Thanks for listening

Gail

[Jack54]

First I would like to tell you how sorry I am for the misery, pain and suffering CAD has caused you for the last 2 years. Our stories are almost mirror images in similarity. I am just a few years ahead of you. I had a heart attack in June of 2003 and now have 5 stents. 4 are side by side in my LAD. 1 is in my obtuse marginal.

You say that your research has you believing that you are at risk for another heart attack. Same for me. I am a member of the cardiac syndrome X "club" or have what is called metabolic syndrome, and have unstable angina. Remember this, STATISTICS have no meaning for an INDIVIDUAL. Statistics have meaning for groups of people and usually very large groups of people. Doctors and scientist are hell bent on statistics, to the detriment of some people, like women.

I went through this stage of expecting another mi at anytime, and yes it could happen today, but I WILL NOT let it consume me. I have grandchildren that love me dearly and I live for them :)

I had the most horrible angina with my heart attack, so I understand your mention of extreme chest pain. What relieved my angina during my mi was the fact that I lost consciousness from having a stroke as I was having a heart attack.

You wont build a tolerance to nitroglycerine. You have bad information if you think you will. The only "tolerance" associated with nitroglycerine is during a 24 hour period for anyone/everyone. Nitro will only stop angina for around 18 hours (on average), out of a 24 hour period, for those that have angina. This is what I have read.

Here are some questions I have in order to try to answer your question about future cardiac events:

1) Why is your blood pressure low? How much damage did your mi do to your heart?
2) What is your normal average BP and heart rate?
3) Are you diabetic or borderline?
4) Do you limit caffeine and other stimulants?
5) Are you aware that being in extremely cold weather can cause coronary artery spasms?
6) Have you had an echocardiogram?
7) Do you take Plavix or aspirin daily?
8) What is your ejection fraction?
9) Is your cholesterol and/or triglycerides high?
10) Was your cardiac muscle enzymes high last weekend? (There are several enzymes that are released when heart cells are damaged.)

Sorry about all of the questions here. I just wanted to say that the problems with CAD might go away. I know of people who have had 1 stent maybe 8 years ago, and no further problems, BUT it takes great disicipline and a heart healthy lifestyle. Sometimes all of this doesn't matter at all. You can do all of the right things and still these coronary artery blockages and spasms occur.

I would like to correspond more with you with a tad more advice. Hey I was once in Anchorage. We stopped to refuel on the way to Viet Nam :) The airport had a huge polar bear that stood like 14 feet high.

Namaste,

Jack