Whats next

Posted By  CCF CARDIO MD - MTR on March 10, 1998 at 13:23:20:

In Reply to: Whats next posted by Barry Tonner on March 04, 1998 at 17:18:27:

: First I would like to say thank you for any help you might be able to offer.

  I'm a 55 year old male, and I am having a lot of chest paint, as well as
  pain in the shoulder and left arm.  I just recently spent 2 weeks in an ICU, and
  underwent an angiogram, which turned out normal.  Previous to this I have
  had two exercise tests, both of which were positive - they showed

[CCF Cardio MD - MTR]

_

Dear Barry, thank you for your question. If you have a normal angiogram, then there
are two possibilities that you mention: Prinzmetal's Angina or Syndrome X.  With obstructions
seen on the angiogram, chest pain can easily be explained by poor blood flow through the
coronary arteries past the point of obstruction.  With Prinzmetal's Angina (PA), the
coronary arteries spasm and blood flow is transiently obstructed by the spasm and not by
critically narrowed atherosclerotic plaques.  Arteries are surrounded
by smooth muscles which dilate or constrict in response to multiple hormonal cues that
regulate blood flow.  With PA, the coronary arteries constrict (spasm) without provocation
and intense chest pain results.  We don't know why this happens but certain factors like
cigarette smoking are associated with PA.  Certain tests can be done during an angiogram
to test for spasm but the diagnosis is made when a patient has chest pain with transient
ST segment elevation on an ECG that goes away quickly.  Syndrome X is slightly different
in that the spasm is thought to occur in the small, distal coronary arteries that are hard
to visualize on an angiogram.  Your stress test results support this diagnosis since you
had ST segment depression with chest pain but you had no blockages on your angiogram.  
Unfortunately, Syndrome X is hard to treat.  The common treatment for PA and Syndrome X
is calcium channel blockers which are a class of medications that act on the smooth
muscle of the arteries to help prevent spasm.  You are already on a calcium channel blocker
called Norvasc at a reasonable dose.  Your other medications are also appropriate for your
condition: Atenolol is a beta-blocker that lowers blood pressure and keeps the heart rate
slow to prevent angina, aspirin which make platelets less likely to form clots in the arteries,
and pravachol which is a cholesterol-lowering drug that also helps to prevent spasm.  
Earlier in February in this forum, there was a question on Syndrome X that you might find
interesting so I suggest that you look there.  Also, if you're still having chest pain
on your current medications, you should see your doctor soon.  I hope you find this
information useful.

Information provided in the heart forum is for general purposes only.  Specific diagnoses
and therapies can only be provided by your physician.