I am 63 years old. I have had some angina for several years. It hasn't changed over that time. I have had two angiograms: both show clear, open coronary arteries. When I exercise, especially run, as I do on a regular basis, for about 40 minutes 4-5 nights/week, I will get some minor angina. I will slow down a bit and not push it for about 15 minutes. The pains goes away and at that point I can run as fast as I like. Once I "warm up" -start to sweat a little-I can push myself to the max without any pain whatsoever. I do hard physical work without any pain, once I warm up.
I have had stress tests which show an EKG that does indeed indicate stress in the heart during those first minutes. I have also had a stress echo which doesnt show anything negative. My cardiologist has cleared me for any level of activity, but says he doesn't know whats causing the angina.
Any ideas what might be causing this. Its not severe pain, but definitely causes me to slow down until it goes away, which happens almost precisely at 12-15-17 minutes after starting to exercise.
what causes the pain? it seems to be a mystery. Maybe artery spasm?
but what makes it go away? the exercise induced vasodilation. So that gives you a clue as to the cause, anyway. Increased blood flow throw arteries makes their endothelium produce more Nitric Oxide.
Do you feel your hands especially get warm and fuzzy at that warmup point in time? I remember when I used to run regularly in wintertime, I'd hit that warmup, take off my gloves and look at my watch - it'd always be within the same span.
Since your production of NO seems good, I'd wonder what is inhibiting the NO initially. Maybe Asymmetric Dimethylarginine (ADMA).
With a respiratory ruled out, and tests show no ischemia, and to have angina would lead to a logical conclusion of variant angina as NTB comments. There is a probability an angiogram is false negative, and sometimes an occlusion less than 50% blockage can be a problem.
I don't believe ADMA can be induced with exercise or rest or combination thereof. But with raised levels of ADMA it appears to be associated with adverse human health consequences for cardiovascular disease, metabolic diseases and also a wide range of diseases of the elderly, the possible lowering of ADMA levels may have important therapeutic effects. However it has yet to be established whether ADMA levels can be manipulated and, more importantly, if this results in useful clinical benefits.
In pre-clinical and clinical studies, ADMA has been found to be elevated by hypercholesterolemia, hyperglycemia, hypertriglyceridemia, or hyperhomocysteinemia.
ADMA levels are highly correlated with triglyceride levels. If you have clean vessels at the age 61, your lipid levels, etc. done with a blood workup, would/should be negative for any conditions associated with ADMA.
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