another opinion

I've had chest pain and s.o.b. on the slightest exertion for 6 years.  It started after taking one pill of verapamil for migraines.  I immediately had tachacardia for 3 hrs.  I've since had 2 heart caths, stress test, echo holter monitor for 30 days.  I have svt, atrial tachacardia, arrythmia.  I've recently awakened at 2 a.m. with exploding chest pain and been ambulanced to ER.  Nitro stopped my pain.  The ER doc took all the tests and all were normal but he mentioned coronary spasm.  I've read about that and small vessel disease which both are difficult to dx.  I've mentioned them to my card. doc but I think I was ignored.  Should I get another cardio doc and is there a way to find out if I may have either of those problems??  I don't want another hospital episode. I do take inderal, and asperin. Thank you

Jule

[Cleveland Clinic]

Episodes of arrhythmia can be associated with chest pain, which is not necessarily related to coronary artery disease coronary vasospasm, but more so caused by what doctors call demand ischemia, meaning that the heart is beating so fast that it begins to cramp up a little.  This can typically be alleviated with medications such as beta blockers (inderal) or calcium channel blockers.  I doubt that you have coronary vasospasm on top of your arrhythmia related symptoms.  One way to know is to get an ECG  the next time you have chest pain and give you some nitroglycerin.  Coronary vasospasm causes significant changes on the ECG during chest pain and both the chest pain and the ECG changes typically resolve with sublingual nitroglycerin.  Of course if you are having chest pain during SVT,  I would not give you any nitroglycerin because the chest pain is unlikely to be caused by spasm and, in addition, your blood pressure could drop significantly.  If you continue to have additional episodes of arrhythmia and chest you should consider seeing an electrophysiologist.