do I need to be worried about heart spasms

[notaro]

I just got out of the hospital after an episode of severe chest pains, dizziness, and pain down my arms and into my neck. I had a series of tests. several ekg's  x-rays, an echo, a treadmill stress test, and an angio. the stress test was abnormal. the ekgs are showing PVC's, and the angio was normal. the cardiologist is thinking that it is the endothelials that are causing the pain. they put me o n 5 mg of norvasc, and zocor because they found my ldl's were 180. I am 44 year old female. I had a hysterectomy 7 years ago and I have not been on HRT.  the cardiologist says if the norvasc doesnt work they might do an ablation.
my questions:  1. do you think the lack of estrogen in my system could have caued all of this?
                           2.  does the norvasc work right away, or does it take a while to build up. what is the recommended dose.
I just started the pills 2 days ago, and I am still having a lot of chest pain.  I feel like my heart is jumping out of my chest at times. I dont know if I should be concerned about all of this or not. I have never had anything like this before.

[Cleveland Clinic]

This condition is known as prinzemetal angina, or coronary vasospasm and is usually found in women.  It has been associated with mild coronary artery disease and endothelial dysfunction.  The fact that you are essentially chemically postmenopausal probably played a role in this, however, hormone supplementation carries its own risks and may have caused other problems had you been on it after the hysterectomy.  Norvasc is very good in treating this.  We usually start patients on long acting oral nitrates (imdur 30 mg daily) because it starts acting fast and then transition the patient to norvasc which takes about 4 days to work.  In addition to the nitrates and the norvasc, we also use statins and antidepressants as well.  The latter have been shown to help as well.  

[joanincarolina]

The Cleveland doc is right on this one. I do not have Prinzemetal angina as I have no nighttime issues but I have confirmed Cardiac Microvascular Dysfunction. Go to this site and read my journal 'joanincarolina'. I have lived with this for years.It is a diagnosis of exclusion.Your larger, easier to be seen coronary (heart) vessels are clear,but nothing can look at the tiny microvessels attached to them.They can be dysfunctional because of an issue with the endothelial lining and they spasm causing the chest pain. Imdur, ranexa are great vasodilators, a calcium channel blocker to relax vessels and my necessary, nitrate- nitrogylcerine. Don't worry about the mentioned antidepressant; this is not in your head but a night time, very small dose helps with the body's response to catecholamines as chest pain is occurring. Statins help stabilize the vessel walls preventing placque build up. I also started a group at this site; Cardiac Microvascular Dysfunction-Cardiac Syndrome X where others with this MVD diagnosis or signs can share there information. I'll send you an invtitation to read it. I can also answer your questions privately. A small dose of an anti-anxiety medication when you're having chest pain or shortness of breath helps. There is no cure, there is no research consensus on 'why' so it is a management issue. Please come read about this and stay quiet; avoid exertion right now until you stabilize. Joan.  

[joanincarolina]

Just another comment.I don't understand why an ablation would be considered if there is endothelial dysfunction. The norvasc or calcium channel blocker (CCB) will help with PVCs, unless you left something out in your post.  A CCB has been shown to have better results against spasming heart vessels then beta blockers.I had been on Norvasc before my Emory encounter but was switched to Cardizem 120 mg 2x day which for me gave much better control over the PVCs helping to relax the heart vessels. The nitro was super helpful as PVCs were a sign that my heart muscle was not getting enough O2 .Now it is only a rare time that I get one, no more runs of PVCs, bigeminy. This MVD is really a customized treatment for patients as there appears to be degrees of severity and presentation of symptoms. But it is all about exertion and cardiac demand for us patients who have to live with it. Joan.

[notaro]

I was at the dr. again today for follow up on this. it was just my primary, not the cardiologist. he seems to think we need to explore issues like gerd, and anxiety as well to try to manage this. I agree. I am told that when i get chest pain to try a dose of zanax to see if it helps.  I was wondering, others who have these micro vasclular spasms, do you have pain over the heart on the left side and down into the left axilla? I was having it across the entire chest wall, but today it is over the left side and under the armpit. I just took a xanax to see if there is any relief. I am not by nature a very nervous , or anxious person, but who knows, I will try anything. also, does cold food make this type of thing worse. I just had a fudgicle.
kathy notaro

[joanincarolina]

After years with these spasms I know there is nothing you can do to prevent them in some instances other than watching your exertion/cardiac demand and even then you cannot totally prevent them.Your body has its own demands out of your control. When the vasospasms occur in the microvessels, you feel pain-lack of blood to heart muscle which then cannot pump efficiently or effectively. Xanax can calm and SLOW YOU down but if the microspasms continue( especially without benefit of a vasodiolator) and travel up to a major coronary artery there is not much you can do to prevent that action but you certainly can reduce your risk beforehand by taking a vasodiolator, continuing with Norvasc, take great care of your lipids, and have nitro on hand. These spasms can present as light tightness across the left chest wall,under the breast, tightness at the bottom of the heart area, into the left axilla, through to back shoulder blade area, up the left jaw. It's hard to determine what microvessels are causing the problem. For me it's all about layering of cardiac demands which with shutting down microvesse means not enough blood/O2 is getting to the heart muscle. Cold foods do not affect me. Joan.

[notaro]

hi joan,
thanks for your responses. I had a really bad episode again last night. I decided to try the xanax, it made me fall sound asleep. when I woke, the pain was gone. but then as soon as I got up off the couch to get a drink, the pain started up again, with palpitations. I have been pretty restful, taking it easy, then when I start to feel better, I try to do some things around the house, like laundry and such, and it comes back. I am getting a little frustrated with this whole thing. my pmd is trying to down play this, but I am concerned that this is a big red flag for me, and I should listen to my body. what do you think? I wonder if I should push to have the eps to see if there is an actual arrhythmia which would be taken care of with an ablation.