painful heartbeat

[RozAgain]

Hello, I am new to this board and have a question.  

I am a 42 year old female.  I've had angina off and on over the past couple years.  So I went in for a stress test and did not pass  (it went upside down).

So they did a cath & it was negative, showing only very minimal beginnings of soft blockage, my heart scan score was 0 for hard blockage/calcification.  I wore a device for a month to watch for abnormalities and they found none.  The last time I had  angina was about a year ago and I was hoping it was gone for good.

Then last week I awoke in the middle of the night from what I can only describe as a "painful heartbeat."  It resolved itself and I went back to sleep.  Then it came back a day later, during work.  So I took a nitro tab, which made it go away.  The beat wasn't fast or irregular.  Every beat just hurt.  I've never experienced this kind of thing before.

Other info: My blood pressure is usually low, I get common & classic migraines occasionally, which were recently aggravated by Singulair (which I've since stopped and switched to Zyrtec).  Other meds: Zoloft & Ativan.  Family history is positive for cadiovascular disease on both sides, mother has spastic coronary artery/ies, migraine and first heart attack before 60.  

They told me they no longer test for spasm when I had my cath, so I guess I will never know if the chest pain is the same thing my mother experienced at the same age.  They gave her a beta blocker for it

So anyhow, what is a painful heartbeat caused by?  The angina I had before was constant, sometimes went up my neck and down my arm.  This is different.

[tonyam]

Hello RozAgain,

I'm also in Milwaukee, 42, migraines, and in the "diagnosis system" for coronary artery spasms "like" symptoms.  My internist has referred me to a cardiologist.  So I'm out searching for one who will listen.  Who is your cardiologist?

Thank you! Tonya

[RozAgain]

Thank you for the very helpful information.   :-)  I don't use the vasoconstrictors for migraine.  With my family history, I figured it was best to avoid them.

It seems strange that a major heart hospital like St. Lukes-Milwaukee doesn't test for spasm when other hospitals still do. When I was told they didn't do it anymore, I just assumed that was the common practice, and that the test was no longer done anywhere.  

Perhaps it is for legal reasons.   Maybe it's just something my cardiologist doesn't do.  While I was relieved they didn't run the test (my mom had a bad reaction when having spasm induced back in the 80's)  I am left with no definitive diagnosis.

Thank you again, for your kind answer.  I will need to look into this further.

[Cleveland Clinic]

We at the cleveland clinic still test for spasm because the treatment for this problem is different from that of the usual coronary atherosclerosis. Now they could have simply initiated a calcium channel blocker as a presumptive treatment, since you symptoms are so suggestive of this syndrome. Also some medications used to treat migraines can exacerbate this problem, and you should look up your medications and their possible side effects.
The only common cause of painful heartbeats is probably pericarditis, or inflammation around the lining of the heart. It is usually better with sitting forward, and worse with laying back. It is usually benign, and has no long term consequences.