Unstable Variant Angina

[SBF]

Have family history of early death from MCI and I've been having "angina when resting" since January.  Had two pos stress tests, last one w/nuclear... lvef 63%.  Went to ER as instructed when nitro stopped working, IM doc wanted to admit me but room not available, so after 8 hours I left when they said I was stable.

2 weeks later saw (public health) Cardiologist for 2 minutes, who decided I had indegestion (had gastro doc 35 yrs, know what indegestion/heartburn feels like, take rannitidine), had to be forceful with doc for orders to have anything done, he chose nuclear stress test... almost didn't do it as research showed wasn't diagnostic for spasms, seemed like waste of $.  But hospital "strongly" suggested be done, so did it... no heart damage "yet".

Have appt. different Cardiologist in 4 weeks, want to use resources wisely AND get diagnosis.  Know my body and something is wrong, have biofeedback training that helps angina if catch it very quickly, not a nut... was pre-med until health stopped me, now "A" student in physical anthropology.  Am taking good care of myself, walk 15-20 miles week, eating right, don't drink, taking 5 grms fish oil and 6 grms L-arginine daily+ lipitor, propranolol, hctz so lipids and BP under control (except stress tests >190/90).

What can I do to make this next appontment count?  Is with Head of Cardio for Regional Hospital, don't want to waste anyones time but feel like doing everythng I can and isn't enough!  Think need cardiac cath with and without ergonovine... doesn't sound like any fun, any other way to diagnose spasms?  Have RSD & TBI w/cervical damage already and get spasms about 30 minutes after stress tests, isn't that enough to image the spasms? Thank you for being willing to help people, is admirable and sometimes lacking in today's world!  SBF Texas

[Annette Quick, M.D.]

You will only know for  sure you have spasm with cath and if they can get it to occur. It is more common in females and younger patients.

[SBF]

Thank you Dr. Quick,
It's reasuring to know that is the definative test.  L-arginine seems to be helping a bit and I'm talking with Dr. Glueck about study to help people with Printzmetal's have better quality of life using L-arginine @ 10grms day.

His hypothesis is mutations in eNOS T-786c and stromeolysin-1 5A/6A genes cause reduced synthesis of nitric oxide from endothelium leading to the vasospastic episodes.  L-arginine enhances NO synthesis, improves endothelial dilatation, decreases platelet aggregation, reverses endothelial dysfunction which may improve quality of life.
http://www.jewishhospitalcincinnati.com/cholesterol/Research/prinzmetals_angina.html

This may resolve why my family has history of early cardiac related death, he's doing PCR tests free of charge to study participants, but diagnosis must be established first.
Thanks for being willing to help, I appreciate your opinion!
Susie