Vasoconstriction

[Ruth Anderson]

Sorry--I think my computer burped before I was finished and may have sent a partial post from me.  Here it is again, just in case:



I have class III CHF.  About a month ago I experienced a series of presyncopic episodes which increased in length and severity.  Eventually I experienced extreme chest pressure and shortness of breath, so my husband took me to ER.  The doctors thought I was having a heart attack, admitted me, and ran the usual tests:  EKG, blood work, chest x-ray, etc.  The computer print-out on the third EKG noted changes and a possible MI.  I did well throughout the night with no signs of an MI and the next day was given a chemically induced stress test.  The result showed no major blockages in my heart.  I was discharged with an updated prescription for 60 mgs. isordil 3 times/day and an explanation that my problem was probably vasoconstriction.  Since then my BP has gone up and down like a yo-yo, and I have felt very dizzy a couple of times while at rest.  I am concerned that my problems will begin all over again.  



Here are my questions:



1) Is vasoconstriction a reasonable diagnosis, or are the doctors just guessing because they can't figure out the real problem?  (I just moved and do not have my own cardiologist yet; the one I was referred to I do not care for.)



2)  Is vasoconstriction dangerous?  Can I have a heart attack, or does it just mimic one?



3)  Since I'm feeling dizzy off and on again, do I assume that my isordil is not enough?  In other words, do I need to make finding and seeing a new cardiologist a priority?



4)  Is there something I can do in the meantime to help myself?  (My CHF is doing OK at the moment.)



Thanks for your time.

[CCF CARDIO MD - DLB]

1. It is unlikely that vasoconstriction of your coronary arteries was really responsible for your symptoms.

2. Vasoconstriction can be dangerous and can (rarely) lead to heart attack.

3. Do not assume anything. The Isordil can in fact cause dizziness, so it might be that you are in fact on too much.

4. You ought to make an appointment with a cardiologist soon.

[Ruth]

Thanks for your answers to my questions. As a followup:



1)  You said that vasoconstriction can be dangerous, and can, though rarely, cause a heart attack.  Is that the only reason it is dangerous, or are there other risks?



2)  If vasoconstriction was not the cause of my episodes, I think it would be prudent to find out what was, don't you think?  What, if any, other tests should we be considering, or do we just let it go for now?



Thanks again for your time.  You all are a god-send!

[CCF CARDIO MD - DLB]

1. Vasoconstriction can cause heart attacks, arrhythmia or fainting. Again, it is very rare.

2. I think, based on your stress test, that your doctors probably concluded that you do not really have significant coronary artery disease. I am not sure why they then raised the dose of Isordil. This is why I think you need to see a cardiologist.