diltiazm and linked angina

[granny877]

Hi doctor,
I have lnked angina, spasms of the oesophagus and coronary artery.  I was put on 60mgs of diltiazm a year ago and after 7 months needed 90mgs.  My question is will I keep needing more? and what is the prognosis for linked angina patients?

[vrruss]

My 85 year old mum has been diagnosed with atrial fibrillation, high blood pressure and asthma.  Her doctors are having a problem medicating her without her feeling sick and her breathlessness is getting worse.  Their latest attempt is a beta blocker called Ramipril which I am sure that she should not be taking with asthma and an ace inhibitor along with a water tablet.

Do you know of any other patients with these conditions and if so do they have a good drug regime that we could recommend to my mothers Doctor?

Thanks

[Jonathan D. Rich, MD]

Interesting and thanks!

All the best,

Dr. Rich

[granny877]

Hi Dr Rich,
From May 2010 to November 2010 my cardiologist and then the gastroenterologist both decided that it was both esophageal and coronary spasms causing my pain which in the UK is called linked angina and is a rare condition.  There is a small nerve between the esophogist and the coronary artery and a spasm from one can start the other off and vice versa.The gastroenterologist said he see only 3 or 4 people a year with this and that my GP may not see one.

[Jonathan D. Rich, MD]

Hello and welcome to the forum:

I am unclear as to what you mean by "linked angina"...do you mean people who have both coronary artery disease and angina as well as esophageal spasm?  These are two different entities.

The most important thing is to identify the cause of your angina...if it is from coronary disease and/or coronary spasm, then medicines like diltiazem as well as other classes of medicines (like beta blockers and nitrates) can help alleviate the discomfort.  In some patients, the disease becomes advanced enough to require angioplasty to alleviate the discomfort.

In terms of esophageal spasm, while not life threatening, this can be quite uncomfortable and is often mistaken for coronary angina.  Identifying triggers of esophageal spasm (ie acid reflux) can sometimes help but sometimes increases in medications become neccessary to fully control this as well.

What is most important is that your doctors clearly determine the cause of your angina--ie coronary disease vs esophageal spasm because the overall treatment approach will differ.

Hope this helps.

Best,

Dr. Rich