Dr. Figures I have Coronary Spasms of heart,

[fluffypurrcat]

Ever since I was diagnosed with what was thought to be a MI, I have been seeking the answer to what happened. I have had a DR. here on Cleveland Clinic say from the sTress tEst I was given and the symptoms that it sounded like I did indeed have a MI, allthough a mild one probably. Also the Stress tests indicated that I may have had one and some area of damage, or what is called Stunned Myocardium. The first cardioloigst I went to did a Catherization which showed no blockages and then a Echocardiogram.

I saw him today and haven't got the actuall report yet, but he told me from the symptoms I have that he now thinks what I have is Vaso spasms of the heart, or atypical angina. He talked about calcium channel blockers and using the nitro I am already taking. He based this on the symptoms and the fact that taking the nitro helped with chest symptoms after taking Nitro.

       The question started when I asked about Ischemia and parts of the heart not getting enough blood, / oxygen, and if you don't have blocked arteries, if you could still have symptoms if you are not getting enough blood. He said yes, then I asked about if there was any connection between Raynaulds disease and Ischemic Disease of the heart. I dont think he gave me a direct answer, but this question gave him some intersest, and  when he found out I have suffered from Raynaulds since the 1980's, he seemed to be putting two and two together. The other thing I thought was interesting, was than this initial attack was very strong, and that I had several clusters of them close together from begginning of April till the end of May. I have not had a Angina attack for about 3 weeks.

My attacks came with no exertion or exercise, no foods or undue stress. The fact is that I have been MORE STRESSED SINCE THE INITIAL ATTACK, BECAUSE I HAVE NOT FOUND THE CAUSE OR DEFINITE DIAGNOSIS.
So it was not anxiety, panic disorder, GERD, or anything similiar. I have severeal EKGS that mention possible Mycardial Ischmic disease. How is that diagnosed or can it be diagnosed?
  Has anyone else had a connection between Raynaulds Disease and this Coronary Vasospasms of the heart?
  I have read different things on the Web about Pretmetals Angina, is this the same thing? How often do these attacks come and go or how do you know when you will get an attack?

One thing I read talked about doing the same thing you do for Heart disease, such as lowering the prevention like high blood pressure and high cholesteral, and smoking. I take meds for high blood pressure and cholesteral, and I quit smoking 30 years ago. What other things can I do to keep this under controll?
           I am still wondering why the dr on Cleveland Clinic had the ( apparently ) wrong diagnosis from the stress test?
Thanks to everyone who helped me in trying to figure out what is going on.NOw I just need to see my Regular Dr. to see what is done next.                                                              Fluffypurrcat

[kenkeith]

I don't remember where I got all the information and some sites require membership, but http://www.cks.library.nhs.uk/Raynauds_phenomenon/background_information#
provides the information of interest.
http://www.madsci.com/manu/ekg_part.htm#The ST Segment: For ST wave, QRS complex interpretation and T wave. Before there can be an accurate assessment of any wave form requires, sometimes, concomitant wave forms and the specificity of electrode position, etc.  But if you review you can get a flavor for the EKG.

I had the same problem regarding my medical records.  You may be able to get around paying if you say it is not for your personal use but you are going to get a second opinion.  Then the records clerk will say we will mail it to the doctor.  My response was "listen (slighlty raised voice) I want to review my records before discussing the case with another doctor...I agree there appears to be some objection for patients to have their own records!!!

[fluffypurrcat]

Hi, I just don't know where to start, except to say thanks again,you are such a Storehouse of wealth and information. I have learned more from reading your messages and talking to you then all the dr.s I have gone to together. and this is NOT an Exageration by any means. Did you ever consider going into the medical field, in some manner, scientific research perhaps? I think you would be very good at it.
You have given me so much info, that I had to print it out so I can take it to my dr. when I go and have some backup to know what I am saying. The part you talked about (" Some individuals with variant angina may have more systematic abnormality of vasomotor tone this may include symptoms of migraine headaches and Raynaulds penomenon.) Where on earth did you find this stuff? The reason I am asking is that I would like to show this to my regular dr. so I can see if there is more she can do, my chart is well documented that she gives me Migraine meds and that I have had Raynaulds for over 20 years. Also my mom suffered the same things. Do you know of any test, blood or otherwise, where they can test for vasomotor tone?
I have a question about the EKG part where you are talking about ST Segment Elevation. Many of my EKGS show St Elevations, ST -T wave changes ST-T changes more pronounced. or ST-T nonspecific changes abnormalities last EKG I dont have the printout which I like to get copies of , but it says Sinus Rhythm, ( doesn't say the heartbeat but it was 60 when they took my blood pressure, )lots of times it is mid 40-50s. Probably elevated while stressed ) Allso says QRS width upper limit of normal.
Minor non diagnostic ST Segment and T wave abnormalities. ( this was the dr.s enterpretation, not the printout of machine.)
       It is interesting that the cardiologist office had me pay $10.00 for my own records for a total of 5 pages. I went to my local hospital and have over 2 inches of records, and didn't pay anything...Also I think the cardiologist in general do not like you to have your own records. I will have to see if my regular dr. can get a actual copy of the Echo test so I can see the numbers and the actual EKG printout.
        You also said: "ELECTROCARDIOGRAPHIC FEATURES MAY INCLUDE  ST-SEGMENT ELEVATION OR DEPRESSION...AN EKG CAN SHOW CORONARY ISCHEMIA TOGETHER WITH ST-SEGMENT ABNORMALITY IF POSITIVE FORE SPASM.  What does that mean exactly. Does that mean positive if a spasm is taking place during an EKG? Please explain.  Sounds like you have given me so much information that I now have a better explanation as to what happened to me. I now need to know if I can give this to my dr. and get some treatment or a diagnosis recorded. I am more confident though that with the info I am getting here on this site and from you, I will have enough info to give to my dr. to make it more likely to get the help I want. Thanks again and will wait till I hear from you . You have made my day!!         fluffypurrcat

[kenkeith]

Prinzmetal, variant angina, vasospasms, etc.is described as a syndrome of chest pain at rest secondary to myocardial ischemia associated with ST-segment elevation. Electrocardiographic features may include ST-segment elevation or depression...an EKG can show coronary ischemia together with ST-segment abnormality if postive fore spasm.
Unlike stable angina (comes and goes with exercise and relief with rest) exercise tolerance was characteristically normal in these individuals...sometimes there is a pain pattern with most episodes occurring in the early morning hours.

"Prinzmetal or variant angina, is due to focal coronary artery vasospasm and may be associated with acute myocardial infarction (MI), serious ventricular arrhythmias, and (not to be alarmed but forewarned)...sudden death.  A substantial number of patients have seemingly normal coronary angiogram results, although many within this subgroup have evidence of early atherosclerosis demonstrated by intravascular ultrasonographic examination or at autopsy".

Distinguishing unstable angina pectoris related to coronary atherosclerosis from variant angina may be difficult and requires special investigations, including coronary angiography. This may be an arbitrary distinction in some patients because it is likely that vasospasm is both a cause and a consequence of plaque rupture and thrombosis in patients with unstable angina pectoris (pain not associated with exertion and relief at rest), and many patients with variant angina have obstructive coronary artery disease.
The absence of risk factors for atherosclerotic coronary artery disease suggests variant angina, although cigarette smoking is a common risk factor for both clinical syndromes and is reported in most patients with variant angina.

Some individuals with variant angina may have a more systemic abnormality of vasomotor tone; this may include symptoms of migraine headache and Raynaud phenomenon. Although in one series, 30% of individuals  reported a familial incidence of variant angina, there is no convincing evidence for a genetic predisposition to arterial spasm. "It has been suggested that an examination of hereditary pathological and polymorphic variations in factors elaborated by endothelial cells, platelets, and leukocytes responsible for maintaining the patency of blood vessels (eg, nitric oxide, prostacyclin, endothelin-1) may prove enlightening".

[fluffypurrcat]

Hi thanks again for a wonderful explanation of what I may have. It seems that dr.s just can not agree on anything and it is easier to get a diagnosis on this forum by listening to other people than having Dr.s diagnose you.LOL.......You are right about the Raynaulds Disease, as I have had that since I was in my 30's. The description of the angina attacks that come at rest and in cycles sounds pretty prescise as to what happened to me. The only difference is that the initial one was about 5 times more severe and included the jaw pain and more severe squeezing pain or pressure in my chest. All of the other attacks have been either at rest, middle of the night or in the home. They allso came in clusters, and now I havent' had one for 3 weeks.

What makes them come and go, what causes the vasospasms, as I still have vasospasms of the fingers , toes etc. Also is there a connection to the Ischemic theme I keep seeing on my ekg printouts, What is Ischemia and does it have to do with lack of blood flow to a certain body part, ( spasms of the myocardium, or heart?) Is there a certain way to diagnose this condition or is it just a matter of elimination? I guess what I am worrying about or should I say wondering about is, how can you tell when you may get another one, and I have read that if they are not well controlled, you can still get a MI or sudden cardiac death even. After you answer this , I will ask you another question regarding treatment, but I don't want to put too much on your diagnostic plate at one time.
         I wish you were in the health care field and had your MD license, I would be the first person wanting to be one of your patients! Thank you for all your hard work!

                                                                                Fluffypurrcat

[kenkeith]

Thanks for the sweet and charming e-mail.

Its good to hear you are active in your diagnosis.  There may be a connection with Raynaulds, disease of the arteries, Prinzmetal's angina (vasospasms) as you suggest.

Raynaud's phenomenon can be associated with various diseases that affect arteries, such as atherosclerosis, which is the gradual buildup of plaques in blood vessels that feed the heart (coronary arteries), or Buerger's disease, a disorder in which the blood vessels of the hands and feet become inflamed. Primary pulmonary hypertension, a type of high blood pressure that affects the arteries of the lungs, is frequently associated with Raynaud's.

Primary Raynaud's. This is Raynaud's without an underlying disease or associated medical problem that could provoke vasospasm. Also called Raynaud's disease, it's the most common form of the disorder.

Secondary Raynaud's. Also called Raynaud's phenomenon, this form is caused by an underlying problem. Although secondary Raynaud's is less common than the primary form, it tends to be a more serious disorder. Signs and symptoms of secondary Raynaud's usually first appear at later ages — around 40 — than they do for people with the primary form of Raynaud's.

Prinzmetal's angina, also known as variant angina or angina inversa, is a syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles. It is caused by vasospasm, a narrowing of the coronary arteries caused by contraction of the smooth muscle tissue in the vessel walls rather than directly by atherosclerosis (buildup of fatty plaque and hardening of the arteries).

[ireneo]

Good pictures. Especially the second one. My toes look like that, especially in the shower. Yeah, warm shower. Example: if I'm shaving my legs and have one foot on the edge of the tub, the toes that are pressing on the tub will be that waxy white while the rest of the foot turns dusky gray. When I sit with legs down for 5 minutes, both feet turn gray. Sometimes my hands do that too. It looks like I've been sorting newspaper. Kind of embarrassing when it happens at work. Nothing I can do about it.

I've never been very brave about asking for medical reports. I just listen to what the doc says and then drop it. The deal with the monitor, when I saw the cardio before my surgery, he said he didn't have the results yet but he didn't think my pain was cardiac related. Sounds like a guess to me. But he didn't seem worried so I just dropped the whole thing. I figure if he got the report and there was something bad going on, he would have told me....eventually.

You mentioned calcium channel blockers. Are you taking one now? I was taking Diltiazem for 3 months and it helped the chest pains. I also felt tired all the time and was in a brain fog. Not very helpful at work. So I stopped the Diltiazem. The arrhythmias came back plus the chest pains but I'm alert. And since the doc didn't seem to think it mattered one way or the other, I opted to go without the med. I think the CCB would be less trouble than popping nitro.

[fluffypurrcat]

Hi Ireno, thanks for the input. I was diagosed with Raynaulds about 1983 and most dr.s at least the ones in the area where I live do not want to do much for pts. with this disease, other than saying trying to avoid the factors that seem to trigger an attack. In my case, avoiding the cold seems to be one of them. In the last 6 months or so, and definitly since the MI, or apparent Mi, which now seems to be an ATypical Angina or Coronary Spasms attack, my fingers will blanch and turn color even when I am in my own house, and under normal temperatures. I do not understand why this happens.

        I uploaded a recent photo of this condition which was taken about a week ago, so you can see what it looks like. Is your color change the same? The other thing that happens is that the fingers will turn bright red or blueish as the color and blood flow returns, then you get the tingling which feels like frost bite and hurts like the dickens!

It will be interesting to see what my regular dr. says about the coronary spasms, but at this point, I still am not very excited, I know how the dr.s in this area have been, and I dont think this thing has been 100% accuratly diagnosed yet, and the only way to get a definite diagnosis is if and when I get another attack that sends me to the ER, and this next time, I will go to the ER, and not worry about being wrong, etc. This is how this whole thing got started. If I had done that in the beggining, I think I would have gotten a better and heck of a lot faster diagnosis, but who knows, mayby I am wrong.

        No, I have not recorded one of my chest pains on a monitor, but I dont know how to go about doing that. In my case, when the intiital one happened, their were a cluster of them, two or three a day immeidatly after the " big one" and they lasted from April 4th or 5th till the end of May. Now it has been almost 3 weeks and no more attacks. This is one reason to reaffirm that it is NOT panic or STRESS, because my stress level was 10 times Higher AFTER this (MI  or Spasms ) event then before it. If I never had a Stress or Panic Attack for the first 54 years of my life, with a heck of a lot of Stressful events, then why would I have one out of the blue, with not exercise or exertion angina to trigger one?

The only symptoms I am having now are the frequent and strong palpatations, and a few of them have been diagnosed on a brand new blood pressure monitor that I bought about a month ago. It detects irregular heartbeat, as well as morning hypertension. One thing I have noticed with the attacks of whatever source they are, is that my blood pressure allways has gone up with the Angina attacks and stays up till the attack is over.
       If I were you I would ask for my record of when you wore the monitor so you can see what the results were. I know from personal experience that dr.s don't tell you everything. I have all my old EKGS from when I was hospitalized and everytime they did one. It gives a good record of what may be baseline and any abnormalities. Good luck and let me know what happens if you get your record.    fluffypurrcat

[ireneo]

Interesting - do let us know what you hear about Raynaud's and vasospasms. I was told I have Raynaud's about 3 years (?) ago because my feet and hands turn ashy gray. About 1.5 years ago I started getting these nasty zings of chest pain, a deep squeezing pain in the chest through to the back. The good news is they don't last long, maybe 2-10 seconds. Like you, they can happen anytime. My stress test was fine (except for the tons of PVC's firing off after the test). I wore a monitor to record my chest pain times but never got an answer. So it's still a mystery. The Diltiazem did stop the pains though.

Have you ever recorded on a monitor one of your chest pains? Did you get an answer? Do you get arrhythmia at the same time as the pain?