Long Term Use of Nitro for Chest Pain?

[Lauro]

Good Morning, Doctor.

Question:  Can a person who occasionally has chest discomfort,
and responds immediatley to one Nitro pill, live like this for years.

This is my situation.  These pains will build up like a cresendo.  Not from any exertion of any kind  but from a cold draft, an emotion of some sort, etc.

I had a Stress Thallium done 2 1/2 years ago and this did not produce the culprit.  Even though, I was exhausted near the end, I did the 85% required but had a horrid headache.  They ended the Thallium and told me by BP went to 260/60 at 85% with a heart rate of 136.  This was the reason for the headache.
(BP immediately went down to normal after they stopeed the test and the headache left)

Nothing was mentioned again about the BP response and I am wondering also, if this big rise in BP at 85% stress level,has any bearing on these occasional, "what I call", Angina Type pains.  

I asked for this med (Nitro) and the doctor at the Large Heart Center prescribed it after they released me.

I am a 59 year old female. My father died suddenly of a possible heart attack at the age of 39.  Mother died at 78 of probable athlersclerosis.

Apparently, exertion of any further Stress Tests will not produce my pains, so naturually, I will get a 'clean bill of health'.   This is why I asked and received an RX for Nitrogylcerin.

Thank You for commenting from the Cleveland Clinic.

Lauren

[Lauro]

Thank You for replying.

Hubby thinks the bad expereince I had with 2 physicians is making me leary about all physicians now.

I just want to relay my concerns to a doctor who will listen and not interupt all the time. The last Cardio was more interested in talking about Golf to my hubby than listening to me.

Good health care takes team effort; the patient and the doctor.
The patient must have complete confidence in the treating physician.  This is how a patient gets well.  

Good Communication is the key for good health.

Chris,in checking the *Thallium Test* results, I had 2 1/2 years ago, I was wrong.  I was told it was a Thallium, but it too was the Sestamibi scan.  All was ok except doing the threadmill with the dye going thru me, and at 85% max, the BP went through the roof.  5 minutes later it was back to normal. I had absolutley no chest pain whatsoever with this test except for a splitting headache at the end.

I will get to the bottom of all this in 2001.

Happy and Healthier New Year to You and all.

[christine m. smith]

Hi Lauren:

I think most people that have had a cardiac cath done will tell you the same thing-it is not that bad. I would say a root canal is far worse (and probably some gynecological procedures as well)
They medicate you (in the future I would ask for no medication because all it seems to do to me is make me not want to ask questions). The actual insertion into the artery hurt a little, not bad though, and the test itself was nothing. Clamping down afterwards on the artery was uncomfortable as was not being able to move the leg for 6 hours. That was it!  I doubt they would put a stent in without a reason. How would they know which artery to put it in? Yes, not finding anything wrong is a possibility.  When you think about it, that is good news, just as long as they don't think its the end of the story. This is what I felt happened with me. There are other types of angina that occur at rest-maybe you have one of those?  If you think you have a problem, and want others to agree so you get treated properly,  then you have to be willing to have the necessary tests done.

A sestamibi scan is similar to the thallium scan. You exercise on the treadmill and then at some point they inject you with whatever it is they use. I guess in the sestamibi scan its a different material than they use in the thallium scan. I really worried that I would not have symptoms so I tried to duplicate the situation that produces symptoms in me.  I went along with them when they wanted to start with the regular treadmill test. Apparently that's the procedure so I agreed, but I knew that if it was negative, which it was, I would want the more accurate test done. As it turned out, the sestamibi was positive, but the cath was negative and I still have no answers. (other than I don't have any obvious stenosis)  

I'm not so sure a female cardiologist would be any more likely to agree you have a problem. It was a female who told me after my negative regular treadmill test that I did not have a problem and that she didn't recommend any further testing!  

Good Luck

CHris

[Lauro]

Thank You Doctor for responding. You have helped many people here in the Heart Forum. I have made notes of your suggestions.
                      ***************

Hello Chris.  Yes, it is very frustrating!!

I have a terrible fear of having a catherization done.  My fear is the test itself and if they do not see a blockage, and place a stent in one of the arteries anyway. Why, I think this way, I do not know.

I am very frightened of physicians except my Gyn and my Opthamologist. <g>  

I know I must get answers to these "non exertional angina type pains" that do respond to nitro immediately.

Chris, I never heard of a Sestaimbi Threadmill/Scan Test.  Is this another name for the Stress Echo?

I have heard of Microvascular Angina and this has occurred in my mind, for me.

I saw another Cardio doc, 6 months ago and all he wanted was to put me on his threadmill in his office.  I knew this would not produce my pains.  I had asked for a stress echo and he balked.  My husband and I left his office.

I guess perhaps the fear is, that I am a female and not listened to by the doctor.  This frustrates me immensely.

Hopefully, I can locate a female cardiologist that will listen to my symptoms and concerns.

Chris, I wish you well also.  Not fun "not knowing" when you know down deep, that something is "not right"..

God Bless us All.

Lauren

[christine m. smith]

Hi!

I had a regular treadmill test because of symptoms that suggested exertional angina  and did not have any symptoms on the treadmill. So then I had a sestamibi treadmill test done and asked if I could walk on the treadmill and not hold onto the bar. (I figured that when I walk uphill I don't hold onto anything and I would think this would require greater effort by my body) This time I did have symptoms on the treadmill (the same ones I get walking uphill-neck/throat/cheek discomfort) The sestamibi scan showed ischemia in the area of the left anterior descending artery during the exercise phase, normal during the resting phase. A cardiac cath a few weeks later was normal. My angina also responds to nitrates (I take 60 mg imdur daily) I have lots of unanswered questions but the cardiologists dont seem to care since the cath was normal. One said that he wasn't ready to call this "microvascular angina" the other said he didn't believe in it.  So I continue to take nitrates and believe them when they say I am not at risk for a heart attack. Its very frustrating! I hope you get some answers

CHris

[CCF CARDIO MD - DLB]

Episodes of very high blood pressure can certainly cause angina like chest pains; the best treatment for this is medications to control the blood pressure.
Given your family history and symptoms which could be due to angina, I would favor further evaluation, perhaps another form of stress test, such as a chemical stress echo, in which you would not need to exercise.