Prinzmetal Angina and continued M.I.'s

[dslmgm]

I am a 57 year old female and I have had 5 M.I. 's caused by vasospams. I had the first one in September 2006, January 2007, April 2008 and the last two have occurred on June 21st and August 1st this year. I have had 4 caths. The 3rd cath in April 2008 indicated a spasm spot on the lower circumflex artery. The cath I had on July 15th of this year indicated that the spasm spot on the circumflex artery was all healed but there was a new one formed on another artery. I am on 5mg of Norvasc, take Nitro as needed, aspirin and lovastatin and Zoloft. I have problems with low blood pressure so doing a continous nitro patch lowers my blood pressure too much. They may try me on a very low dose of Imdur if I continue getting the angina. I am at wit's end as to what is causing this. For the past 3 years I was able to manage the pain and knew what to do to prevent the spasms from becoming a heart attack. These last two M.I.'s the past couple of months have presented themselves as pain in the middle of my back and my neck at times. I can't tell if I am having a back ache or a vasospasm. My family wants me to get a second opinion. I have hypothyroidism, had gastric bypass 7 years ago and I am wondering if I may have a vitamin or mineral deficiency that may be caused by malabsorption. Is there anything else I can do? Thanks.

[Jifizap53]

Probably far fetched or you would have mentioned it, but do you smoke?  I've had 2 heart attacks caused by Prinzmetals (I'm also a 57 year old female), the first when I was still smoking.  I then quit smoking for 9 years, didn't have the spasms during that time, started smoking again (stupidly) and after about 6 years started having spasms, and my second heart attack.  So now I quit (for good, I hope) and have had no more problems with the spasms.

[ed34]

I fully sympathise with you. Only having them for three months, once or twice a day, was quite enough for me. Even though I knew what they were, it was still quite scary. I kept wondering if my time was up. When you get your spasms do you feel a strange twitch in your chest and go a bit light headed? I wonder if people feel different symptoms from it?

[ChatterAlly]

Yes, I take the Norvasc, Isosorbide and carry Nitro tablets.  But I am always looking for other answers to this.  So far, even with the meds and supplements I continue to have the spasms.  I can say they are more controlled then they were 2 years ago. But nonetheless still a bother to me and I have no real answer as to why I have these.  Strangley, Lupus has been mentioned to me recently.  I have Raynaud's Syndrome, too. Not sure if there is a connection, but some say there is. That along with the problems in my joints Lupus was casually mentioned to me.  Who knows!

[ed34]

The normal starting dosage for  Norvasc is 5mg which can be increased to 10mg, but when you get close to the highest recommended dose, you become more at risk of the known side effects. Is this the only Calcium channel blocker you have tried?
When I had vasospasm in my Left Anterior Descending, I was put onto Diltiazem, 60mg three times a day. I took it for three months then stopped and the vasospasm has been gone ever since. I stopped taking them in November 2010. Nitrates gave no response at all to vasospasm for me, all they did was make me dizzy and give me chronic headaches.

[isailthe7cs]

I too have Prinznetal Angina and suffered numerouse angina attacks and a MI until my Cardiologist switched me to Isosorbide mononitrate (time release nitrate) 120mg each evening before I go to sleep. I have had no episodes of angina in nine months. The drugs half-life is 6 hours so that after a period of time its out of your system thereby reducing the chance of the drug reaching a level where it ceases to work.  I also carry  a nitrtate tablet in the event I forget to take the Med. GET a second opinion from another Cardiologist assocaited with a teaching hospital in your area.  Those folks are much more up-to-date on esoteric diseases such as ours.  Good Luck

[ChatterAlly]

I forgot to add that I have been reading up on some of the Amino acids.  Evidently, certain types of amino acids are suppose to help with vasospasms.  I'll get back to you as soon as I finish my search on this.  Ally

[ChatterAlly]

I was told to take Magnesium supplement.  I cannot tell you how hard it is to live with vasospasms.  I have many nights where I wake from a dead sleep and have to take Nitro because of the spasms.  And when I have these episodes there is never just one.  I usually have 4 or 5 before they stop.  They come about an hour apart.  Thank God the nitro always works.  I am afraid I will not be able to tell the difference between the pain of a spasm or heart attack.  I had the same pain with my heart attacks.  Take care and try adding magnesium to your meds.  Ally

[merly66]

Definately get a second opinion. Preferably from an immunologist who has an interest in cardiology. Get well soon xxx

[jrbon]

As far as I understand, you cannot use nitro patches "continuously". Apparently if you do so your body get used to it and you no longer get the desired effect. I was using them for a maximum of about 10-12 hours/day. As you know they come in different dose to best fit your needs.

As I see, you are in a relatively low dose of CCB. Is there any reason not to increase it?

As you point out, you need to have WELL controlled your Hypothyroidism.

And yes, gastric bypass may produce lack of Vitamins and minerals, you can get a blood test to check Vitamins D, B1, B6, B12, Selenium, Calcium and Zinc ... those have influence on your vessels (I am sure that you doctor already check Sodium and Potassium).

Of course a second opinion can always give you more peace of mind.

Jesus.