Prinzmetal angina or panic attack?

[newzor]

To all the knowledgeable ones who can answer these questions,
please do.


1. Does a prinzmetal angina "attack" cause the heartrate to skyrocket?
2. People who have panic attacks and chestpain that is not angina or prinzmetal angina related,
how exactly does that chestpain come to be? What causes it?

My doctor has told me I have panic attacks,
but i doubt his diagnosis. I suspect prinzmetal.

[TTR1990]

First off if your pain is in 1 place its not angina, angina travels from the chest to the arms, back etc... I suffer from taccicardia iv been dianossed with it for about 4 years now but iv suffered with heart pains that travel to my back and shooting pains in my neck for almost 10 years iv finally got myself an appointment with a cardiologist

[sidsuae]

I am male 46 years old with severe health anxiety since 12 years. Since childhood I have been a worrier, very sensitive & fearful. I struggle with unemployment after marriage & HIV fear for 2 years. Since last 12 years I have obsessing about heart related fear, heart attack, heart disease, arrhythmia, angina etc. Time to time I was being occupied & living with fear that, something happened to my heart. I did 3 Echocardiography, 3 stress treadmill test, 4 24 hr holter monitor test, several ekgs. I have Mitral valve Prolapse with Trivial MR, which was diagnosed 5 years back. I am been googling that, anxiety chest pain/chest tightness or palpitation are harmless to be relaxed from anxiety & mvp & came across many unwanted  heart related symtoms, which made me very obsessed & fearful. I was trying to get assurance on one symptoms, another symptoms I will pickup from the internet, like this cycle continuing, While browsing the anxiety I came across a word Variant Angina(which is without blockage, your arteries will go to temporary spasm/stop blood) I somehow manage to overcome this fear after lot of efforts but, one setback came, that, the way to diagnose is to hyperventilate the patient & do EKg. Since then i got more feared. Now i am fearing if i hyperventilate i will get coronary artery spasm & will dies. I know that it is wrong, but i started obsessing about the word hyperventilation. If it is like that, all anxious people who hyperventilate will get coronary artery spasm & die. I am trap in to fear. plz help me to come out of the vicious cycle of fear. I will be grateful to you all my life. I have two kids & wife. I don't have any help from anyone. I was coping with the anxiety symtoms (chest pain/palpitation/chest tightness/dizziness/lightheadedness/jelly leg etc), by reading Dr. Claire weekes book, that, anxiety will not kill you. Now I came to where I was in the beginning. I started to worry about all anxiety symptoms & fearing that it will cause coronary artery spasm/heart attack. I know anxiety causes hyperventilation, i am misinterpreting all this symptoms. I am coping with the fear of coronary artery spasm that, it is similar to heart attack & chest pain should be severe for more than 10 mintues & mostly are young females, but whenever I think of word hyperventilation or whenever I feel anxious, suddenly it comes to my mind. I ask one cardiologist whether, hyperventialation can cause coronary artery spasm. He replied me No hyperventilation does not cause coronary artery spasm or variant angina. but still it is not going from my mind & obsessing. I became obsessed with the word hyperventiation & when ever i feel little anxious, i am thinking coronary artery spasm will come. Plz help me how to fight with this fear. I was coping with anxiety that, it is harmless & suddenly a setback came. How to come out of this. can u give me some tips.

[newzor]

I have found many answers to my questions,
as well as a lot of information on Coronary Vasospasms as well as Prinzmetal Angina
on the following website.

http://ajcc.aacnjournals.org/cgi/content/full/13/4/350

the scientific articles say that coronary vasospasm can induce ST depression instead of ST elevation (during episodes i have significant ST depression),

but prinzmetal is usually ST elevation... not sure if always.

[newzor]

Wikipedia states "For patients with Prinzmetal angina, ECG finding will more often show ST segment elevation than ST depression."

More often does not say exlusively.
I suppose spasm induced constriction of veins and arteries comes in different degrees of severity and probably in different forms as well.

Anyway, I guess the only sure way to know if i have prinzmetal or not is probably having the specially designed tests for it.

If anyone can point out any more mistakes in my logic or knowledge (As did grendslori),
and if anyone wants to share anything else please do!

[newzor]

My apologies for my lack of understanding of true cardiomyopathy.

I've been feeling slight pain in my chest for a long time which i believe is caused by tense chestmuscles.
The tenser my chest feels, the higher my resting heartrate and the more vulnerable i am to having these possible(?) prinzmetal attacks that make my heart skyrocket.

I've felt poor blood circulation but this might be because of betablockers and my sedentary lifestyle.
I often feel many different muscles of my body twitch rapidly,
sometimes my legs, often my arms, sometimes my shoulders.

During previous tachycardic episodes,
I've had moderate pain in my left axillary,
which looking back on it...
might have also been an artery spasm like the ones i might experience recently in my chest?

[grendslori]

It will cause changes on the EKG because there is a lack of bloodflow.

You DO NOT have a cardiomyopathy and having any kind of tachycardia does not constitute a cardiomyopathy. Tachycardias involve the electrical system of the heart; Cardiomyopathies are all terminal and involve the heart muscle walls. (they are either too thin or too thick and cause either a systolic or diastolic heart failure) tachycardias would NEVER be classified as a cardiomyopathy! I can't understand a spasm in your chest to cause angina; it would be the other way around in Prinzmetal; the tachycardia would come first. The thing is that most people, like I said earlier, usually have other blood restricting problems as well, they don't usually have just the heart spasms. Do you have other issues like that?

[newzor]

Before I begin to reply to your statements,
I have one more question...

3. Does Prinzmetal angina ALWAYS cause ST elevation in the ECT,
or is it just in most cases?


I often have tachycardic episodes (145 at rest and gradually it dies down) and sometimes I have a lot of PVC's,
so i guess that classifies as cardiomyopathy.



Yesterday i had one of these possible "prinzmetal attacks" and i took a high dose of cayenne to get the blood flowing.
It relieved the (chestmuscle or artery?) spasm and my tachycardic heartrate retrieved it's normal rhythm much sooner than i had in previous tachycardic episodes.

Drinking 1 cup of coffee is for me a sure way to get a muscle spasm in my chest and my heartrate to skyrocket.


Prinzmetal can occur in people with no (coronary) heartdisease.
i guess that if the spasm is strong enough or lasts long enough,
it can cause heartattack even in young healthy people.



Panic attack is often confused with prinzmetal angina.
I think it's atypical for "panic attacks" to feel totally relaxed while riding your bicycle or sitting in front of the computer,
and then suddenly feel a spasm in your chest that causes the heartrate to skyrocket?

Doesn't that sound more like prinzmetal?
Maybe i'm too paranoid by not believing doctors who tell me it's panic attack...

[grendslori]

I have Prinzmetal Angina attacks and have never had it cause tachycardia. If I am having tachycardia then sometimes my arteries will constict and I will get angina. Usually people who have this type of angina have other vessels that constrict. I, myself, also have Raynaurds. Also people who have tachycardia problems actually relate the pounding as chest pain; it's not. Chest pain is caused by a lack of bloodflow to the heart muscle, usually it is a result of having CAD (Coronary Artery Disease) which is usually seen in middle aged patients or diseases of the heart muscle known as the Cardiomyopathies. (Believe me, you'd know if you had those problems!) I have no idea how the angina would manifest itself during a panic attack; without true heart disease problems, the angina would not be true angina. Nitro will open blocked arteries to a degree, but it isn't a pleasent pill to take: your BP can take a nosedive and you get a horrendous headache when you take the pill. At your age, you most assuredly aren'y going to be having a heart attack; you are way to young for CAD and if you had the carddiomyopathy, your doctor would have picked that up rather quickly. The muscle twitches all over your body would have nothing to due with any of this.

[newzor]

I went to the general doc and told him I wanted to go on verapamil calcium channel blockers for sinus tachycardia and possible Prinzmetal.

My betablocker (prescribed for tachy) lowers my bloodpressure and HR too much, so i had to quit them. They work ineffective for my possible "prinzmetal" attacks.



The only thing i have now to treat these tachycardic episodes
that could possibly be Prinzmetal related is Ativan and Cayenne Pepper.

Ativan relaxes the muscles and prevents spasm.
Cayenne pepper dilates the bloodvessels in case i get a Prinzmetal attack. (the problem is i get heavy diarhrea and bowel spasms 3 hours after ingestion of the cayenne :))

I hope i will soon get an Angiography for prinzmetal,
so the docs will be able to give me nitroglycerin in case i really need it.

I don't want to be the 23year old victim of a heartattack because the doctor's believed i was just being "panicky".

My possible "prinzmetal attacks" are characterized by
sudden onset tachycardia triggered by chest pain.
I also have muscle twitches all over my body all the time.

The only place where i get painful spasm is in the chest though.
That's why i would still love for someone to answer my 2 questions in my initial post.