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Prinzmetal or microvascular angina

I have a 23 year old daughter who at the age of 16 had open heart surgery to repair an ASD.  For over 6 years she has only had off and on symptoms of pericarditis and pleurisy which we've been able to treat and learn to live with.  About a month and a half ago she woke up with chest pains which continued to get worse as the day went along.  When taken to the emergency room late that night they treated her for a heart attack as she had an abnormal EKG and high heart enzyme levels. Was admitted to the hospital and more blood work taken the next morning with even higher enzyme levels.  Was transferred to the hospital where her cardiologist is for arterialgram and 2-D echo.  All tests were clear.  One week later she had a second episode but was able to get through it. She still has off and on numbness in her left arm which will happen at any time and some chest pains that come from the center of the heart.  The only conclusion they can come to is that she has prinzmetal angina. After finding info on microvascular angina I'm now curious as to if that might be her problem.  No stress test has been done.  Should one be?  What is the best course of action to get a definite diagnosis?  She is on Norvasc and baby aspirin once a day and carries nitroglycerin tablets with her.
1 Responses
238671 tn?1189759432
I suppose she may have Prinzmetal's angina or microvascular angina. A stress test would not necessarily help sort this out. There are sophisticated sorts of measurements that can be made during a cardiac catheterization to provoke spasm or to assess the microcirculation done at referral medical centers. If her doctors feel that a more definitive diagnosis needs to be made, this type of testing could be pursued. Given her history of pericarditis, this seems like a more likely cause for her symptoms, though it would not entirely explain the abnormal blood work.
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