cad, spasms, heart attack ?

[itsa4847]

couple questions. i have a history of cornory artery spasms found in the cath lab.  And slight cad.
questions:
1. what is a mean arterial pressure of 99 mmhg
   resting left ventricular and diastolic pressure 20 mmhg
   midly elevated left ventricular end diastolic pressure?

2. what is LV score of 5?
3. what is ejction fraction 70%?

I have slight cad i was told left anterior descending coronary artery exhibited a 30% ostial stenosis and then 20% mid stenosis.

i have in the dominant right coronary artery 20% proximal narrowing, 20% mid narrowing and then a 30% distal narrowing just before the crux.

the right artery is the one that did the spasm.
I have now been hospitalized twice in 4 months with spasms that didn't respond to nitro. i take imdur, cardizem,lipotor and now periactin, they said i was hyper sensitive and we don't know what the trigger is that causes them, but both times had to go to the morphine, and i was admitted.

my last question is with the above, seeings iam only 42 are these low numbers for cad that i have?  and can i expect to be a heart patient for the rest of my life? my dr. says it is not life threating he said it is more of an inconvience!

what do you think?  do you deal with patients with coronary artery spasms, could i get a heart attack from these spasms.  I tend to wait before going to the er.

and last but not least i always seem to have normal ekg's, do these spasms not show up on ekg's? cause they always say well your ekg is normal but i'm clearly having a spasm.

thanks so much for your help.
Lynn

[LADYBUGOHIO]

A related discussion, coronary artery spasms was started.

[docedo]

A related discussion, vasospasms was started.

[seed]

I had angioplasty october 17/02. what a roller coaster this has been.  i experienced the spasms, didnt know how to express them in emergency, i called them cramps so thanks for the terminology.
what has been working for me to get rid of them, I was on .4 Nitro-Dur patch (i wear on my hip to avoid head aches) and the last emergency room internist recommended increasing it to .6.
I havent had the spasms for two weeks.  I wear the patch from approximately 9am to 9pm. and rotate  it from side to side everyday.  for colesterol i take zocor.
it has been great to find this site. i have found more answers by researching myself than the cardiologist or emergency departmens could explain.  there is alot of ignorance about the reaction to medication and the mixing of them.  each doctor/specialist is so limited in their knowledge.  i have learnt alot from my pharmacist.  thank you for all the input. please keep me posted how you are doing.  i am only 51 female. my colesterol is not high, never has been, they just like to keep it low.  or as low as they can ...

[itsa4847]

well, went back to my visit on 7/8 i aslo had a visit with my ep. my reg. card. was very pleased with the cardizm rusults so iam going to stay on the 240 1x day, however he did agree that the toperal cause cause me to have more eposides of the cas so...he reduced it to 50mg, and i go back to him in a month and he plans to take me off the toperal. and my ep is having me do a tilt table test next tuesday to see if my dizzyness is caused from my atrial tachcardia or from drops in bp.  so he will know how to treat this.

My cardiologist seemed upset with me, because my reg dr. recommened me to go to the ep.  Well he seemed put out! by this.  Why can't all these dr.'s work together.  I'm just trying to feel better!

[itsa4847]

hi there
i know what you mean about having problems with the meds.  I have had this cornary artery spasm diag. since jan. and have had nothing but trouble with the meds.  many changes iam surprised i remember what iam on.
here is the latest list, however at this time I'm also seeing an ep for elec. problems with the heart not related So they say!
cardizm 240 1x
imdur 60mg 2x
lipitor 10 mg 1x
asprin 81 mg
nitro spray if needed
toperal xl 100 mgs (now this seems to be where my problems) are they  continue to changed this many times recently to the 100 mgs and i noticed that i have trouble with my bp rising apon standing and shortness of breath.  I see my cardiologist monday and I have to let him know that i have been cutting this in half.

The ep said he wants to put me on solotol (spell) which would require another hospital stay.  so we shall see.
All i know is that it is very much a pain going thru this and I hope you are doing better on your meds.
good luck to you!

[Canadian]

Hi
I was recently diagnosed with Coronary Vasospasm during an angiogram cath. and put on calcium channel blockers and aspirin.

I am a 53 year old (young) male (former smoker as of attack)with no previous history of heart problems until this episode that took me to the ER and subsequent hospital stay and testing.

I am having a real hard time getting the channel blockers to work, have tried Norvasc 5mg x1, Cartizem 120mg & 180mg x1 and presently Verapamil 120mg x1, which seems to sort of work half of the time.

I still have mild attacks and I always seems to have a sort of ache in the heart and get tired really easy, is this normal when taking this medication?

Someone told me that Coronary Vasospasm sometimes just disapear, is this tru or just wishful thinking.

Any answers or thoughts are appreciated

[ccfitzner]

the meds i take are
(1) Lipitor 10mg
(2) Baby Aspirin
(3) Cardizem 180mg
(4) Enalapril 10mg twice a day
(5) Imdur 30mg
(6) Protonix (for my stomach)
We take almost the same meds.  I just started taking 10mg of Enalapril.  I had been taking 5mg twice daily but my blood pressure kept going up when I did any exercise.  You said you drank a beer in the evening, I was told that any alcohol could cause a spasm. The Doctors have me afraid to do anything. I can't smoke, drink, can't go dancing because of the second hand smoke in the dance halls.  Can't go gambling because of second hand smoke. Did your Doctor say anything about second hand smoke?

[itsa4847]

to briane,

well for me when i have the coronary artery spasm, my first sign is i feel like iam being squeezed around my chest like an elephant is sitting on me and wont' get up.  then my pressure which is normally low because of all the meds i take jumps up to 145 top number usually is around 105, then i feel short of breath.  sometimes i have pain when the artery is closed up the blood can't get thru and this causes angina symptoms such as above.  then if it continues for me i get numb in my arms and sometimes pain in shoulders, i get dizzy and then cold, but sweaty palms.  by now iam using my nitro spray.  and if that does not work i end up at the hospital.  i have since jan had two stays and a er visit.  but my cardiologist is working to get my meds so that i don't continue to have this problem.  I also carry a nitro paste patch that i can apply over heart, if traveling till i can get help.  I hope this helps you, if you are having symptoms please don't hesitate to check it out.  I personally know two people whom have had heart attacks cause they were not on all the nitro and beta blockers iam on.
hope this helps. Ps my spasms don't show up on the ekg so i carry with me the cath. report in all my cars to take to hospital. And age does not matter i will be 43 in aug. i had high cholsteral and now it is down with lipotor.

[itsa4847]

msgal
i'm glad you quit smoking that is one thing i don't do, my eating habits are terrible but since being diagnoised in jan i have changed that.  
what kind of meds do you take? now
i take
imdur 60 mgs 2x
cardizm 240 mgs 1x
toperal 50 mg 1x
lipotor 20 mg 1x
baby asprin 81 mg 1 x

and carry nitro spray, nitro paste.  I do drink a beer or two after work.
i still have the heart pac's and pvc's which i noticed get worse during a spasm and those do show up on the ekg.
but i think they have increased since the cardizm increase.

i go back july 12th so i will see and pray that maybe this is it.
everyone drives me nuts to get another guess, but i really have a lot of trust in my cardilogist and when he was not there for my last hospital stay i had his partner and he treated me the same. so....i think i will stick with the plan for now.

[briane]

what does it feel like when you have a coronary artery or heart spasm?

[itsa4847]

wow to eddies' girl that must be very scarry.  just having the spasms is enough and so far i have been very lucky.
i had another one after i wrote this to the dr. i had to again go to the hospital, my blood pressure was 145/80 its normal is 105/70 and i was short of breath, cold but sweating and was already using the nitro when my school nurse called my dr. and he said go to the er. anyway I found out more information on my spasms.  for one thing they don't show up on the ekg, unless it goes into a heart attack, which lucky for me mine have not.  they had to give me oxygen and nitro paste. the only thing that showed up on the ekg was alot of pvc's and pac's which i seem to get more of these when im having a spasm. I just went over my heart cath report.
and it reads,  during the iv methylergonoine challenge was performed which reproduced the patient's chest heaviness. There were no significant electrocardiographic changes.  There was however noted focal discrete distal right cornary artery spasm to about 50%  with diffuse distal right coronary artery spasm.  There was no significant focal spasm in the left system.  Upon intracoronary nitroglycerin administration this focal spasm was totally abolished. So for the computer dr. to say that what i have he isn't so sure, he needs a second opinion.  Ps when i had my last spasm wed. at the hospital there again no changes on the ekg except the pvc's and pac's.
So i really feel sorry for people that come in and get ekg's and they say will its not your heart.  I cringe when i hear that without further testing they don't know that 100%.  
My dr. feels tht mine won't lead to heart attack, cause i take imdur, cardiem and carry nitro.  But one never knows.  But I don't dwell on that either.

[Eddie'sGirl]

I'm living (living! Yeah!) proof that spasms can lead to a heart attack.  I am a forty=three year old woman who has had three MI's.  High cholesterol runs in my family and my is not being effectively controlled with all of the ususal treatments.  This causes my blood vessels to to collect plaque build-up.  When my arteries go into spasms they can cause a piece of this plaque to break off and cause a blood clot which of course results in a heart attack.  With my first MI, I was given medication to dissolve the clot and it was sucessful.  With my second MI, I was given two doses with no positive results and had to have emergency angioplasty and a stent implanted.  My third MI was very mild and the doctor said my nitro and taking of aspirin managed to break up the clot before I got to the hospital.  Although I take a long list of medications I still have the spasm attacks and I have no doubt that I will have more MIs.  I just have to pray that I will get help in time to survive them.
Good Luck!

[ccfitzner]

I was told that I had Endothelial Nitric Oxide Synthase.(eNOS) It is spasms of the heart.  The thing that they told me would trigger this was cigarette smoke. Even second hand smoke. If I even walk by someone who has just put a cigarette out, it could trigger a spasm. I really have to be careful when we go out to eat or even go shopping.  I don't think it is known what all causes these spasms.  They just found my problem in February of this year and I had been going to doctors for over 4 years with chest pain after eating. I smoked, so after eating I was also smoking.  I haven't smoked a cigarette since December 16, 2001. I had smoked since I was 14 years old.  I am now 56.

[itsa4847]

Lastly, if you are having pain that is due to a coronary artery spasm it should show up on the ECG. If there are not ECG changes I would question the diagnosis of spasm somewhat;

well i was glad to hear my numbers were normal and my cad is considered low.

however, i have been told tht spasms do not show up on the ekg, unless it goes as far as a heart attack? so iam still confused on this issue.  I know what my diagnoises is and i have coronary artery spasms. (better now with the medication) the nurses told me they do not show up on the ekg.  Even when they made the artery spasm in the hearth cath lab. my ekg was still normal?  I guess i will have to ask my cardologist next visit, but i would have to disagree with questioning my diagnosis.

if anyone else knows about these spasms i appreciate your thoughts.

Lynn

[CCF-M.D.-CRC]

Dear Lynn,
In regard to your first questions these are all normal numbers describing the pressures and pumping system of your heart.  Mean blood pressure is the average between the systolic and diastolic blood pressures, end diastolic pressure is a measure of the filling pressure of the heart and ejection fraction is how much the heart pumps (normal is 50-70%).  

Concerning the coronary artery disease (CAD) and spasm: Everybody has some degree of blockage but not everyone has associated coronary artery spasm.  I would consider your blockages mild but they can progress.  Now that you have been diagnosed with CAD you should do everything you can to prevent progression of the disease and possible heart attack. Stop smoking if you smoke, eat raight and exercise as directed by your doctor.  It is hard to predict who will go on to have a heart attack but I would consider you at higher risk than others due to the underlying condiiton of your heart.  

Lastly, if you are having pain that is due to a coronary artery spasm it should show up on the ECG.  If there are not ECG changes I would question the diagnosis of spasm somewhat.