Microvascular Angina And Eds?

[Radha]

do any of you have microvascular angina or even heard of it and know if its related to POTS or EDS? i have POTS and possible EDS and get this type of angina pain once in a while, i know taking the medicine trimetazidine helps to make the pain go away when i take it at the time of the attack, i know i am too young to have any kind of blockage and no risk factors. the attack is very scarey and so painful but i dont get it often, i think because i take aspirin daily and use oxygen often through out the day everyday, if anyone can offer any insight into how this angina connects with POTS or EDS, i would really appreciate it, thanks

Radha

[mkoven]

Great question. I've just had a full cardiac workup, including catheterization, and have no blockages in the big coronary vessels. I am 41 and have eds.

I get chest-pain regularl7. It seems to be at least in part an ans problem--sometimes instead of getting lightheaded, I get chest pain. It's as if the blood flow is in short supply to my chest, not just brain.

I also get this with exertion, which led to the full workup.

I've been told that it's possible there's a microvascular component here, nut not sure what the treatment would be. In my case the case is it's more likely a drop in bp. So now we're working on keeping my bp from dropping.

What is the med you said helps? I've never heard of it...

It's tricky, because the meds one would take it there's a problem with vessels being narrowed are the opposite from what one would take it they are too dilated.

Do you know how they determine that there is a microvascular component?

[seaboardbc]

I was diagnosed with both POTS and microvascular angina almost 6 years ago. I don't know if they are related but I started feeling the effects of both about the same time. I also suffer from tachycardia daily. I take 120 mg of Imdur and 40 mg of Coreg and use a spray sublingual nitro as necessary. I take some other meds too but the ones listed were prescribed to deal with the angina and tachycardia. They have helped me a lot, without them I was having angina attacks almost daily. Although I still have tachycardia daily my HR is has slowed to between 90-100 BPM when it's good and usually no higher than the 150s when tachycardia (before the meds I could have HRs as high as in the 230s BPM).

I hope this is helpful info for you.

Bren

[Radha]

when i get a really bad angina attack, i have the terrible crushing chest pain on the left side and sharp jaw pain, i thought nitro would lower the bp and thats why i couldnt take it since my bp is already low, thats why i tried Vastarel or trimetazidine, but i dont know if its ok to take long term and daily or its ok just to take when you are having the pain, i just wonder if this has to do with the blood vessel problem involved in the blood vessel problem and blood pooling in EDS, although i am always sitting when it happens, i cant stand or walk at all, thanks again for your replies, its so frustrating that so much of this is unclear.

Radha

[mkoven]

Can you tell me how they diagnose microvascular angina? I was told that it was a diagnosis of exclusion, as those vessels are too small to image. My cath only looked at major arteries, as the catheter can't fit in the smaller vessels.

I asked the docs how they would know, and they sort of shrugged--saying even if I had it it wasn't dangerous.

And people are afraid of further lowering my bp. I was told they thought most of mine was ans-- but don't know how they know that.

[Csmith3]

I have had occasional attacks of angina, but never had it properly investigated. Mine is typically triggered in cold weather if I'm doing mild exercise (eg, walking up a hill, dashing for the train), perhaps when I'm tired or had a busy day at work. The sort of scenario you would expect in an ageing businessman, but this started in my 20s! It has happened more recently after sustained tachycardia (only in low 100s but for more than a day). The chest pain comes in waves and is very intense, but 15 minutes later I'm absolutely fine. I'm quite relaxed about it now as I seem to recover OK, but there is a doubt in the back of my mind that one day this might turn out to be serious. I share your concerns about the possible solutions. It is one reason that I don't take beta blockers as they made these attacks occur more frequently.

I hadn't heard of microvascular angina, and have just had a quick look on the internet. It would be reassuring if that diagnosis applied to me. I might ask my cardiologist about it - if I find out anything useful I'll let you know, but this won't be for some time.

[Serbo]

Hi, sorry to bump this old thread.

I also have POTS and EDS III and get the chest pain bought on by stress. I wondered has anyone pursued the microvascular angina and had it confirmed? Cant see any studies linking EDS/POTS to it specifically/

Reassuring that to some extent that the Docs think this functional pain is not dangerous.

[Serbo]

this article was written by a harvard prof on causes of chest pain, not specific to EDS/POTS, but very good

[E246]

Hi Serbo,

you did not finish your message - i was interested in the article you were referring to.(and anything else you knoW)

I have wondered about microvascular angina or Syndrome X. i just found this from a web page:

In some women with CSX, there is evidence of abnormalities of the autonomic nervous system (i.e., of dysautonomia) - specifically in the case of CSX, an increase in sympathetic tone (i.e., adrenaline levels) has sometimes been seen. Furthermore, CSX has been associated with otherdysautonomia syndromes, such as fibromyalgia and inappropriate sinus tachycardia.

I asked my doctor about it but was fobbed off. I have no doubt this is what i have. The chest pain is worse than anything else and is often there even when my heart rate is not too bad. When i took calcuim channel blockers it made the chest pain better but i was less able to walk.

Has anyone had this diagnosis recently?

[Serbo]

Hi Emma

Thanks for the link, this is the article:

http://knol.google.com/k/noncardiac-chest-pain#

[juliegee]

Some with POTS and EDS have a mast cell disorder. Kounis Syndrome, which could explain your pain, occurs with this disorder.

http://en.wikipedia.org/wiki/Kounis_syndrome

[sandymbme]

I have actually just started having severe chest pain, right over my sternum, occasionally shooting down one or the other of my arms, (not just the left, it can be the right, but never both at the same time) and have not the slightest idea what the cause is. Cardiac CT came back okay, as well as the EKG. That is the only testing I have had. I do have an implanted monitor (a medtronic "Reveal" loop recorder) but when I saw Beverly Carabin last week she said that nothing popped up on the reports there either. I do have EDS and POTS, and my mother just had essentially a heart attack caused by a major artery in the one of the upper chambers "spasming". No blockages of any kind, the cardiologist said her arteries were gorgeous on the cardiac cath. But it makes me a bit nervous! (Mainly for her!)

Sandy

[juliegee]

Sandy,

Your Mom's episode sounds exactly like Kounis Syndrome to me. The treatment is (in part) antihistamines. Maybe try one next time you feel the pain & see if it helps.

Julie

[issie]

I had this happen to me and cause a rather expensive ER visit. I think my reaction was to glutamates from aspartame in sugar free gum. All indications were that it was a massive allergic reaction that caused me to think I was having a heart attack. The docs weren't totally against that idea either. Nitroglycerin helped me and I had three doses under the tongue and wore a patch for about 16 hours. It calmed down and I was released from the hospital not really understanding what had happened. Julie, (MacksMom) suggested Kounis Syndrome and all the doctors are intrigued by this idea. No one has said for positive that was it - but it is a possibility. I had taken massive antihistamines before I went to the hospital and either that or the nitro helped. Probably a combo of both. Since then it's been determined that I'm HyperPOTS with high NE (noriepi) and lack of NO (nitric oxide) can trigger more NE. So, it all fits with me. There is probably a NET issue too. Along with EDS, also have autoimmune issues. So, that's the conclusion for me.

[Serbo]

thanks for your post Issie. How do you maintain NO?

I saw a Professor today here in the UK who's just got a grant to look at the link between non cardiac chest pain and true chest pain, e.g gerd making angina worse.

[juliegee]

The way I understand it, Kounis Syndrome CAN actually cause an MI. The artery is blocked- not by a physical blockage, but by a vasospasm. So, although it may be mediated by an "allergic" response, it most definitely can cause a heart attack. I, too, get intermittent chest pain & probably have experienced this on a mild level. Scary stuff.

[issie]

I'd suggest doing a search here on this site, in regards to NO. There has been a whole lot written on it and also references sited as to the studies. Most of what I've learned is from Ramakentesh. He lives in Austrlia and is very knowledgeable about it. I was asked whether or not I'd tried B12 and if it helped me. I had not tried it and got a sublingual one to try. Oh My Goodness, that was NOT, NOT good for me. When I did a search on it after the experiment - I found out that B12 is a powerful NO (Nitric Oxide) scavenger. This test along with the fact that the nitroglycerin helped me confirmed that I was LOW in NO and needed more. If the B12 had've helped it would have indicated that POSSIBLY (not conclusively) I had too much NO. Some people with POTS have too much NO - and some of us have too little. What I'm personally using to up my NO is l-Arginine. I have to take only a quarter of a pill or it is too much - it will bring on a migraine. It makes your veins and arteries expand - not constrict. Just the opposite of what most POTS people try to do. You see, not all of us can be treated the same. They are finding out that there are varieties of POTS and we have to sometimes be treated as EXACT opposites.

Issie

[sandymbme]

Thanks Julie and Issie. Mom actually sustained damage to her heart muscle from the spasming, not to mention nearly drowned to death as her lungs filled with fluid as well. (Did I mention how beyond grateful I am this happened in a hospital! Her docs are convinced had it happened at home she would have died. Thank God!)

I am more than willing to give an antihistamine a try. We usually have zyrtec and benadryl in the house, is there something else that is better, or would one of those do?

Thanks!

Sandy

[issie]

There are two types of histamine blockers. One blocks H1 the other H2. The H1 blockers are like Zyrtec or Claritin the H2 are like Tagament and Prilosec. Then there is also NasalCrom - which has another effect. I use, Claritin and Tagament and sometimes NasalCrom. The Zyrtec was too strong for me and Benadryl (these are H1) makes my tremors worse. So you just have to see what works best for you. Also, the allergy doc told me to NEVER take an H2 without an H1. Because the H2 will convert to an H1 and the allergy will be worse. You can take just an H1 by itself and use the NasalCrom. But, if you take Tagament you must take the Claritin with it. It's worth a try to see if it makes a difference. I was afraid of the H2 blocker because it can decrease stomach acid and we need that for digestion and assimilation - but when the allergy's are bad - it's a necessary thing. I will just use an enzyme after meals to make sure I assimilate properly. I was told to go off the H2's occasionally and see if just one type is enough. If the allergy's re-appear then go back on the H2's. Also, he said you can take more than one Claritin a day.

[E246]

HI Serbo,

That's really interesting - would love to find out what causes the chest pain. Today went for a walk - have only managed this 4 times in a year and yet that is because of the chest pain not the tachycardia.

Which Professor is doing the study? I am in UK to.

[Serbo]

Hi Emma,

http://www.gastroenterologycentre.co.uk/qasim_aziz.php

[E246]

Hi Serbo,

Thanks for that.

I feel fairly sure for me the chest pain on exertion is not gastric. You sort of know when something seems to fit and the microvasular spasm theory fits for me. Would be really interested to know how you get on.

Best of luck

[Serbo]

Is it chest pain literally every time you try and exercise? Or get to a certain level of activity, if you havent done one maybe get a stress test done, or a stress echo. I understand MVA is under a diagnosis of exclusion.

Not really sure what's going on with me, can walk for up to 3 hours of some days and no pain, stress seems to bring it on though.

[E246]

Hi,

Have just started a post today that explains how it happens.

Basically just standing up will bring on chest pain , often like dragging downwards or constriction or pressure. This will go on until i sit or lie down. It does not usually come on when sitting. Bur it stops me doing anything.

I think it is worst if i have had a sudden tachycardia ( often only know this has happened by checking watch) Then the cheat pain eases with sitting but takes hours to go away. Today i took half a valium to ease it.

The thing is my heart rate is not that high normally. When i was out walking yesterday (and have only managed this 4 times in a year) hr was only between 85-95 but the chest pain was there and this is what stops me.

Perhaps i need to see a cardio again- am waiting to be admitted in London for tests but not even sure my tt would class me as pots these days and yet i dont seem much better.

Is this very different to what you experience - it has always been my worse symptom.

[Serbo]

Hi - Have had similar sort of thing in the past, i'm a guy so used to get chest discomfort some times just standing up shaving. TBH I think the tests would put your mind at rest and give you an idea of whats going on.

Have had chest pain with tacky before when i had averse reaction to beta blockers. it's not nice, so sorry that you've got it all going on at once.

Pain is so subjective it's hard to compare i guess. With the EDS for example, all my cartilage in my chest clicks, that feels like a pressure, and i literally have to move to click it to stop the pain some times.