Angina/arterial Spasm-diagnosis And Treatment?

[mkoven]

It looks like there are a handful of people here diagnosed with coronary artery spasm or variant/prinzmetal angina--caused by spasm not blockage of a coronary artery. I was wondering if someone could tell how they were diagnosed and treated?

I have had two late-night episodes this week of bad left-sided chest pain radiating to left arm with nausea, while lying in bed around 3am. I've had a catheterization which showed clear arteries. I went to ER once this week, and all they did was an ekg, which was normal. I'm wondering if this is what I"m having. Looking on line, it looks like this tends to occur at rest and in the early hours of the morning.

It looks like nitrates and calcium channel blockers are the treatments? I guess my question would be what that does to bp in people with ans difficultes and low bp?

I didn't end up going to ER last night--maybe I should have? But maybe a call or page to a cardiologist?

[Guest tearose]

I do not have the diagnosis, I have had only a few extremely bad spells of this type of of spasm. Good thing for me, they were very short in duration. So, the dr. suspects a vairiant angina BUT it has not been captured on paper yet. I pray it never comes back! Mine were for just 10- 20 seconds. IF they were to continue for more than 3 minutes, I would have gone to the ER.

Actually, probably would have called 911.

I was prescribed nitro only for an attack that lasts for more than five minutes and told to basically only use it for a split second and lay down by my unlocked front door and have the telephone in my hand. My dr is concerned that it would lower my bp too much!

Side note, I NEVER use supplements without first getting my dr. approval. He would not even let me use a supplement of arginine because it has vasodialating properties. I think it must be very individual.

sorry I don't have more understanding to share, this one is a new challenge for me too!

tearose

[Csmith3]

I've taken calcium channel blockers in the past at low and relatively high doses. At that time I had POTS and low BP, but wasn't getting it monitored so I don't know exactly what effect it had on either. However, I can say that I didn't feel any better or worse on the calcium channel blockers. I wasn't getting chest pains at that time so can't comment on whether it would have improved them.

I bought a GTN spray, but I've never dared use it. In a small percentage of people it can make matters worse and I would have thought that with POTS, EDS and low BP, I would be one of those people. I was interested to see in replies to your recent post that others successfully use GTN. To be fair, I haven't needed to use it recently either, but if I did I would want to be in easy reach of the hospital in case I made matters worse.

Sorry to hear the chest pains are continuing. Hope you can get some relief and some answers soon.

[bjt22]

No firm, exact, diagnosis, but following several episodes that perfectly fit the description several years ago, it was assumed that this was what caused certain specific kinds of attacks that I have. When this happened, I did a lot of research and found many studies that linked such spasms to autonomic "imbalance" as well as such common co-morbidities as migraine, raynauds, etc. A couple of years ago, while having a stress test, there were slight indications of this occurring in my ECG as well. I will also confess here that on my own I did a very foolish thing....something I would advice no one else to EVER try at home on their own. I did the hand-in-ice water thing. I literally thought I was going to die. Within the space of a few seconds, this produced the most horrific spasm feeling in my heart imaginable. Kinda removed my own personal doubts, you know? The gold standard of testing, however, for coronary artery spasm is through having several agents injected into the coronary arteries during catherization in an attempt to provoke such a spasm.

A couple of the drugs that I am on seem to have calmed these episodes down considerably. Between a strong dose of a beta blocker and Catapres, I get considerable relief. What was occurring several times a day now only effects me periodically...maybe a few times a month for the stronger episodes while at other times, they are much, much milder.

As long as one has arteries that are fairly clean, there doesn't seem to be much significance of these spasms. As I grow older, however, and my arteries are no doubt becoming, well, less so, I am a bit more concerned. In fact, this was why my family doctor insisted that I take a statin drug the first time my cholesterol levels tested high....its presumed that statins work quite well at sort of stabilizing any plaque growth making it less likely that a piece would dislodge and form a clot during such a spasm.

[Gracefulprincess]

i was dx with coronary artery spasms a year ago. i had several echos done as well as other tests, that all came back showing everything was clear and there were no blockages. He put me on Cardizem CD (calcium channel blocker) and nitro. I think both meds have really helped me with the chest pain. Before, my chest pain episodes would last for over an hour and i couldn't move cause it would hurt so bad. Now when i start having severe chest pain, the nitro usually works within a five mins.

[Radha]

i get these spasms too, but not an official diagnosis, but fits every classic symptom of this type of this microvascular angina, i know i am too young to have

any blockage since i am only 33 and never smoked or drank and low cholesterol, chewing an aspirin and inhaling oxygen defiantely helps, i can say when i

get it it is very scarey and so so painful! i would loke to have test done at that time but there is no way to get there in time since it would probably be gone

by then! so frustrating! but glad to know i am not the only one! i get terrible jaw pressure with the crushing chest pain too. so this is related to the POTS and

EDS? thanks for any info.

Radha

[Carly87]

I will also confess here that on my own I did a very foolish thing....something I would advice no one else to EVER try at home on their own. I did the hand-in-ice water thing. I literally thought I was going to die. Within the space of a few seconds, this produced the most horrific spasm feeling in my heart imaginable.

Kind of off topic, but can someone explain to me about this "hand in ice water" thing? I have actually done this recently without even knowing it had anything to do with this, but nothing happened to me...Except I got a really cold hand.

[mkoven]

Grrrr.... I had another episode last night around 2 am--just like the other two this week. Chest pain, left arm and neck pain, nausea. I did try to page a cardiologist this weekend, but never heard back. Anyway, ANOTHER ER trip. In case it is a spasm, I tried nitroglycerin in the ER. It did lower my bp, but I was okay if I was lying down. I got a prescription for nitro if it happens again-- and if it happened 3 times in one week, not to be a pessimist, but it very well may. It makes me feel better to know I'll have some on hand.

I'm worn out, as is my spouse. I have instructions to follow up with my pcp and cardiologist. Don't know if the cardiologist will call back. I guess I may end up waiting till Cleveland, if not-- just ten days away. And I guess I can use the nitro, and if it helps, I guess that supports the notion of spasm, since my arteries are clear?

[bjt22]

Yes, it would support the notion of spasm, or, as I think happens, too, very quick swings in blood pressure causing the pain. Does your blood pressure ever go high? Spiking a bp and dropping it back down very quickly can be very painful, too. So can a heart rate that does this....same principal, I believe, would cause nitro to be effective as it would keep the bp low and steady and not popping around so much. Have you read much about arterial spasm? A few years ago, I found several articles that proposed it occurred due to a "imbalance between sympathetic and parasympathetic activity"...well, duh...the group that would happen commonly to would be us! By the way, do you happen to have problems with migraine or cluster headache? To me, these go hand and hand with this...and in fact, when I'm in cluster mode, I have the pain in my chest and in my head at the same time. Its always the same pain, just in a different place.

And the hand/water thingy....or, the "cold pressor test" is a test that is sometimes done to test cardiovascular reactions to the hand being in cold water. I cannot recall what kind of readings they are specifically looking for in autonomic dysfunction, but usually, if this generates the pain in the chest that one is complaining of, it can be assumed to be due to a cardiovascular cause. I think they were using this years and years ago to try to provoke arterial spasm, but I'm not sure if they still are.

[mkoven]

I suppose could be bp swings. I occasionally swing high. I've read a little on-line. The er doc wasn't convinved this was spasm, but said a cardiologist would be the one to consult. but he was perfectly willing to let me try the nitro, and I'm glad I could do it supervised. I could feel my bp drop--but not too low--100/57 supine. My head was a little poundy and it was a little hard to breathe, but not terrible. I took his advice and stayed lying down for 30 minutes before trying to sit up.

I do get migraines, and the nitro made my head pund. It didn't blossom into a migraine.

I hope it will be like an umbrella. If I have it by my bedside, maybe I'll never need it. I do get cp from low bp alone during the day, and I would hesitate before using nitro there, as I think that's a different mechanism.

Very interested to hear what Cleveland says about my constellation of symptoms. Apparently they could have done provocative testing during my cath, but didn't. I don't think that's a very common thing to do, and has some risks. I'll ask about the cold pressor test.

[mkoven]

Arrgh! I had another chest pain episode last night. that's four in eight days. Called pcp this morning. He told me not to take nitroglycerin, for fear it will bottom out my bp. I have to go to the ER EVERY TIME this happens until I get seen at Cleveland. This is what I was told.

What the?

Don't know what to think.