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What To Do? Recurrent Night Time Chest Pain/prinzmetal?


mkoven
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So long story short, I keep having late-night/early morning episodes of chest pain.nausea/left arm pain. shortness of breath after lying back dwon from a bathroom trip. Two of my docs suspect prinzmetal angina, as my arteries are clear.

I"ve been to the ER three times in ten days. I've had six episodes.

I am being given contradictory directions:

Primary care: Go to ER every single time, even if all previous tests have been normal.

ER: they no longer give me the full workup-- just an ekg, which has been normal, and send me home. I get the sense they don't think I should return.

Out-of-town cardio-- get admitted to a hospital (probably his) and start a trial of cardizem, a calcium channel blocker. He wants me admitted to monitor me, to make sure my bp doesn't bottom out. He is afraid that the one time I don't go to ER may be the time a spasm does damage.

Local cardios- do not want to do this. Sit tight till cleveland, because all my tests have been normal to date.

I have an appointment at Cleveland on 8/14, but at the rate these events are occurring, could have more between now and then.

So here are my options:

1. Continue to go to ER every time, regadless of the hour, regardless of the frequency. this could be daily. and almost always in the middle of the night. But still get evaluated at Cleveland. No treatment until then, just repeated ER exams, till I see the "experts."

2. Stop going to ER. Assume these are just like other times that have always been okay. Get evaluated at Cleveland. (Prinzmetal is not entirely benign, and does carry a small risk of heart attack.)

3. Go to hospital of out-of-town cardio to try cardizem; get discharged in time for Cleveland (I hope). I might also wonder how starting cardizem might affect my evaluation at Cleveland.

I've been told not to take nitro out of fear it will bottom out my bp.

How am I to decide what to do? The outof town cardio, ER docs, my pcp, and local cardios are all of different opinions.

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Ideally, you want a medication that will not put you in the position of having to decide what to do once the attack begins. For me, the combination of a beta blocker and catapres reduced these attacks by about 80 percent. I imagine they help me by keeping my blood pressure and heart rate at more even levels...I think what happens to us at night is that the surplus of sympathetic activity quickly departs once we get quiet and horizontal at night. Circadian rhythms probably play a role, too.

What to do when you do have an attack? Well, I have never once gone to the ER in over 10 years of having them. And I'm obviously not dead. You recently had an angiogram that showed your arteries are clear, right? Many don't believe that arterial spasms are particularly worrisome in a person without coronary artery disease. To be on the safe side, I always take an aspirin at the onset of the pain. Heck, a couple of high dose strength aspirin can even lessen the amount of pain. I've also found that the oxygen I keep for my cluster headaches can sometimes be helpful as well.

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Guest tearose

YOU must make the call! I do understand because I have experienced these. Are you brought to your knees? Do you feel like on a scale of 10/10 it is 10? Lack of sleep and cold temperatures are my triggers so I feel a bit able to manage this. If ever I am down on the floor for more than seconds, I'm calling 911. No question.

You only have this one heart my dear. You don't want to do damage that makes life harder for yourself. The thing that bothers me for you is that you have had too many in too close a period of time. Do you sense any contributing factors? I so wish I had "the answer" for you but only you truly know what you must do. Be brutally honest with yourself and trust that.

warm wishes,

tearose

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Before I got control of my episodes, I was having them 4-5 times a week. I stopped going to the ER because they really didn't help and didn't take it seriously. You are so close to your appointment that I would probably wait. However, you are the only one who can make the decision. Trust your instincts.

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I'm really torn. The pain is not off the charts, but bothers me that it is there at all. It's maybe a 4.

Contributing factors? My approaching period. There is also something about getting out of and returning to bed at a certain hour--some tension between trying to relax and having been roused. If I don't get out of bed, it doesn't happen. So when I need to pee super late at night, I am not happy. It doesn't happen every night, but probably every other night. If I could just have an empty bladder! I've tried limiting fluids close to bedtime, but there's no way I can make it for a seven hour stretch. Maybe I should just not go back to bed if I get up and use the bathroom after 2am-- at least until I get to Cleveland? The only was I could tolerate the effect on my sleep would be to go to bed super early. But even this is no guarantee.

I've tried sitting on the side of the bed to try to settle down for a couple minutes after returning from the bathroom. then lying on my side for a couple minutes till it feels my hr has slowed. then turning on my cpap machine. then just trying to breathe really slowly and evenly. And STILL, this started up.

They did give me an event recorder, which I'm told is far inferior to a full ekg, as it only has 2 leads vs 12. I pushed the button twice, then got up and called in the events. The person on the other end did not react or tell me to seek emergent care, as I think they have to if they see something scary. but otherwise they can't tell you anything. But my doc told me not to rely on the event recorder to tell me I'm okay. I guess it's better than nothing.

I was then pretty stirred up. I took a teeny bit of klonopin, and did manage to get back to sleep for another 90 minutes. But I"m worn out. These are happening so often.

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