Chest Pain

[gjensen]

The EP at Mayo called my chest pains coronary vasospasms, and prescribed a calcium channel blocker.

[gjensen]

I have an appointment with Mayo on Sept 9th to test for coronary vasospasms. My local cardiologist has jumped on the bandwagon and is calling it this now. I am not sure what the test(s) will involve, but I will post the results. I would not be surprised if this is another wild goose chase, but this symptom has gotten so bad, I feel like I have to.

[gjensen]

They decided against the test because of the risks. They considered the history convincing enough. I have been officially diagnosed with coronary vasospasms.

It appears that for me, dysfunction in one place has led to dysfunction in another. My veins in the periphery are not constricting as the ought, and my arteries are constricting wen they should not or too much. Occasionally leading to all out spasms, that are very difficult.

I am convinced that many of us deal with this on some level, but may not mean all out spasms.

There was some clues all along that should have hinted at this for some time.

[little_blue_jay]

The EP at Mayo called my chest pains coronary vasospasms, and prescribed a calcium channel blocker.

Is the calcium channel blocker helping with this?

[gjensen]

The EP at Mayo called my chest pains coronary vasospasms, and prescribed a calcium channel blocker.

Is the calcium channel blocker helping with this?

Yes, and no. If that makes any sense. They tried upping the dose, but I could not tolerate it. I was getting runs of SVTs with this, and I have had none on the medication.

I am on Diltiazem, and another might work better. Usually they do. Diltiazem helps with the HR and rhythm issues though.

I need to do better, but all of this for me is not spasm. I am starting to be able to differentiate what is and is not.

What I cannot get a grip on is the chest pains that I get when I wake up. They seam different than the all out spasms, but are severe most days. They last anywhere from 30 minutes to 4-5 hours. If I do any moving around, it gets worse so I am bedridden until they subside.

I have had less concerning spells while on this medication. Also when I feel the medication taking effect, I get some relief. It is only temporary, unfortunately.

Mixed results.

[Goschi]

I seem to be a quite rate case, regarding the poll results. I actually never have (or had) proper chest pain.

What I do sometimes feel is a kind of very specific chest "discomfort" (chest feeling too tight or not getting enough air) but this doesn't include any type of pain.

The only parts of my body that really hurt (very often) are my (lower) legs.

[Susan3]

Gjensen-my chest pain sounds similar to yours. I have it first thing in the morning, with exercise, and stress and sometimes random. Its clearly what i refer to as "heart pain" because i know its not a sore muscle, rib, or nerve pain and its specifically on the left side often migrating up my neck to my jaw or down my left arm. Ive had many workups and only the usual POTS type evidence has resulted (sinus tachy, minor PVC's, minor regurgitation). Im really starting to think i may also have the vasospasms. Do you have Raynauds by chance? Wondering if its like raynauds in the heart???

[gjensen]

I do not have Raynauds (I do not think LOL.).

Vasospasms might be worth discussing with a doctor. Hopefully you have an open doctor and one that has a good understanding of vasospasm. I was surprised (should not have been) by the inconsistency. All had a basic understanding, but most were not up to date. The Mayo cardiologist has been the only one that is up to date. Most were clearly wrong on some important points.

You can have them with and without ECG changes. In an ER they are usually looking for ST elevation, but it is often associated with ST depression. You can have them with and without enzyme changes. Some do not get diagnosed until they have heart damage, and everything else has been ruled out.

It is difficult, because no one will test for it now. No one I could find. There is some risk with the test.

Sometimes it can show up during a Cath. They see the artery spasm, but unless it happens in front of them . . .

I would suggest being cautious about assuming the chest pain is vasospasm. Chest pain is common among POTS patients, but vasospasm is not. It does occur with POTS patients. I found a half dozen that have confirmed diagnoses.

Someone mentioned sympathetic over activity earlier in this thread. It seams that can cause them. There is a relationship between the spasms, and the alpha receptors. They rarely treat vasospasm with beta blockers. Vasospasm can occur with those that have anxiety/panic attacks. See the overlap?

I wonder with me if it is not a response or connected to deficits elsewhere. Then I wonder about norepinephrine levels. Exertion is a trigger for me. Especially after laying back down. Waking up is a trigger. Hyperventilation is a trigger for me.

It is common for people with spasm to complain of sub sternal chest pain. For the general population, they are most common between midnight and 8am. That is true for me, other than my triggers.

I get a lot of chest pain, and I have become reluctant to call all of it spasm.

Outside of spasm, I am unsatisfied with the common explanations for our chest pain.