Angina / Drugs

Oh that sounds terrible.  what is vasospasm.  

Im going to start tomorrow taking an hour before food instead of last thing at night.  What syptoms did you have which led to this all i had was a pain in my jaw for about twenty mins 

Vasospasm are whats happening to my arteries that supply the heart with blood,they got a mind of their own and go into spasms causing a lot of pain hence 30mg morphine in morning 30mg at night and if i need it oromorph during the day.My symptons started years ago with chest pain.

Hi peter,

May I ask why you can't have stents ? is the coronary artery spasms the only reason why they won't fit them or is there more to the stenting ? I sufferer from coronary artery spasm in a bad way as well and if my blockages don't clear up with drug therapy and keep the exercising up I will need stents as well, my cardiologist has never mentioned the problem that you mentioned ( squashing ) when artery goes into spasm, if anything it should stop the spasming because of the artery being opened up, Yes I realise you can have extremely healthy arteries and still suffer coronary artery spasms, that's how mine started out, however, over time people will have a tendency to get plaque build up, especially if it runs in the family, this makes the spasms worse (Plaque build up ) so by removing the plaque according to science your spasms should reduce, but we all know nothing goes by the laws of science. I'm just curious as to why a cardiologist would rather you take opiates rather than stents. I'm on opiates myself for pain relief as well ,also all the top of the line medication for Prinzmetal Angina. They consider my blockages as "baby" blockages 50% Stenosis in the LAD and 60 % in the RCA, so no stents at this stage as mentioned, those blockages are considered not threatening.

Hi 🙋 Samuels,well my friend we seem to have the same symptoms but hope you don't get the same pain as I get sometimes even though I'm on morphine it still grabs me at times sometimes lasting a matter of moments to 20 or so minutes,but you asked me about the spasms well I have seen my spasms in action,not good for me but brilliant to watch,I was having my 2nd angiogram and as you know they pump dye into you well I'm watching my blood being pumped round my arteries then all of a sudden it stopped as if I had a 100% blockage ,this is what happens when you have a spasm It closes the artery and stops blood going any further but will relax letting blood flow again,I do have plaque blockages allowing blood flow but they be happier if I had more flow but can't fit stents as the spasms I get would crush them and make things worse so as I said I'm at home with a mountain of medication hoping the spasms will go on vacation and leave me alone ,,I hope that answers everything my friend.😊.

Hi peter,

Actually no it doesn't but hey we are all different and have cardiologists with their own theories. Like you my spasms last 10 minutes to 2 -3 hours and I have to take more pain relief if the first lot doesn't work. I have developed a tolerence to all the medications with the exception of may one perhaps 2, My spasms were reduced dramatically at first with an introduction to a medication called Perhexiline and higher than general allowable doses of Cardizem ( Diltiazem ) To the best of my knowledge and what my research I have done on this Perhexiline is that the Western World cardio's seem to think this drug is to dangerous, it's been around since the ' 70 s' and Australia and New Zealand are the only countries that cardio's prescribe it for coronary artery spasms.

As you know this condition is debilitating and has the potential to ruin lives. Also as you know cold weather, severe heat and emotional stress can be the biggest triggers, and what's more it's a real pain in the back side because the spasms seem to come from nowhere while at rest. I'm on endone for my pain relief as the newer generation of doctors don't believe in opiate pain relief for coronary artery spasms, they act as they think they know coronary artery spsams don't hurt, however I'm lucky that some of the regular older doctors that are aware of the condition will automatically give me endone, morphine was stopped because of the amount of time I was in emergency and the ramifications that morphine can cause, endone is the same but "apparently " not as severe , only the other day another emergency doctor asked me to mention to my GP about Targin, apparently the same as Endone but is longer lasting and much less troublesome on the gut.

Hi 🙋 there my friend,sorry if I didn't make things clear last message kindly let me know what it was,read you message thank you with great interest now I assume you live across the pond from the UK,seems we are in the same boat as it were going to give you a list of my medication,so I take Esomeprazole 40mg morning to settle stomach then its Atorvastatin 80mg at night,Isosorbide mononitrate 60mg twice a day,Aspirin 75mg morning,Nicorandil 10mg twice a day,Adizem (diltiazem)120mg twice a day,Zomorph (morphine sulphate 20mg twice a day,Oramorph (morphine sulphate)5/10mg when needed which is most of the time,Glyceryl triitrate spray,when needed,,Well any of those ring any bells with you and I have a couple of inhalers for my emphysema plus waiting on the ok for oxygen so that's my lot apart from stuff I take to stop constipation..Have ever not been in pain but felt the spasms happening?,feels like someone has their hand inside your chest sqeeezing your heart,weird feeling,like you I was in our local hospital a hell of a lot but now I know what it is and as long as I don't think I'm having a heart attack then I won't bother them,trouble is there is no set cure as I said I needed a bypass but because of my severe emphysema the surgeon wouldn't risk it as I probably wouldn't make it off his table so they tried yet another angiogram but this time they put a pressure wire into my heart,not sure what it was suppose to do but it left my right arm black and blue where the pressure burst loads of tiny blood vessels that's when they found they couldn't fit stents as the spasms are too strong and would crush them give me even more problems,,have you ever seen a stent they are not that hard so I can see how easily they would be crushed,so buddy its down to medication and getting it right,luckily I'm retired now so haven't got to worry about work etc but as you say it would be nice to have a life,take it easy my friend.

Hi Peter,

Yes I live accross the pond

My medications are pretty well similar, I take the Nexium as well, mine is morning as well but also take when required, I am on 120 Mg of Monodur 1X daily, Nicorandil 20 Mg 2X daily, Perhexiline 100 Mg X 2 daily, Cardizem 600 Mg 2X daily although I must point out that is divided up for the day 360 Mg of AM and 240 Mg in PM, I was on 600 Mg Cardizem 1X daily but it was decided to try it in divided doses as 600 Mg isn't ordinarily a dosage rate to be given out by doctors, well here anyrate, am also on low dose aspirin daily and a puffer when required , ohh nearly forgot the good old GTN spray as needed. I also take Endone when required, even though it takes care of the spasms pain it doesn't take care of the spasms themselves, I can live with that I hate that heavy / crushing sensation in the chest, left arm, back and on the odd occassion the Jaw.

Now I understand why they won't operate, due to your emphysema , however I do know personally of 2 people who have had quadruple bypasses although they haven't / didn't have coronary artery spasms but they had dicky tickers and emphysema , they were told there is an extremely high chance they may not ever get off the table but as their faith played out they survived one has passed on due to a bit of both old age and heart related problems, the other is still kicking along, doing Ok for a person that is pretty close if not already 80, they do unfortunately require another bypass but due to her age she has decided to let medicine and nature take it's course, she was in her mid 70's for the triple /quadruple bypass.

I hate being in the ED but because all my episodes feel exactly the same as when I had the NSTEMI's I cannot differentiate between the spasms and what might be an NSTEMI, know what I mean ? I may of had a small event this week just gone, I did as instructed, took the endone kept up the GTN , the Endone kept the pain at bay for 4-6 hours , then I would have to have another one and in all that time I wasn't feeling myself as usual so come the third day I called for an ambulance, followed my management plan in the emergency department,troponins came back as raised, was to be admitted, no beds available, had to lay back in one of their "comfy " chairs for repeat troponin, came back lower so was discharged home, Back in there the following morning with worsening chest pain, trops done again, they were still on their way down . I realise if I was to have a full blown heart attack I'd be pretty well much be dead on arrival of face planting the ground or the very least unconcious, but having an NSTEMI isn't the nicest feeling either but at least you have a chance if you're at home alone like I am most days to call for help. Even though I know what it is there's just no differentiating between the 2 for me.

Yes I've seen stents and I was lead to believe that they are pretty flexible to handle spasms ? This seems to be where your cardiologists and mine seem to have given us different information. I to have had that pressure wire test and I was also unsure what it was doing but it did recreate my chest pains, I also am retired, well for the moment, I'm to young for full retirement but unfortunately I have these 2 conditions that prevent me from working at the moment.

Hope you have an enjoyable and happy Easter

Hi Samuels how you going my friend?.hope you havent been to your local hospital lately?.i havent been although my wife has said i should have gone a couple of times but we know the problem is so as long as it dont get any worse then why bother them .im still waiting for an appointment to see my cardiologist and also ive just had an operation cancelled on my prostrate because of my heart condition which even my GP cant understand as they only stick a needle in your back and numb you from the waist down.dont have to have a general for this one.but my GP did tell me my heart is very unstable so maybe thats why.anyway hope your getting on ok mate.

Hi Peter,

Doing so so, you know the old saying , no use complaining    Yes doctors like to have in house well even out  house fighting don't they, some are for and some are against surgical procedures, If only we could predict the future ourselves.

I've had about 3 trips in since I spoke to you last, troponins all over the place, one lot was raised again but not enough to concern anyone but it was still positive, my trops have been sitting higher than normal even though they are in the negative range, I'm sitting between 11 - 14 lately, prior to those readings I was sitting between 5-8, that tells me something and is a question I have for my cardiologist next time I see him. I had a puffed up leg 3 weeks ago and a very sore calf muscle, both my GP and I thought I may of strained the muscle as I had been pretty active around the house doing all my odd jobs, I had to go to our emergency department a day or 2 after seeing my GP for the chest pain and breathlessness as it was getting worse, the triage nurse was actually worried about my leg than my angina chest pain,I was taken straight into emergency to be seen instead of the usual, sitting out in the waiting room for blood results, the emergency doctor looked me over, measured both legs and the left leg was swollen considerably, he said he was going to do the usual blood tests and he was going to slip in another blood test, he said I'm sure it will come back negative but he would check anyrate, I couldn't remember the name of the blood test til I asked another doctor, they call it a D dimer, tests for blood clots, the doctor came back and said he has to eat his words because the tests came back positive, both trops and the D dimer test. I was admitted for a contrast CT scan for the following day as it was late in the evening when I was admitted, they found several blood clots in both lungs, apparently broke off from down in my leg and travelled to the lungs, on blood thinners now as well as my normal daily aspirin, they say it can take up to 6 months for the clots to completely dissolve. I'm lucky I had an on the ball emergency doctor that bothered to investigate my sore leg rather than fob it off as a strained muscle as did my GP and I.

Having a few spasms today but it's at the controllable level so  I hope it stays that way for the rest of the day.

Stay as fit as you can and look after yourself, is good to hear from you again

thats what i have been doing but today told noooooo has to be first thing in morning

 

I guess you can experiment, as long as you're taking it every day I don't think you'll do any damage by trying what suits you best with regards to Time of dispensing

Im going to start tomorrow taking it in the morning to see if it makes a difference, im just fed up feeling queezy all day 

Hi christine,

Reflux medication is best taken in the morning, your Doctor  probably has suggested that way for you because perhaps that's when you start taking angina medication ?