Coronary Artery Spasms

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Ok I have had this condition for years, some cardiologists agree with the diagnosis and a couple do not .Cut a long story short, last week I was out shopping, I had sudden crushing chest pain and felt really ill , had a spray, rested for 5 minutes and was able to able to continue on even though I was still feeling very unwell, the chest pain kept returning and it got to the stage where I just do what I usually do, grit my teeth and put up with it, as I was out had no other pain relief. Finished the shopping went back to my mothers to install a new telephone for her and then came home, I was then able to take my prescribed pain relief, after an hour I was pain free. Five hours later it all started again so back to using the GTN, this would help but for no longer than 10 minutes, I followed my cardiologists instructions in this case, after 30 minutes pain was still there and GTN was pretty much useless and I was still feeling quite unwell, I decided to call an ambulance, their ECG machine showed a normal tracing , however on the way in the machine started carrying on, alarms going off every  couple of minutes, it had the paramedic a bit confused I think because it was telling him I was in VTAC, which in laymans terms means I was flat lining to which I wasn't, the machine was telling fibs smile then further down the track the machine went off again and told him something else was going on, once again if the machine was accurate with what it was telling him I would be dead. We reached the hospital their ECG showed nothing, had blood taken for troponins, waited for the hour and then I was called in and told I had to have a repeat, I asked what the first trop came back as, I was told 22, second test came back in at 31, doctor was happy to send me home, this was early hours in the morning, like 2am. I had to call an ambulance again around lunchtime that same day, once again ECG showed nothing, troponins done again, was called back in and told I  had to have another repeat test, first one came back 32, second one came back at 32, this doctor was also happy to send me home, that night I ended back in our emergency department again that night which ticked over into the early hours of the morning, ECG done again, all good, took more blood for troponins, first one came back at 45, once again second test was done and that came back at 40, no explanations as to why it was up after me asking what was going on with me, was told they don't think it was cardiac related so sent home again. By this time I was sick of going back and forth to the emergency department and I just kept the pain under control with my pain medication. 2 days later I had to go back in with same chest pain and associated radiation pain, you know all the normal angina symptoms, I was still feeling quite unwell, I called for another ambulance, arrived at the emergency department, ECG normal still, bloods taken, first troponin came back at 49 this time so had to have repeat troponin, that came back at 49 as well, that was Ok, even though it was relatively high from the cut off point it wasn't increasing this time. I asked questions and was given the same answer, they don't think it was cardiac related, although I did have one doctor say that angina attacks can raise the troponins, but I wouldn't of thought that high ?

?I understand the basics of troponins and I know with the machine they use the cut off point is 14 for any kind of event, now from what I have understood from my cardiologist, he has stated that troponins are heart specific enzymes and are only released when the heart is in distress, like slowly being damaged or quickly damaged depending on how high the numbers are. I also know kidney function/failure, infections and pulmonary embolisms can raise troponins amongst a few other things, now I had nothing like that wrong with me, although I am recovering from a pulmonary embolism, I had more test done about 4 weeks ago and was given the all clear of a PE, it had disappeared, the clots had all gone, so I am assuming that could be ruled out as a cause for the troponin rises. My cardiologist said to me several months ago when the clot was found and my troponins were sitting around 20, he told me that the PE was only secondary to the troponin rises, because as I stated above as to what he said, troponin is heart specific, so the way I am understanding it, at that time when I did have the embolism it was putting strain on the right side of my heart in turn releasing concentrations of troponin, basically the heart was being put under strain and injuring it to release the troponin. What I can't get my head around is now that the troponins are almost double and they insist it's not cardiac related ? How does that work, does it sound right to any of you ? any kind of input or experiences would greatly be appreciated. I feel like I did when I have had previous NSTEMI's, quite unwell and feels like I have been hit by a bus. I'm still experiencing intermittent chest pain, even as I write this, it maybe another trip into emergency if the pain returns after the pain relief wears off.

 

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  • Posted

    Strewth Samuels - sounds like a clarification with your cadiologist is urgently called for !  What a stressful time.  Hope you will be OK - but assuredly sounds like the emergency dept hadn't got a clue !!  Take care -

     

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    • Posted

      Hi molly,

      ?Yes emergency doctor has put in an speedy request to see my cardiologist, I'm due to see him next month but the doctor and her consultant are of the opinion I need to be seen well before then, the public health system runs extremely slow here. Still getting chest pain on and off but at least troponins are going back down to normal, last trop test 2 days ago, after a week of being up it's down to 15 now. 

      ?Yes some of the emergency doctors just don't have a clue, I had a doctor ask me, me, mind you, what would I like him to do, I said I don't know I'm not a doctor, but let's just start in easing this pain eh, he ordered endone then sent me on my way, at that time my troponin was 35, 2 days later it peaked out at 49 and I felt like I'd been hit by a bus. I understand 49 isn't heart attack material, it needs to be up into the 100 -200 + for them to start thinking full blown heart attack. Something was causing my troponin to rise even though it only peaked to 49 and troponin is a heart specific enzyme, something was causing my trops to increase, they ruled out infection, kidneys, virus, etc etc 

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  • Posted

    I have the same thing going on. Amoplodine 2.5mg and I take a nitrate when the attack starts but I still have a pretty much uncomfortable heavy feeling a lot of the time.  omg and just found out the cold weather is a trigger too. 
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    • Posted

      Hi Dollabill,

      ?Yes cold weather is a definite trigger for prinzmetal angina (coronary artery) spasms, even a small puff of wind to the face will set it off. I think my system has built up a tolerance to nitrates, my retired cardiologist said I would. High emotional stress is also a trigger as well as extreme heat, can't really win either way.

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