prinzmetals angina

Hi cher,

There are many factors that can trigger Prinzmetal, the most common is caffeine in any product, chocolate (chocolate has caffeine in it - I believe not all brand names though) cold weather, extreme heat, colds,flu's and viruses that weaken our immune system also pnemonia, lung problems, heavy meals can also trigger an event, stress is another big trigger,sometimes there doesn't have to be anything needed to trigger it off they just happen out of the blue.

I'm not one for taking supplements or into naturpathy, they can interfere with a lot of our medications I have been informed by my cardiologists, they can't stop us from taking them but the do plead that we seek their opinion first before trying due to to many things interfering with each other.

I have had 4 visits to our ED in the last 2 weeks on the second visit the attending doctor wanted to try another approach with me, it is an addictive approach and I have to watch what I'm doing, for you see we are trying to cut the number of trips to emergency , he prescribed 5mg Endone to be taken once every 4-6 hours but no more than 4 a day, was working a treat,but then I had an episode Saturday just gone where I had exceeded the 4 tablets and called an ambulance , I was told I could take 2 endone to start off with and if pain returned I could take 1 again 3 hours after and then another 4 hours after, because it's been so cold down here it jusdidn't work properly on saturday. IN between visits I've had other consultants tell me that I'm actually taking a dangerous path by following the other consultants way of taking endone, they tell me to call an ambulance regardless of when I take the endone as they have told me that they may be spasms now and my past history of NSTEMI's and a TIA, I could have a STEMI anytime or even a stroke....pretty weird how emergency consultants views differ from some of the others.....

Does not say where you are at I think you should seek out some one familiar with Vriant Angina & Micovessel disease as well. So many Cardios say they know the disease but really fail to understand the indications. It gets very frustating for all of us. A really good Cardio will think to look for coronary spasms. Many of us have foudn they bad ones will not look and instead suggest antianxiety meds or keep having the GI's redo test for GI issues even though the GI 's are adamant you do not have those. Right now I am going thru Pericarditis on top of it and it took them weeks to figure out I had gone into to Pericarditis. The physicians seem to gorget you can have other things with the CAS as well. Very frustraing for patients.

cher,

I live in USA, North Louisiana.  So far I was given a prescrip for anxiety, but pains in throat will come when I am a bit anxious.  The Variant angine hasn't even been mentioned as of yet.

Another site that is helpful to us all is myheartsisters org.  These are the names that PA is used in various places & articles it is the same disease

 Coronary artery spasm (CAS)  ie Prinzmetal angina (PA)  ie variant angina

Variant (Prinzmetal's) Angina

Variant angina is rare. A spasm in a coronary artery causes this type of angina.

Variant angina usually occurs while you're at rest, and the pain can be severe.

It usually happens between midnight and early morning. Medicine can relieve this type of angina.

Microvascular Angina or Syndrome X can be more severe and last longer than other types of angina.

Woman may have chest pain that feels like a stabbing, pulsating, burning, heavy or  sharp form of

chest discomfort rather than the more typical vise-like pressure and tightness of men. Women are

also more likely to experience nausea, shortness of breath or abdominal symptoms. These differences

may lead to delays in seeking treatment for many women. Remember, too, that about 40% of women

experience no chest symptoms at all during a heart attack.

Dressler’s syndrome has also been identified as something that happens to a small number of people 

three to four weeks after a heart attack. The heart muscle that died during the attack sets the

immune system in motion, calling on lymphocytes, one of the white blood cells, to infiltrate the

coverings of the heart (pericardium) and the lungs (pleura). It also starts generating antibodies,

which attack those two coverings. Chest pain is the predominant symptom.

Places with specialists

Cleveland Clinic Ohio , Florida there may be other locations

C. Noel Bairey Merz at  Cedars-Sinai Cardiology LA Calif

Mayo Clinic's , Scottsdale, Arizonia & Rochester, MN

Thank you for this clarification.

Hi mlafitte,

​If you are a known panic/anxiety sufferer like I was for close to 20 years it won't be mentioned either unless something shows up on an ECG (EKG ) for our USA friends, but that's another scenario in itself, spasms do not always show up on an ECG, *touch wood* I haven't had a panic attack coming onto 3 years now, still suffer from Agoraphobia but I was told that's normal after having a heart attack.

​Just keep at them , the doctor(s) you will find one that will listen.

Hi samuels,

No, no panic/anxiety sufferer.  I have not seen my cardiologist yet, as his office is moving, but I plan to and taking these printed papers with me to "suggest" the Variant angina.  If I have to learn to live with this and there isn't a permanent help plan, am in trouble.I rarely leave home and husband nags about going out alone (we live in a forest and very rural).  I can deal with that.  Concern is = mostly no throat pain during the day, unless I get into a hurry doing something, it will strike then, but at night, inactivity, heart is resting (unless you count nightmares the Isosorbide creates and Trazadone creates - No prob dealing with those), cannot figure why the spasms bombard me.  I feel so full of nitro the next morning, takes a good while to jump start the day.

Been through all types of pain, except the pain in the left arm.  Have had chest, mid-chest, left jaw, even a light stroke on the right side of body, stroke was a year before first heart problems.  But the throat pain is pretty darn close to the jaw pain, and that was BAD.

I take Isosorbide ER, one in the morning and one at night (right before bed), as I said -not too much discomfort during the day, but night time can be an absolute pain in the arse.

Thanks for all the help and input

Hi mlafitte,

​Yes it's very frustrating, I had an appointment with my cardiologist Monday just gone and had a decent discussion with him, actually I had a bit of a moan to him ...lol..., He tells me that all the anti angina medication that I'm on should stop the spasms in it's tracks, It doesn't always work and when you tell that to him/them they think that we are weird or something.

​Just lately my night time spasms have returned as where I am it's winter, well thankfully it is nearly over, Cold weather brings the spasms on something shocking and it takes ages to try and get rid of it, I end up in our ED to see if they will give me pain relief....9/10 they do but I occassionally get that one nasty  emergency doctor that won't prescribe pain relief, Endone works but I don't realy like taking them as I sleep the whole next day and feel completely buggered the following day, Morphine seems to work better for me with none of the above occurring the following day(s).

​The jaw pain is the real spooker for me as well as and indigestion feeling with a pain in the back, I know it's not indigestion as it has a slightly different feel about it, even the ED's pink ladies doesn't get rid of it . If I were to get indigestion Nexium takes care of it, I rarely get indigestion now while on medication for it, I will get indigestion if I forget to take the medication.

Hi Spotty,

Don't worry about them, just ignore them, I'm in the same boat , I think we all have and probably still are. Nothing a complaint to the hospitals complaints and compliments department should'nt fix, I'm sure your hospital would have one. I'm not even offered a bed anymore because they know what it is and if there's no changes in the ECG they shove me out in the waiting room, and wait for my Trops to come back, they'd be buggered if they come back positive again wouldn't they....lol....but in reality my Trops only come back positive once in a blue moon, been told I've had what they call NSTEMI's, ECG doesn't pick that up either. "apparently" I'm on the best medication for Prinzmetal Angina ,I'm sure I am but I think my system is getting immune to some of them, especially the GTN spray, Nicorandil and Cardizem helps a lot but I was reading the other night that patients can become "immune" or just doesn't work anymore because the body is so use to it.

If I get a doctor that gets a bit cocky I bite back now, I got sick of the way I was being treated before, the nurses are fantastic here and a majority of the senior doctors are as well. In winter time I'm in emergency up to 3 times a week(only if exposed to the cold air to much ) and prior to having my Cardizem increased I too was in there once a week, the spasms come in clusters at the same time each day or whatever. I had a doctor last week try to tell me that I haven't got PM that it might be pyscological, and Panic attacks, If I had of read the letter prior to leaving she would of got a serving, my GP knows I haven't had a Panic attack in 3 years, I still have Agoraphobia due to several NSTEMI's (mild heart attacks) and I have been told that is normal after having a heart attack, Yes there maybe a degree of anxiety involved when the chest pains come but it's definately not a panic attack.

So don't put up with it anymore complain if you have to, We all have better things to do than be sitting or laying in hospital.... I even get that sometimes, being told could it be a bit of" hypercondria".....lol if it's not a panic attack.

Thanks for that I'm so glad I'm not the only one.....I shall be making a complaint today then. So I guess when I say I have palpitations it's actually a spasm which you can feel.

I actually get pain with it, I do get Palpitations with the chest pains sometimes.... There has been a few times where I thought I have felt the spasms, I can't honestly say if you can feel the spasms or not, I just feel pain, short of breath and pain radiation ....

I get exactly what you describe...the pain is so intense isn't it, i get in all kinds of positions to try get comfy. Thanks for sharing kind of made me feel better that I can relate to other people. Wouldn't wish this on anybody though.

No it's something I wouldn't wish upon others either, and as we both know some doctors think we are making it up or give us some other exscuse. I actually apologised to a senior doctor in our emergency for being such a pain in the arse...lol... but she said don't be because it's one of those conditions where It has to be looked at each time, I also asked her how many others have this condition and she said there is around 12 of us with it and the other 11 are frequent if not more frequent visitors to emergency than me, that in itself kind of made me feel a tad bit better....lol...

The emergency physicians are so ill informed. Mayo recreated my issues int he cath lab and in the OCt 2013 one the did the injection ot recreate it saw the artery spasms multu vessel saw the flow deviation & of course Iwent into angina. NO ECG chnage.  I took mutiple doses of Nitro straight into the arteries to stop the attack.  I carry a DVD copu of articles plue that caather reprot to hand to those that say 'in all my years never seen this'.... 

And oh yes I have a letter from my cardiologist that gives ER physicians instructions to place me on IV Nitro drip titrate up until pain stops leave it for 200hour try to titrate down. I if they cannot get it stopped I ear an ambulance ride to the Cardiac  intensive care 70 miles away. There i stay until under control. These are the meds that worked for me at times ditalizem(cardizem)  worked for years, when it stopped working  we went  tto Verapimil which held for several years along with Imdur 120 1x. Always had nitro spary to stopp breakthrus, In those years only had Emergency visits a few times. Then in 2010 collapsed lung and been downhill from there. Nicardipine wokred for a while then they addd Nifedipine and more different types of nitro. But I am a complicated case with fibromuscular dysplasia renal arteries casues BP's to 220's over 140's as well as hypoxia due to Tracheobronchomalacia affects the Trachea & mainstem bronchi, the tubes that carry air to the lungs. When the tracheal cartilage softens and collapse. I also have Tachycardia/Bradycaria, irregular heart beats, PVC & Pacs. SO right now those are the main triggers that have me in bad shape. So there are alot of options if your physician has nto tried several meds see if they will try. I have been told not to take betablockers they make it much worse. Current medical research shows that Calcium channe; blockers work best with the CAS(Cororany Artery Spasm/variant angina/ prinzmetal. 

Went to A&E about three weeks ago (will be tomorrow) and had an urgent angiogram, checking for blockages and all, didnt find any of those but didnt look for spasms while they were there (pity!!) went last night and docotr was well why are you here.... hmmm so why are you here then.... hmmm so really why are you here.... having explained three times now that i was there because having taken loads of gtn (6+ pairs of sprays in 3/4 hour and previously been advised that 3 pairs of sprays and i should go in... he reluctantly did cardigram... then said ah well these look ok you i am not going to bother to take bloods you do probably have prinzmetal spasms, ...bye...   no pain relief no bloods and oh the feeling was why are you wasting my time all the way through the interview... felt like i was making it up to get sympathy, result is i now feel i wont call for help even when i need it (yes i will at the time but currently) very embarrased very frustrated and prettyy darn annoyed! Wife wasnt too impressed either. We know the spasms can go on to heart attacks but he wasnt interested in the effect of the pain, the cause or anything else, and it was only a 1/2 hour into their shift... 

Hi Andrew,

​Know that feeling all to well, I was in emergency last week, everything came back negative and no acute ECG changes, the doctor that saw me had written out a letter for me to give to my GP, she gave it to me in 2 pages, not in an envelope so I read it, while consulting she told me it was my Prinzmetal acting up, I read the notes she gave me to give to my doctor and in it she states that she believes it's more panic attacks than anything and that my cardiologist had his reservations that I am suffering from Prinzmetal Angina, funny thing that, 3 cardiologists have told me that's what I have,(yet she asks if the York Angina Plan had been tried on me- totally weird) she also doubted that I had 3 mild heart attacks, I think she is sick of seeing me in emergency , I had at least 6 doctors and 3 cardiologist say that I did, she totally contradicted herself in the letter and the consult on the same night as of her writing that letter, I wonder if they actually read our notes properly or even go back a year or 2 to read notes insted of the most recent notes.

I have just come home from emergency tonight, been home now for just under an hour, the attending doctor today did the blood test and the repeat blood test,both came back negative so he said it was just my Prinzmetal acting up today, he had written up pain relief but I never got it,I found some endone when I got home, pain is almost gone now. todays doctor said that I did the right thing by coming in even though it was just my angina acting up, it's always best to be safe than sorry or worse ...dead...lol..if he could see all this in my notes why couldn't the doctor see them last week, makes one wonder.

It is horrible that we often go thru this in the ER.  Even with my standing orders in my hand that say to put me on IV nitro to calm it down they argue against that. But here they call over to my Cardiac physician and the reitterate what it says in writing because my cqardio has put a note in for all the oncall hysicians to that affect.  But even so I have this one older women ER physician that is always nasty to me. We hate see she is on shift. She was Monday when I had to go in again.   When they are like this I wonder how many patients with Variant Angina they do nto treat properly and send home to have MI at home.

I know that feeling so well one doctor belittled me in front of my wife telling me there was nothing wrong with me and that my problem was in my head and should go to the GP.

Yes it's shocking, no-one should ever have to go through things like this, I to have a few notes from my cardiologists to emergency , I know one of them is at least one troponin blood test has to be done, I use to have the GTN infusion but I think Professor put a stop to that for some reason, I was also prescribed GTN patches by emergency doctors and then followed on by my GP, Professor told me to throw them straight into the bin, to this day I still don't know why exactly, he just says they are "useless".

​I have actually heard of a couple of people been told it's only indigestion and given a pink lady and sent home and then a couple of hours later have had a massive heart attack, I heard on the grapevine that one family were taking legal action as the patient said he just didn't feel right and also didn't really want to go home.... when someone is like that, that is a mighty big indicator for something in my books.

Hi Samuel and Cher, indeed, saw GP today and he wasnt too pleased either... he said in view of my symptoms i should have had trops done (symptoms were Pain around heart and up into upper left chest, pain in left jaw, behind left shoulder blade and into left arm, felt a bit sick and dizzy) I guess today i am lucky... he also pointed out he wanted me to go to A&E regardless of what i think of the whose on duty, just to tell them that was his requirement and next time that he required trops to be done.... makes that a bit easier... "my GP wants" sounds better than "i think i am poorly but not sure if it "just" prinz playing up...." thank you both for your horror stories, makes me feel less lonely even if sorry for you and them!

 

Sorry Spotty missed your post first time round.... Yes Suzanne (wife) arrived there worried about me, i left feeling worried about the docs future prospects of surviving  ooops, gets frustrating though we were well behaved and half the things i wanted to say i managed not to....  

OH well in those cases I take the copy of my Cardiac docotrs instructions & I write a letter to the baord in charge of complaints and attach it along with waht the ER doctor said and did. That physician  then normally never give me an issue after that. 

It's so frustrating isn't it.....I'm now home but still in pain I've now been put on 90mg Diltiazem so I'm waiting for these to get in my system......I've noticed people mention Prof Kaski so googled him last night and I've been in contact with his secretary who has forwarded my concerns to him and she said he will be in contact with me tomorrow....might as well use my private health care....and at last sombody who understands just like you guys and gals do.

I'm doing this straight away had enough of being treated like crap.

Hi Spotty... i am on 2 times 120mg one in morning one at night along with the other bits... Prof is very good and will give good advice, my advice to you is to get referred to him and go and get looked at properly if you can or do it through your local hospital but ask them to send results to prof...From experience getting advice and getting firm ongoing diagnosis is different.... as i said to "My local" cardiologist if it walks like a duck, talks like a duck has ducks feet, has ducks feathers and no other birds are around.... why wont you confirm Prinzmetal? (as prof Kaski advised/diagnosed me over 16 months ago) he said 'cos i havent seen its beak yet... (annoying good answer) ie not seen a raised ST on cardiogram, i showed him the raised st on Alivcor and showed the comparison with the base line graphs (4 different people) he said well Alivcor is really only to show arrhythmias but my GP accepts this data so... hmmm he said i will have to think on that, as he is currently on 3 weeks leave.... darn... But if he agrees with the GP then life will be a bit simpler if not its having angiograms until raised st seen i guess and that is not my idea of fun. As i also have ME having two illnesses that are shown by exclusion of all else is very very very very frustrating. Good luck with Prof, i really like him and think he is very helpful. Let us know how it goes! All good wishes!!  

Thanks Andrew....I was kind of lucky in the fact I had a spasm whilst having the angiogram.....Thought I was a gonna at the time but it cleared with nitro and the Dr said straight away you have prinzemetal angina or syndrome X and we have tablets to help (ibosorbimononitrate) That was 2 years ago and I've been ok so to speak but this past month has been absolute hell for me. Thanks to everyone as this forum has been a breath of fresh air to me and I can relate to you all.

Nice one, i had bumpy heart feelings and so on but as they were looking for blockages and i had been slotted in... missed oppertunity... brilliantly everything else has been ruled out.... That day the consultant doc did several planned angiograms and two "planned that day ones", one was me...Sorry to read you are having a bad month, i get that too longish good times then weeks of trouble!!!! or suprises either day or night...

Hi Andrew,

​Finally got some more information on that drug I'm awaiting on, unfortunately my cardiologists time of release of the drug is way off I have to wait another 2 years before it will be available, providing it passes our Government medicines reveiw board.

I'ts called PCS K9, when you read the papers you will see what they have been able to achieve with this drug , cardiologist is highly confident it will very much help with my prinzmetal angina.

 

Thank you and pm'd back! very interesting indeed!!!