prinzmetals angina

Know Corbell - his colleague, Dr Alain Perrens, at the same practice is the guy to see - but, is not taking any new patients !   I had an address 'ancienne' for Corbel, (Pages Jeune no updates, as they had moved several *months - possibly over a year...!  N.B. correct address :  4 Boulevard Jean Moulin, 29270 Carhaix-Plouguer - on the main drag, not far from Carhaix H.)   I walked forever trying to find the practice, so, was 15/20 mins late.  Corbel lost his rag with me.  Really abusive.  I walked out, refuse to ever go back there.  Perrenes is the recommended guy.  Reckoned to be really professional, takes time, listens, knows his stuff.  Corbel, impatient, full of himself...no thanks.  Try him out, see how it goes.  Can always dump him !  As you know, am looking for a good cardi myself, do not want to go to Paris.  Sigh.

Take care, be well Mike - Molly

Hi No More Scuba,

I was told about this L-Argenine? and how it was benefiting a lot of patients, so I asked my GP and pharmacist and I pretty well got the same answer from them, they didn't think it was beneficial for this kind of condition, remember what I said about vitamins and supplements in my previous comments, I'm lead to believe L-Argenine? is a supplement ? I honestly don't know, but anyrate I never bothered purchasing any based on 2 health care professionals opinions, 2 opinions were enough for me. I have had experience with the good old fashioned Epsom salts, you know for the aching muscles and it's relaxing properties while soaking in the bath, It did seem to have an effect on the frequency of my spasms, not much but did notice that attacks were spread further apart, Even this product  has mixed reactions, works with some, not for others, but as you probably know, Epsom salts like Bi carbonate of soda has a lot of remedies both health and around the home and work for cleaning properties, etc etc .

?Glad you have a cardiologist, sorry I thought you already had one, my bad, hope he can sort you out and give you answers to all of your questions/concerns. I ended back up in emergency early hours of yesterday morning, we can't work it out, troponins are raised again, only slightly, first one was 32, repeat test was 33, they have been sitting in the 30's - 49 in the last month, I'm not considered an emergency case to see cardiologist if admitted, see here we have a real bad health care system problem, in actual fact for a first world country we have a third world health system, admit to hospital only if emergency or near dying attitude, I do have a cardio appointment next month but the emergency doctors want me seen ASAP due to the troponin rises so they have put in an urgent request that my appointment be bought forward as much as possible but being so close to the festive season I don't think this will happen,

?What does your GP say about having to use the GTN more often lately, did he advise to go to emergency after so many sprays in a certain time frame ? Here it is one spray every five minutes, if pain is still continually there after 10 minutes to call for ambulance, however in some cases like mine, 1 spray of GTN every 5 minutes and if the pain is still there after 20 minutes to call an ambulance. I don't play by those rules because I'm sick of having to go to emergency, perhaps that's why I have built up a tolerance to the GTN and I just keep spraying away until either I can't handle the pain or I can manage to get on top of it, I have at least one bad attack a week, but the last month ever so more frequently, hence how we found out my troponins were up slightly.

?Best of luck, (you may of attended your appointment by the time you read this  )  hope all goes well. Take care

Not surprised about the Epsom salt as they’re high in magnesium. Another supplement known to reduce spasms.

A) quit smoking 

B) try the supplements (What’s 30 dollars is it helps your health)

Still spasm free one year on, simply on supplements alone. 

I'm very happy to hear that you have managed several months without another attack however you quit smoking nicotine is one of the worst antagonist to prinzmetal angina. The other antagonist that are even worse are epinephrine and acetylcholine although you don't usually run into acetylcholine in the real world there are some drugs that decay to acetylcholine and acetylcholine is also one of the main chemicals in lettuce. As much as I would really love to say that you're probably right and you have beat the angina I'm sorry to say I have never heard of anyone ever actually beating it you can control it you can hold off the attacks as long as possible but it never really goes anywhere because it is your muscle cells that causes it. My cardiologists team has come up with a treatment for me which is working extremely well they have me on 360 mg of Verapamil which is the maximum dosage you can take what it does is it interrupts the calcium cycle which stops the attacks but it also stops my heart because of the dosage so they give you a pacemaker to keep your heart running at a minimum rate and then use whatever they can to control the calcium cycle, the calcium cycle is the single major cause of attacks in my case I have CLL chronic lymphatic leukemia and my leukemia is cd20 negative cd20 is the genetic marker of a calcium channel on the white blood cells so my white blood cells pick up calcium in an effort to try to fight an infection and since they can't internalized the calcium they deposits of calcium with the smooth muscle cells in my heart triggering attacks. I have managed nine months now without a serious attack. I still have stress attacks and the reason why you get attacks from stress is because cortisol is one of those chemicals that decays into acetylcholine in the bloodstream and cortisol is the stress hormone. I would to anyone recommend that you go to your cardiologist and tell them the symptoms that you have been experiencing tell them that you think it might be prinzmetal angina and please have them check the reason I say this is because you can go years without an attack and then expose yourself or have attack at random and you will not have anything you need to help you in the attack. If there is even a chance that you have prinzmetal angina you should be at least carrying nitroglycerin tablets in your pocket if not nitro spray if you're in Europe or natural patches if you're in Eastern Europe depends on what your country refers to use for that type of medication although my cardiologist insist that the patch is the worst way to go because it can lead to Nitro tolerance the quickest and the last thing you want is natural tolerance because then the only thing that will stop an attack is morphine. A lot of doctors that don't understand the disease and a lot of patience who are listening to their doctors who are saying that it is a minimal risk disease don't really understand what they're facing it is anything but a minimal risk disease it can lead to myocardial infarction, transmural infarction, or many other serious failures not to mention the fact that prinzmetal's is not always just and Jonna you can have prinzmetal syndrome which affects 90% of the smooth muscle cells of the body including the esophagus the upper lungs and the main arteries. I have had prinzmetal's since I was 15 which is roughly 42 years although we didn't know it was prinzmetal's until 9 months ago I had been diagnosed with everything from a rithmatic tachycardia 2 coronary arterial disease too arterial myopathy. Just the sheer number of misdiagnosis that are involved with prinzmetal angina makes it unsafe simply because it's there because doctors don't want to believe that's what it can be. For me it was 18 months of arguing with the cardiologist and trying to convince him I was having heart attacks every morning at 3 a.m. excuse me let me change that to angina attack and the reason I say it that way is because the cardiologist do not recognize long-term angina as a heart attack even though at .02 tropamin you are steadily doing damage to the heart so if you have .02 tropamin for 4 days you've done some substantial damage. If they wait until you reach .05 tropamin they have waited until a myocardial infarction has formed the first time they did this to me was the first serious heart attack in the series they sent me home telling me I could not possibly have been hurting as long as I said I was I stayed home for another 4 days in constant pain finally on the fifth day I could no longer handle the pain and became incoherent until they took me to the hospital and found out I had had a transmural infarction that's a myocardial infarction that burns its way all the way through the heart inside and out. The prinzmetal angina itself did not cause the Mi it was the long-term slow damage to my heart that was ignored that caused the MI so when they say prinzmetal's can't cause a heart attack or he can't cause this or can't cause the other they're basically telling you the truth but what they're not seeing or recognizing is that long-term slow damage is just as bad if not worse then sudden damage such as from coronary arterial disease. I did not shop around for a cardiologist to help me with my disease even though some of my life were saying that's what I should have done instead what I did was stay with the best cardiologist I could find and then argued with him and showed him and recorded my problems on paper repeatedly until he finally fell in line with prinzmetal angina now I have a cardiologist who's one and only goal with me is to find new ways to treat it. Please don't give up and please do not accept that prinzmetal's is not a dangerous disease and if they have not already found the secondary disease please get them to start looking it usually shows up in the lipids or in the white blood cells almost everybody on this website has one type of lipid or white blood cell disorder or another it kind of goes hand-in-hand with prinzmetal it's as if one causes the other no telling which way it goes. But there can be successful treatment again don't let anyone tell you otherwise I was beginning to think that there couldn't be but my cardiologists once he agreed with what the disease was he did find a successful treatment now they're working on how to stop the stress from also triggering attacks. I wish you all the best in the world and I pray that God will look over you and that he will give you a doctor that will treat you properly and you can have a very long and high quality life I pray this for everyone in our condition. But I have to say the worst thing is convincing someone that you actually have it. It was the largest aggravation involved in the entire ordeal

Okay I hate to put this on here this way but this website does not give you any way to edit a post there are several errors in my post reply to you if anything is confusing please contact me and I will correct it I wish I could go through it and edit it and correct it but it won't let me

Excellent post.  Thank you.  As and when needed, I will quote your input.  Please take care and be better, be well -

Molly

Thank you so much for replying so quickly and so thoroughly! I'm going to make appt with a Cadiologist today and get to the bottom of this. I'll be sure to ask about secondary disorders, which scares me, but I'd rather know than not. I'm sure I'll have questions, but just trying to digest it all and get a definitive diagnosis. Really hoping I get lucky and pick a good cardiologist - feels like throwing darts in the dark and I don't want to ask my Gastro for a referral, as he seemed dismissive about it. so glad to have found this space and people who understand this stuff. It's all very overwhelming right now. Sounds like you have had a long, difficult journey but it also sounds like you are on the right track now. Best wishes of health to you and thanks again!

Hi linseyp,

?Good on you for getting some of your lifestyle changes under control, however I have never heard of belching as a symptom of prinzmetal, I have never experienced that, but of course that doesn't mean it isn't a symptom, it is a symptom of a heart attack, this belching.

?Can I ask you 2 questions, 1) how is your cholesterol even with the weight loss ? 2) I'm intrigued by your board name of linseyp, are you of Asian descent, especially  Japanese ? the reason I ask that is because it is more prevalent in the Japanese than any other race and they have no idea as to why.

?Back to this indigestion, I like you have had indigestion for ages, mine started in my early teen age years but it is controlled by medication. have you been checked for gall stones ? 

Hi Bishpick,

?I have had nothing but trouble with my troponins for over a month now, even though they are low positives, I have had a couple of emergency doctors tell me it's not heart related, I could of smacked them fair upside the head, I'm not that stupid, I've had troponins explained to me and what other causes that can raise troponins, to which none of them played a part in my increase. My cardiologist explained it all to  me and what numbers they start to think "heart attack".

?I have had constant problems with my spasms all this year due to high emotional stress, then cold weather and now just occurring out of the blue and lasting longer, every time I present to emergency my troponin started off at 22, repeat was 32, discharged with no great concern, back in there twice throughout the day and early hours of the morning, trops still at 33 on both intial and repeats, 2 days later I go back ininitial trop was 35 repeat was 49, discharged with no concerns, back in 7 days later trops down to right on the cut off point of 15, no repeat done because of the negative number. 2 days later presented again, troponin back up to 31, repeat 33, sent home again, re presented a day later initial and second troponin test 39, sent home yet again, 2 days ago had to go back, first trop come back at 32, repeat at 33, this doctor was concerned but not enough to admit, only enough to put in a request for my cardiologist appointment for next month be fast tracked to see him ASAP, but being the festive season I can't see that happening. I had told them I feel like I have been hit by a bus and really lethargic, I felt this way when I had my NSTEMI's I asked emergency doctors if it was possible on those low but positive troponin levels, the answer I got from them all was NO. Sorry if I'm confusing you with numbers, we use the high sensitivity troponin testing equipment and it has changed from decimal points to whole numbers, basically it's the decimal point moved 2 numbers one way , an emergency doctor told me this 2 years ago when the hospital updated their troponin testing equipment, we use to have readings as like you mentioned .02 - .05 as the reference negative range. High  sensitive negative range is 0-14.

?Somethings not right with me, I keep telling them that and I could end up back in emergency in the next 24 hours again, spasms, pain, feel like I've been hit by a bus and lethargic still, like you say opiate based analgesic pain is the only thing that stops the pain, I'm sure it doesn't stop the spasms but it definitely takes the excruciating pain away, I'm on endone for mine , I'm lead to believe they are morphine based, they use to use morphine but because of the frequency  of my emergency department visits cut it out for obvious reasons, addiction and gut problems that morphine  itself can cause.

esophageal symptoms as well as indigestion can be symptoms of prinzmetal as well, it's usually prinzmetal syndrome when it involves the esophagus you'll find more gastroenterologist that are familiar with prinzmetal's then you will cardiologist. I'm not sure if belching could be a symptom either but with esophageal spasms I suppose it could cause belching. I showed symptoms of a hiatal hernia for many years and it turns out it wasn't... it was the prinzmetal's. getting rid of the symptoms of the hernia was a blessing and a half. now I know someone's going to call me on it sooner or later so I'll go ahead and call my cell phone it technically there is no difference between prinzmetal's and prinzmetal syndrome the only difference I can find and it is anecdotal at best is that prinzmetal syndrome affects most of the smooth muscle cells in the body while prinzmetal's angina centers around the heart. I separate out the two because I know people that have prinzmetal's angina that show no signs of hiatal hernia or any other vascular spasms or any of the other symptoms associated with the syndrome also know people with the syndrome that show no signs around the heart so either they're two different diseases that act the same or it's the same disease that affects different parts of the body so difference between prinzmetal and prinzmetal syndrome is the definition of my own at this point. But this does help my cardiologist when I discuss the symptoms with him because I can separate out what my heart is doing and what other parts of my body are doing in a similar manner.

Cholesterol - I did have borderline high cholesterol before I lost weight about 6 years ago. But ever since the weight loss, it has been "normal". The last time it was checked was Jan 2017. 

Ethnicity - Not asian. I'm actually German/Italian. My parents had some fun with names. I got lucky, only have to explain that there's no 'd' in my name. My brother, not so much, his name is Ché. no joke. 

I ran across the belching thing last night as I was feverishly google searching "angina". It wasn't common, but there were enough sites about the it being in relation to angina, that it spooked me. 

I have not been checked for gall stones. But I have an esophageal endoscopy in about 2 weeks which will give a clearer picture of what's going on. So I guess if nothing is found there maybe a gall stone check would be next? 

morphine is actually one of the drugs that will stop the spasms it's the only thing they can use once you become Nitro tolerant. the hardest thing for me to get through the doctor's heads was that where the prinzmetal attack I felt like I got run over by a bus for about 6 days afterwards they actually accused me of trying to get just pain medication a couple of times until they started to realize that it was a very consistent length of time after each attack. There is a stress test specifically for prinzmetal there's two of them actually but one of them use is acetylcholine and is almost always fatal you don't want to do that one. I'll go back to my records it's in my file somewhere I'll find the name of the other test if you can't get anyone to diagnosed you any other way start screaming you want this particular stress test they will give it to you and if you have prinzmetal it will show up. Give me a day or two to go to my paperwork and I'll find it for you I'll post it here open so that everyone can see it so that they can all if they so choose go to their doctors and say they want this stress test run this one is safe the one was acetylcholine is not. almost all other stress test Echoes everything designed to look for heart disease will come back normal with prinzmetal it'll say that there's nothing wrong because there is technically nothing wrong with your heart the arteries are all open and flowing the muscle tissue is good usually cardiologists a people with friends metal have the strongest Hearts they've ever seen you don't show a problem until the spasms are there and as my cardiologists was so fond of telling me until we get a picture of prinzmetal's we can't prove it's printed metals. that went over with me about like a lead balloon as well as one of my other cardiologist who finally did get the picture and took it to my head cardiologist and chunk them under his nose and said here have a look a these. Less than 12 hours later my cardiologist stood in my hospital room and actually apologized to me for 18 months of torture the only reason I'm on this side and the only reason I'm so vocal is I don't want to see anyone else ever go through the same 18 months of hell that I went through to this day I cannot fall asleep without panicking just as I go to sleep cuz I'm scared that I'm going to wake up with a heart attack no one should ever have to go through that so if I say bug the crap out of your doctor it's not because I don't like doctors or I think your doctor is wrong it's because bugging the crap out of your doctor is the only way you will ever get an answer. Cardiologist don't like prinzmetal's because number one they can't diagnose it and number 2 they don't know how to treat it all you have to do is look at the wide variety of treatments just on this site alone to find out that these doctors are guessing at the best way to go. I say get on YouTube watch the symposium's on prinzmetal's watch the lectures go to the medical sites read the literature read the test read the old completed test read anything you can find it's got the word prinzmetal's or arterial spasms on it and then ride your Dr back like he is a Georgia Mule

In my experience, having suffered an MI as a result of prinzmental angina and diagnosed as such from day one in hospital. I’d say these days, it’s very much common knowledge that it can indeed cause a heart attack. Which is why doctors recommend prophlax regardless of spasm frequency 

In some countries it is more recognized, in some not so much, I would hope in parts of the US it's better than here in Florida but then it wouldn't take much to be better than this. If you are lucky enough to come from here you get to be told you're a hypochondriac and put on psych meds while you wait for someone to help you. You also get all the ridicule and accusation you could dream of. I am VERY happy some or even most receive competent help. But there are horror stories that happen, and they happen way to offten.

Yes I imagine it depends on your general health, other ailments and competency of training doctors receive.

Having lived in the US myself (Charlotte NC) I know here in the EU the docs tend to have more international influence and this is prevalent with East Asians.

Coronary Artery Spasm is what to call it if you suspect you have it and your doctor is struggling to give you a diagnosis 

Hi  Bishpick,

?GP and cardiologist were testing me for the 2 separate conditions, yes they present the same , GTN has been used for reflux but more so for the  esophageal ? spasms many,many years ago, like other drugs pharmaceuticals found other uses for their products and GTN was one of them, I don't kow the technicalities or how doctors and cardiologist differentiate the 2, prinzmetal angina and esophageal ? spasms, I suppose you described it pretty well, one to do with the digestion tract, which pretty well has nothing to do with the heart, well directly, and the other is coronary artery specific.

Hi,

?Yes been there and experienced that, been accused of "drug seeking"  they know morphine stops the spasms, but will not administer it any more, their excuse was it does all kinds of weird damage  to intestines and the mind, well as you know when we had our first shot of morphine our mind did alter eh ? spaced out, glad to get rid of the pain, however, the experienced doctors will give me endone, which is basically morphine based, well so I have been told, works well to. I've just had to take one 15 minutes prior to writing this.

?I know the 2 tests you are talking about and they aren't performed here where I am due to the high mortality rate for both of them, cardiologists here refuse to do them. I did come across a paper, just like you, give me a day or 2 to find it, they say that in a majority of prinzmetal sufferers cases the nitrates have none to minimal effect on the condition, GTN doesn't touch it for a lot of sufferers, I can't remember exactly what they said about calcium channel blockers so I won't comment on them until I find the paper written by someone studying prinzmetal angina.

?I have even asked about the nerve snip so that I don't feel the pain , I can't remember it's actual name but there is a lady on here that has had it done, she was once an emergency nurse wherever she was from, it'll probably take me days to find it but I will find it, it's on this site somewhere, you may of even seen it on here , roughly about 2 years ago, I can't even remember the ladies name, but cardiologists here say , no we don't perform that kind of procedure either as it has high risks, you know the usual stuff from them

Hi,

?The reason I asked about cholesterol is because with that, and this is how it was explained to me, after having a couple of mild heart attacks NSTEMI's, the cholesterol running around in our blood when it's in the endothelium it is actually absorbing/eating away the nitric oxide that is produces and in turn causes the spasms, the nitric oxide when produced and not interfered with keeps our coronary arteries and small blood vessels with In the heart smooth.

?Generally with early signs, not sure about full blown attacks, they can pick up gall bladder problems via blood tests as an indictor if pain isn't as intense as what I have heard it can be, excruciating pain is the most common word I have heard about it. doctors seem to think gall stones can mimick angina, that's why I mentioned it.

Exactly, and you will find that attitude  here in Australia too, because they can't find a "true" organic cause via conventional testing, they are oblivious to any other condition(s), rare or not.

?Although they got short shifted when my now old GP wanted to put me on anti depressants and it's written in my files .... Cannot tolerate any of family of anti depressants, SSRI's, SSNRI's and the  other family, the name of that family is on the tip of my tongue but I just can't spit it out, even the older drugs like amitriptyline? and the ,likes, they did put a name to it, serotine syndrome I think it was, my system nearly shuts down if put onto them, well that's what it feels like, nearly shuts down, I feel so, so crook even after the first tablet, I simply refuse to take that kind of medication now, I'm not going to subject my body to that kind of torment again.

I have  noticed that the USA, UK and France are the main countries that have delved more into this condition than anywhere else, everyone else just seems to follow the readings in their findings, and I don't think a lot of cardiologists keep up with the new findings and recommendations .

?Although my retired cardiologist was telling me he use to do the testing Bishpick was talking about in France and he witnessed a lot of things that went horribly wrong with those tests, so I'm not sure who informed Australian cardiologists that they are dangerous procedures, I have spoken to quite a few people from the USA that have had the test done, not many if any at all from the UK 

Actually the first time I heard the name prinzmetal's I was in the hospital receiving 50 drips a min of IV Nitroglycerin which barely help off the spasms. A young-ish doctor working the floor below mine (a gastroenterologist) heard about my case a came to my room to see me. He was an Air force Doctor who had been stationed in Afghanistan and they had a spike in prinzmetal's diagnosis over a two year period... no one ever figured out why the spike had happened but he had seen personally 6 separate patients all with prinzmetal's and he was sure I was his seventh. I did FINALLY have a place to look for answers but it p*^* off my cardiologist. I thought he was going to have a stroke the first time I brought it up.