prinzmetals angina

I've had Prinzmetal  Angina for years  , I've "supposedly" had 2 mild heart attacks   and  a TIA , I have a 50-60% occlusion in my RCA which is non flow limiting ....to suggest  that I don't have "normal angina"  however the diagnosis of Prinzmetal was made due to it's frequency , the tomes of day they occured and weren't bought on by exertion.

I noticed your comment of your clusters occuring out of the "normal times" in the research they have found that Prinzmetal usually occurs after 8pm through to the very early hours of the morning some around to 8am , other triggers are cold weather, a puff of wind to the face, just sitting or lying down and stress. Before I was put on Nicorandil I was in emergency late at night up to twice a week, since taking the Nicorandil it has stopped the night time spasms but I get the around middayish spasms which are relieved with GTN (Nitro Lingual Spray) but sometimes it doesn't respond to GTN after awhile I take up to 20 sprays before calling for an ambulance, I don't get your other symptoms....full body muscle spasms/tightness. What I experience is just chest pain(heaviness) and it's usually the shoulders and left arm radiation pain (heaviness), breathlessness and nausea, over the last couple of months I have had the pain radiate into the jaw, broken out into sweats ( at rest)   , 2 years ago I had a mild heart attack even though I was going through a cluster of Vasospasms with chest pain and shoulder pain I also had indigestion so I just put it down to that but when I started to feel like I had been hit by a truck and feeling really ill  and lethargic I called the Paramedics, nothing was found on their ECG (EKG for you Americans ) Another one done in emergency as theirs is different to the paramedics...once again nothing found, I had blood taken and was sent out to the waiting room feeling like...well...blah and yukky, about an hour later a nurse came and got me from the waiting room and a doctor was waiting for me and that's when I was informed I have had a heart attack (mild) the blood work showed rising troponins that started to dip back down during the early hours of the morning.

I noticed you said you was released with the diagnosis of a heart attack, how did they dicover your coronary artery spasm ? They are hard to catch, the only way they can catch them is when you are having one right at the time of an ECG (EKG) or during an angiogram, they can test for Prinzmetal Angina with a drug ,if you have Prinzmetal this drug will provoke the arteries to spasm whilst performing an angiogram but my cardio said it's not a test that they perform here due to risks "supposed risks" A troponin rise can also be caused by dicky kidneys and I'm led to believe the above blood levels that you are asking about are kidney related, well not just kidney related but it's something I would be thinking about or discussing with a doctor, there are many things that could cause what you have described above and the first thing that came to my mind when I read your post was Chronic Fatigue Syndrome, others include myasthenia gravis, panic /anxiety dis-order, maybe multiple scelorosis (bit harsh I know but just thinking of the big picture )

When you went to emergency they usually order a full blood work up  so obviously your troponins were elevated to of been diagnosed with a heart attack...were there discrepencies with your calcium/magnesium and potassium levels ? Another thought is Diabetes but I'm sure you would of known about that by now.  

It's been awhile, how are you doing ?

I had a very interesting talk with a cardiologist a few weeks back as I was admitted with another troponin rise and when on his rounds it came my turn and we had a discussion about what was going on with me, I had asked him , Does he agree with the ER's diagnosis of Prinzmetal Angina and he said he does and then I shot him a lot of questions mainly about high cholestrol, I had asked him if high cholestrol would cause chest pain and his reply was yes hence why he agrees with the Prinzmetal Angina diagnosis, He explained to me what the cholestrol does, it actually stops the production/eats the nitric oxide in the arteries/small blood vessels in the heart and the endothelium/myocardium....He went on to tell me that Cardiologists are eagerly awaiting a release of a new drug, it comes in injection form and doesn't come with the side effects of statins and this should also stop artery/ small blood vessel spasming, he did tell me the name of it, it name sounded like something named in the canine ranks in the Police   All I can remember is something to this effect CHK9 *******, so on my follow up with my regular Cardio I shall grab the actual name of this new drug they are awaiting for

Now we come to the third and much more rare type, Prinzmetal's angina.  This is what most of the people posting on this site have.  Similar to the other two types, there is a decrease in blood flow through the arteries of the heart, causing lack of sufficient oxygen for the heart muscle and resulting in the same symptoms (chest pain, sweating, difficulty breathing, etc).  The difference here is that the inside of those arteries can be in perfect condition, but for some reason, those arteries get a mind of their own, and just like a muscle can spasm, the coronary arteries can do the same thing.  Depending on how bad it spasms, there may be a small, medium, large, or complete stoppable of blood going through that artery.  This can last for a few minutes to an hour, but rarely goes beyond that, although it is possible.  Because most spasms don't cause a complete closure (which can cause a heart attack), it is a pain to live with (literally and figuratively), but most people who have it are able to live a near normal life.  However, many of the people on this site, because it has had such an impact on their life, are worse than average.  

Statistically speaking, it is more likely that you have stable or unstable angina, just because so few people have Prinzmetal's, compared to the other two.  However, the vast majority of Prinzmetal's pain is during the night, believed to be due to hormonal changes that occur during that period.  The only completely definitely way to diagnosis Prinzmetal's is to have an angiogram showing one of two things.  The arteries look OK, they inject something to irritate them, and they spasm (most people's won't respond like that), or they do the angiogram and see a very narrow artery, inject nitroglycerin directly into it, and the artery immediately opens up.  The ladder is what happened to me.  It is extremely rare to catch it like that as you can't plan weeks in advance the exact day and time you are going to have a spasm so it can be caught on angiogram.  It can be frequently diagnosed using EKG and lab work during a period of pain, but there are times when even both of those look OK and there is spasm of the artery (aka vasospasm) occuring.  

Talk to your cardiologist to find out what kind you have.  Other than us all using nitro when we have pain (because regardless of the cause, it makes everybody's coronary arteries dilate), the different types of angina have different treatments.

I honestly tried to keep this one short, but in order to explain the differences, it took a little more time than I had planned.  In any case, I hope this was helpful and I answered you questions.  

(( hugs))