Prinzmetals/Variant/Vasospastic Angina

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For a very long time I have been experiencing very painful chest pains. These where continuous and would last all day, they would happen at rest but exercise would make it worse.

I have a very long family history of heart diseases from an early ages. My dad was diagnosed with angina at 21 and my uncle at 27 and my grandad had major blockages, it goes on and on this history. I'm 25 now and recently discovered I have a 55% narrowing in my proximal LAD

I'm now on Bisoprolol 3.75mg and Isosorbide Mononitrate SR 30mg a day and it's the most effective thing for the pain I have ever been given and controls my heart rates and palpations which where horrendous.

a recent Myocardial Perfusion scan revealed no signs of any inducible angina which left me and the cardiologist confused as to what my source of pain is and why it improves with anti angina medications.

Anxiety was ruled out due to that being very much under control now. And various medications not helping the pain except beta blockers, nitrates etc.

Acid reflux/GI tract issues where also ruled out and every doctor was reluctant to give me and answer or knew what to do.

Nerve pain was ruled out too, it has been a very difficult 3 years for me with no answers and worse pain ever. I'm on the Autistic Spectrum and have always found it hard to express my pain/feelings etc so getting a doctor to realise how much pain I was in was extremely difficult so was always dismissed for ages.

Thankfully my new GP are much more supportive. And the isosorbide has made and incredible and extremely noticeable difference.

I have for a very long time theorised it could be vasospastic angina but have no idea who to go about testing/diagnosing it. I get these pains at rest, they can be spontaneous and happen at any moment. Often used to wake in the night in pain before my new medications. I notice from 9AM (When I take my nitrate) to 6PM(when it wares off) its no way near as bad. After 6PM it's the luck of the draw, with some days good and others bad.

only contradiction to my theory is the fact that bisoprolol helps which beta blockers are known to sometimes make prinzmetals/vasospastic angina worse. Propranolol was most unpredictable with sometimes it seemingly making it worse but since being on cardio-selective beta blockers it's mostly helped.

I was wondering if anyone who has been diagnosed with prinzmetals may have had a similar experience or could advise me how they got diagnosed as any advice would be very welcomed.


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3 Replies

  • Edited


    I too suffer from MVA

    I'm currently on omega 3s and arginine and:

    5mg Bystolic

    5mg Amlodipine

    My episodes are still pretty bad and my doc thinks im a psycho for thinking i have heart disease.

    • Posted

      So sorry to hear your having bad episodes, after having a long time relatively pain free I have just had a several days of it being really bad so I know the struggle.

      I'm assuming MVA stands for microvascular angina? if so how was you diagnosed with this? does it show on a cardiac CT?

      I had never heard of the beta blocker Bystolic (Nebivolol) before but after reading about it, it's very interesting. Do you find that helps you at all? I have been thinking about switching my beta blocker for a calcium blocker just in case my Bisoprolol is triggering spasms.

      The best advice I can give you is keep pushing your doctors, ask for a CT or myocardial perfusion they will show any larger narrowing's/stenosis in the larger arteries. It may be worth asking for a long acting nitrate such as Isosorbide Mononitrate XL/SR as that may help your microvascular angina provided your blood pressure isn't low due to your other medications. Or try a GTN spray and if it helps you know your on the right track.

      All the best 😃

    • Edited

      Thank you. I will ask about Isosorbide. I take arginine and it supposedly facilitates nitric oxide production or something of that sort, if im not mistaken, nitrates do the same thing. I haven't been on nitrates at all yet but I think they will work for my episodes.

      Wish you the best of luck 🙏

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