I have had this condition for about 4 months and it is really getting on top of me. I sometimes have it all day, with tightness, pain in chest and into my neck, now have a cough. Have trips to ED with tests, but usually normal, except for stress test which I lasted for less than 1 min. They wouldn't let me continue. Had angiogram, normal. Are now on GTN tablet and spray, Diltizem and Atenolol. Have now got Morphine at home to control bad episodes. My life is very restricted, I used to be very active with walking and running, but can now do neither. Sometimes even a flight of stairs is too much. Has anybody got any suggestions?
Hi, I suffer from coronary artery spasms, similar to what you suffer, angio was clear but am fatigued and suffer neck, chest pain etc. i take isosorbibe mono nitrate which gives me a massive headache (although better after time) but it has helped, also take drug called verapamil, GTN and pain relief. Have hope, when I was first diagnosed in December I was in and out of hospital for three admission by ambulance, thought I was going to die every day... i was terrified of walking upstair to visit the toilet. But as time has gone on, you learn to manage the pain and your stamina will improve, am now back at work part time. Try some CBT therapy too, helps with the panic of your attacks which make the Angina and stress worse. Have faith Priscilla things will get better slowly. I am 46 and before this happened I would run up hills and play football, think nothing of walking our dogs 5 miles. For a while I was chair bound but now this week walked my first mile again! All my best wishes nod prayers to you and others like us out there...
Hi Priscilla.
I'm in discussion with my cardiologist about Micro Vascular Angina, Ihave been given the impression this is exactly the same as Prinzmetal Angina which I have been diagnosed with but as usual there ar at least 2 specialists that dis-agree with that diagnosis. My pain isn't every day it comes at least once a week and it was suggested I start a chest pain diary, I can see a pattern involved in all of my episodes,winter time is the worst for me as cold weather and even a gust of wind to the face is enough to set off the prinzmetal angina and the chest pain lasts for ages,I do get relief from using the GTN but there is always that one day where the pain lasts half the day. I have had 2 NStemmis, I have CHD and familial cholesterol also have had 2 suspected TIA's which as you know is completely different from heart disease but works on the same basis as angina but as the doctors call it "Angina of the brain" due to blockages in areteries and vessels leading to the brain. My GP will not prescribe morpheine due to the addictiveness so therefore when I have a bad attack with Prinzmetal angina "Micro vascular angina" I have to call for an ambulance and then morpheine is administered by paramedics or emergency doctors, Morpheine only masks the pain it may get rid of it but it's not fixing the problem and my Cardio specialist has told me it is something I have to learn to live with and if I get to the stage where it becomes unbearable is when I need to call an ambulance.
Nowlybear I have myself tried CBT and it does not work in "Angina instances" well that's what I have found and only my opinion, You speak of "Panic" as a panic/anxiety sufferer of almost half my life you can tell the difference between "panic pain" and "organic pain" that feeling you get with chest pain is normal for everyone you think "oh my what's going on here" or that feeling of "doom" both present in panic attacks and heart attacks..funnily enough I have been fortunate in both my heart attacks, I never experienced that "doom feeling" it was just wham bam you've had a heart attack (mild on both occasions) ECG's were normal but troponins were positive for heart attack
Medications that I am on to try and prevent this rare kind of angina consist of
Cardizem...works effectively
Nicorandil...Works better than Cardizem
Monodur...Didn't really notice any difference
Plavix.. don't see any thing in this medication to relieve Angina as it is only a blood thinner
GTN ..to be used as required I can take up to 30 sprays in one bad episode of Prinzmetal angina, I do get told off by paramedics and emergency doctors for not calling an ambulance after the first 20 minutes of no relief from GTN but I'm at the stage where I'm embarrassed to call for an ambulance as I feel I'm wasting vital resources ...Although I have been told by emergency doctors that I'm not wasting resources because there is going to be "that one day " where someone is going to find me when it's to late....So I fully understand your frustrations.
Hello, this is interesting, as I am only 49 and finding it hard to not be active. Prinzmetal Angina does seem to be a bit different. My angina mostly only comes on with excersise, be it walking or whatever. I was also told not to turn up at hosp if I could help it, but can do so if I need further morphine. That is all they will give apart from anaesthetic. So I have tried to put up with it. I have had a radio ablation on my heart a few years ago for palpatations. That really helped back then.
After a bad attack, the next day I have a sore chest and also lumps down my throat which goes away in a day or two. I have used the ambulance 3 times, been to hosp more times.
A doctor did tell me that taking morphine does give your body a rest from pain and are very tempted to use it more often, but your body can get 'used' to it too, and what then?
I was told by a specialist that microvascular angina tends to go in cycles, could have it for 5 months, then go away for a length of time then return. I am looking forward to that time!!!
Thanks for your comments.
I was around 42 when I was diagnosed with Prinzmetal Angina, first heart attack at the age of 46 and the second one at 49 and the suspected TIA's at 49, Your body can also get immune to the GTN and other trinates.
If your angina seems to only come on with exercise that is generally called stable angina where as prinzmetal comes on whilst exercising or resting,generally though at rest.
I can also relate to you being told not to turn up to the hospital if you could help it, I have had a couple of insensitive paramedics who have made that comment to me but not in a polite fashion either...I follow the emergency room senior doctors advice and that is to get straight back into hospital if the pain comes back and persists, as I commented earlier both my heart attacks weren't picked up on an ECG only by the blood test for troponins...
You most probably have done this but there is a lot of information out there about micro vascular angina ,hence why am going to be having a discussion with my cardiologist as micro vascular is more of the blood vessels with in the heart and not the coronary arteries and give off the same symptoms as prinzmetal angina..My cardio did want to do another angiogram to perform some kind of pressure test in the heart to see what the blood flow was doing but he decided against this as I have already had 3 angiograms and he says that he doesn't want to use that artery in case they really need to use it later on down the track in life....so very frustrating.. I'm limited as to what I can do now as well and have to be vigilant in the colder months.
Some interesting reading about Micro Vascular Angina (MVD)
https://www.hon.ch/OESO/books/Vol_4_Prim_Motility/Articles/ART347.HTML
Hi,
If it helps there are articles as below on the patient.info site :
https://patient.info/health/cardiac-syndrome-x-leaflet
Very good articles but I have noticed a lot of researchers have differing views on Prinzmetal Angina, whilst a majority of their research is pretty well the same there are a few with varying opinions on Prinzmetal, I've even come across some research papers where they state it's more prevalent in men rather than women and that it's not always possible to catch episodes by an angiogram or ECG. I've even heard that when the catheter is inserted and worked up through to the heart your arteries will be spasming anyway because they aren't use to having things placed into the artery...
It looks like research from different countries vary even though the specialists all communicate between others ...After reading all the links supplied by me and Emis I have read further readings on Prinzmetal and probably 2 out 4 papers or research differ from each other.....
If this is allowed you may see some slight difference between the British Heart Foundation compared to the Australian Heart foundation, their info is pretty similar but not completely the same .
http://www.heartfoundation.org.au/SiteCollectionDocuments/Coronary-Artery-Spasm.pdf
Thank you for the info, I will check it out. The doctor who did my angio said my arteries didn't spasm during it, but I had just had a dose of morphine before going to the theatre, so would they have done anyway????
Microvascular angina is angina of the micro arteries which don't show on the angio anyway, so may not have had any affect. He was not sympathetic anyway and also told me to throw away the GTN spray and get on with life, so tried to, but my local GP has been very good. But it doesn't seem very common in New Zealand.
Hi Priscilla,
I'm not sure of the effects the morphine would of had on the arteries , but you are right about micro arteries they are difficult to pick up/or to being able to see if they spasm on Angiograms and it does state this in the diagnosis guides, it took an AMI for my GP to change his tune and be a bit more sympathetic towards my case. One question if I may, Does the GTN work when you have these episodes ? If it does it usually means it's doing it's job with the problem arteries and blood vessels with in the heart mechanisms, I realise GTN also helps other conditions, the other most notable one is indigestion.
I have to use 2 GTN sprays at a time and they take about 1/2 hour to work then only last for about an hour. They give me a headache for about 5 - 10 mins then I'm okay. Doctors have told me to only use 2 lots of 2 sprays, if that doesn't work to use morphine. I have suggested indigestion to doctors including Hiatus Hernia, but they said it doesn't act that way. Also spasm of the oesophegus, but not in my case. I believe this can be a bad pain too. My pain comes after I get the tightness which spreads to my throat and feels like I'm choking. But have learnt to tolerate this. Morphine works but sometimes makes me vomit, so use as last resort.
Yes GTN will give you a head ache especially if you are using it for the first time or if you don't use it regularly,they will dis-appear when your body adjusts to the GTN , The way I have been instructed to use my GTN is one spray if that doesn't work take another single spray after 5 minutes, The advice given here is one spray of GTN every 5 minutes if pain has not resolved in 20 minutes (4 sprays) to call an ambulance and this is where I run into problems and according to Emergency doctors...I'm playing with my life for not calling after 20 minutes, I persist with the GTN and take nexium and the strongest pain medication I can have is Panamax (Panadol) and I take 1/2 a tablet of Karm (Alprazolam) that doesn't even shift the chest pain , although panamax does get rid of the GTN head ache 
. I can have up to 30 sprays of GTN before I call for help,the GTN reduces the pain but only by a couple of notches on the pain score, it sits around the 6/10 then drops down to 4-5/10 then creeps back up 5 - 10 minutes after having a shot of GTN. I now call an ambulance when I've had 20 sprays, I have at least one bad episode a week (Prinzmetal Angina) Depends on the paramedics if I get to have morphine for the pain, if they don't administer it then it's up to the treating emergency doctor,they usually write up morphine and it works I usuall end up having 10mg of it before I'm pain free, sometimes it can take up to 15 mg's, The paramedics and doctors have informed me that our bodies can become immune to GTN and morphine if it's used on a regular basis. Yes morphine has that effect on many people ..feeling nauseated or actually vomit. I haven't had to use my GTN for a week today . It's been a good week for me.
You mentioned indigestion...does the GTN help that as well ? I don't mean to alarm you but that symptom you have described is in fact a known and documented heart attack symptom (Warning Sign)..Chest tightness and going to the throat either with a burning or chocking sensation.
Specialist told me to only take 2 lots of 2 sprays then use morphine (I took 10 mls yesterday), as the GTN can lower the blood pressure too much (so does morphine), thats why they don't like you to have too many.
Having morphine at home saves having to go to hosp. I don't think I would get addicted to it, as I still feel the effects of it the next day. I have been told that when you need morphine you are less likely to get addicted to it than if you have it when you don't need it, eg for less worrying conditions.
My tightness has always gone up into my throat, ECG's mostly normal, also Troponins normal.
I'm not sure if GTN helps indigestion as I'm not sure if I have it. I am on Losec just in case.
I have not got an oximetre to keep an eye on the oxygen level in my blood, is very interesting and mostly okay.
Our doctors here think differently...lol...they don't trust us to prescribe morphine,they are happy to prescribe endone but only in small amounts due to the addictiveness and for that exact same reason you mentioned, it can lower your blood pressure. My blood pressure is usually unmoved with large amounts of GTN 160/90 after the 20 sprays...If I take the old regime of 1 spray wait 5 minutes, if pain still persist then take 2 sprays wait 5 minutes if pain still persists take 3 sprays wait 5 minutes if pain still there take 4 sprays then start the old GTN regime over again and if no relief call ambulance, that's a lot of GTN in a 40 minute period, when I do the old GTN regime it will drop my blood pressure down to 140/80.
ECG's are a good thing but as a nurse once told me you have to be having a heart attack at the time of an ECG for it to show up or have something wrong with your heart in the first place like a leaky valve, you know those kind of heart problems.
Here's an example that I have experienced personally, Paramedics have arrived at my house, did an ECG, was normal upon initial first examination he repeated ECG and instantly he saw old heart damage this was in a space of something like 10 minutes, He then did another ECG and the old heart damage had dis-appeared the tracing was back to normal (these were all printed off for him to study) He was amazed at how this had happened and he was literally scratching his head. My troponins come back negative as well,I have been told they are slightly raised but is of no concern because it's below the Guidelines of a specific level of increased troponins, usually sitting on 0.01 - 0.03... I have had 2 troponin levels come back indicating a heart attack and yet ECG was normal so somewhere in between ECG's I had a heart attack, there is a specific figure > than .05 from memory (I could well be wrong with that figure so don't quote me on that one ) before they class you as having a heart attack. I would imagine NZ would have the same guidelines as Australia for determining a heart attack via a troponin blood test ?
I found it incredible that people have written here that certain paramedics have told them not to call an ambulance or go to hospital etc (in other words not to bother them) when I have had my bad attacks I have become paralyzed (no oxygen) and if the people around me had not called an ambulance I would have been dead !!!!! It would have been impossible for me to call as arms where completely paralyzed and legs where nearly gone!!! Can you imagine if these people had to go through one of these attacks !! The last one I had was whilst working in a shop and I just happened to be exceptionally lucky because a paramedic was in the shop and she took complete control and called the ambulance etc and she was able to administer the nitro (my arms where mot working) she came into the shop 3 weeks later and said to me that she new it wasn't simply angina as my heart rate didn't change and neither did my colour !!!! So I was exceptionally lucky!! Whilst in hospital I had another angiogram and once again the doctors where surprised that there where no blockages !! All I can say to all the people out there is do not take any chances just call an ambulance !!! By the way I am from Australia the lucky country and I have never been told not to call an ambulance !!
Hi Windylindy,
I live in Tasmania and have had 2 paramedics tell me off for calling them, I can't go into to much detail for obvious reasons, their attitude is just because nothing shows up on their ECG machine and that there is nothing wrong with you they say" it's
in your head" or "it's a panic attack" .... I have also had 2 doctors say the same thing even though what my condition is recorded on hospital records. All the senior doctors in emergency tell me to call an ambulance after 20 minutes if no relief from GTN but see in my situation I average 1 visit to our emergency department once a week sometimes up to 3 in a really bad week, what I have found is that they are sick of the sight of me...lol...the nurses are fantastic with one or 2 that may come out with a smart comment and the paramedics in concern have been spoken to by their superiors yet they still say something, one paramedic has completely changed their tune since they were informed of my 2 AMI's and a blockage in one of the coronary arteies...When you have professionals downgrading you it can make you feel like absolute crap and humiliated, they have you thinking " could they be right" am I making a mountain out of a molehill and you are to embarrassed to call for an ambulance... I hear this a lot here where paramedics say to patients why are you calling us for (chest pains) they are assuming certain things when nothing shows up on their ECG machine and your BP is fine, your skin colour is normal,etc etc. I got a lecture from a paramedic about how much I have cost the tax payers everytime I call an ambulance,($1000 a pop) I have even had one tell me to move closer to town or at the very least catch a Taxi....now I know a taxi driver won't take you to hospital if you tell him to step on it because you are experiencing chest pain they would tell you to call an ambulance or call one themselves for you.
In regards to my previous comments 99.8 % of the Paramedics are fantastic it's just that you do get that .2% of the "bad apples" saying unwarranted things,I understand that they may of had a stressful day or have family matters on their minds but they should not let that give them the right to speak to patients like this.
This is typical of the nature of the type of angina, I felt like I was putting it on, but not when your BP rises and pale colour and nauseous that they take any notice. I also have noticed that travelling in a vehicle is one of the worst things, which apparently is typical. I have tried taking 2 sprays before going in the car, but only lasts a little while and then back to being tight. Much more than 1 hrs travel is too much.
Hello.
I have just come across this forum and am so pleased & excited to find it. I have had problems for the last 18 months and am desperate for answers.
I have had 2 heart stents and a balloon angioplasty; 2 clear angiograms following these but still experiencing a lot of issues. I don't know what to think and sometimes wonder if I am just a silly crazy woman. I know i'm not - you don't imagine this pain or these episodes and its controlling my life!! I often think the medical profession just have no idea what to do with me or disbelieve what I am saying.
I am on a lot of medication that I strongly believe is responsible for keeping me alive!!
I have been diagnosed with unstable angina but they had mentioned last year that i have micro arteries that may not be oxygenating properly. Why then are they not in any rush to see me even though I and my doctor has contacted them saying that I am struggling??
Your help and advice would so greatly be appreciated.
Ellie.