I have Prinzmetal angina. My first attack was when I was 44 but not diagnosed until I was 51. I just recently found out i have eNOS T786C mutation which most likely is causing the vasospams. I'm curious if anyone else has been diagnosed with this mutation. A doctor that is doing research on Prinzmetal patients recommends taking L-arginine. Anyone else take this supplement? If so has it helped? I have never had an EKG during an attack and was wondring if ST segment elevation is ALWAYS present on an EKG during spasm?
Hello Sheri,
I have microvascular angina (MVA) which is spasms of the micro arteries. I'm not sure about the mutation, but I am currently taking a cardio cleanse which a naturopath has given me and are trialling it, which does include L-arginine and other amino acids. I didn't take them last night and found my angina was worse today, but have not taken it long enough to test it out. I am only half way thru the bottle, so will be interesting when I'm finished them. Can get some more if I want, but I want to see what happens. EKG's don't always show up anything, I normally have ST depression when I get a bad attack, but usually normal for milder ones. I have had MVA for a year and am 50.
Hi Sheri, not had that genetics test but will look into it and see what my GP says.. I have read about Arginine before and another amino acid both have blood vessel support as part of their read up (no i cant remember atthe moment but will post again later when i do) I would be interested in knowing which doctor (who) and why / what he has found happen when using it on their patients. I would be happy to try it, anything ot reduce / improve pain and etc.I have usually found ST to be raised and is part of my check using Alivcor,
Sheri,
I am a 47 year old female from the USA. I was diagnosed in January of this year with Prinzmetal's, also known as Variant Angina here. My symptoms were more crushing chest pressure, shortness of breath, and severe fatigue, than actual chest "pain". My left arm has always hurt much more than my chest during attacks. I went from a healthy, active lifestyle to being barely able to walk across a room. After 7 months of MANY tests, ER visits, specialists (some attentive, some dismissive!), I went to the Mayo Clinic, had a heart cath, during which my L anterior descending coronary artery spontaneously spasmed 60% closed. With methergine,it closed to 80%. ST segment depression was noted.
I have decided against the eNOS genetic testing, as it costs $250 and we are already working through a pile of medical bills.
My current treatment is: Amlodipine 5mg daily, Magnesium 400mg daily, L-Arginine 4.5 grams twice daily, multivitamin,calcium, D3, fish oil, lots of water, lots of green leafy veggies and other antioxidant foods. I have nitroglycerin tablets that I keep with me, but have only had to use it 3 times. I am still having spasms at various times daily, but the severity is decreased. On days with many spasms I am fatigued, but have been able to resume moderate exercise otherwise, I think because I didn't have heart damage. (Normal Troponin) With careful attention to my lifestyle and a supportive family, I have found a new "Normal" that is acceptable, especially when I compare myself to a year ago!
I definitely feel for others on this forum who are trying to keep working and have this disease. It is incredibly unpredictable and disruptive to a normal lifestyle! That has been one of the ironies of this diagnosis, " avoid stress". What adult out there can avoid stress?!!
Hi Sheri,
I have also been diagnosed with Prinzmetal Angina I was well into my late 30's when it was first suggested, I have never heard of anything about this mutation you are asking about, I'm not taking any supplements for this condition but am taking anti angina medication which works to a degree, I think I have developed an immunity to most of them, they only work for a short term now. I had this discussion with a doctor about a week ago actually...ECG's (EKG for you Americans 
) They would usually expect to see some kind of change during an attack but it doesn't always happen (show up ) there is a way for testing for Prinzmetal Angina , it's performed in the way of an Angiogram and a drug to see if it can make your arteries spasm, if they do they can clearly diagnose you with Prinzmetal Angina however where I am it's not a test they like to perform, the reason I got was due to the drug the use.
I was admitted to hospital a few weeks ago due to a Troponin rise and I had a good chat with the Cardiologist and he was quite excited about the pending release of a new drug that not only lowers cholestrol and I was also of the understanding that it would stop all aretery and small blood vessel spasms in the heart.... all I can remember of the name of this drug is CHK9***** , I'm due to see my normal Cardiologist soon so I will ask him for the name of this new drug they are waiting on, it's not taken orally it's an injection.
Hi Samuels,
Thanks for your response. If you are interested you can google Dr. Charles Glueck who is doing the research in Prinzmetal. He suggested I take 4.5 grams of Arginaid twice a day 12 hours apart. I'm curious what caused your Troponin to rise. What is that?? I am very interested in the new drug that is suppose to stop corornary spasms. Please let me know what it is when you find out.
What is the diffence between MVA and Prinzmetal? How can they tell the diffence? What is the cardio cleanse? Is it a prescription? When you have an attack what do you do to stop it? Nitro gylcerine does not help me. I was wondering if there is anything else that can help.
Hi Andrew, Thanks for your response. Dr. Charles Glueck is doing research on Prinzmetal. You can google him and read his research. He recomended I take 4.5 grams of Arginaid twice a day 12 hours apart. You can actually get it on Amazon. I too am desperate to find something that works. I take 10 mg of amlodipine a day and nitro gycerine spray during attacks. Unfortunately the nitro rarely works. Does anyone else find Nitro doesnt work for them. The amlodipine seemed to help reduce the severity and freqency but lately my attacks are getting stonger and longer. Has anyone develped arrhythmias. I use to have the attacks only at night or early morning now I have them all diffent times of day but still when I'm not active. I also feel very tired after the attack which I didnt before. Anyone else feel that way?
Thanks Ainsjam, Did Mayo clinic suggest those medicines and suppliments you are taking? Did they explain why those particular ones? Have you had any side effects from taking the L-Arginine and other meds? Curious, do you have swelling in your feet? How long does your attacks last? My last from 30 minutes to 1 1/2 hours. They are very scary. Unfortunately nitro spray doesn work for me. When you had the coronary artery spasm during your cardiac cath how did they stop the spasm? How long did it last?
I'm not really sure, but my angina only comes on with exercise. I don't know what is in the cardio cleanse, only that it is a mixture of amino acids. When I have an attack, I try 4 sprays of GTN, but usually know if it is going to work, then I have morphine liquid to take and take 10 mls, sometimes that doesn't work and end up at ED and all they give me is more morphine by IV, which is about 3x stronger. Last time I had to have that they had to give me 30mls IV, which is about equal to 100mls liquid. Mine does tend to come and go, have 'good' weeks, then bad weeks. I do find that ginger is a trigger. Even gingernut bisc.
Hi Sheri, I have used Taurine before and will add Arginine and see if the combination helps. My Arrythmia comes mostly from spending many years keeping very fit but there may also be a link between the two. Micro vessel spasms are the small blood vessels around the heart and usually called variant or syndrome x PM is the major blood vessels some doctors lump them together some cardiologists dont as they think they are slighlty different. Do you get migraines? i find if i use gtn sparingly but intensley when needed it still helps a bit... i take 30mg isosorbide at night (bedtime) and two of diltiazem 120mg one at breakfast one at night and flecanide for the arrythmia but that only when they happen The diltiazem i can take onther during the day if i am having a bad day and that helps. doc is keeping the doses as low as works or tolerable to prolong their useful life span as we adapt to them and they become less effective.
Hi Sheri,
Troponin blood test is the gold standard for letting emergency doctors know that you have had a heart attack, Some doctors still use the old CK-MB blood test in determing a heart attack but as stated above the troponin test is the gold standard now.I've also been told Kidney failure /damage etc can also raise troponins but I'm led to believe that kidney function tests aid in determining if the kidneys are the cause of a troponin rise.
I will definately let you all know about this new drug that our cardiologists are keenly awaiting on, the discussion I had with the cardiologist that saw me after my last troponin rise gave me some really good information on Prinzmetal Angina, he described it in laymans terms so it was easier to understand rather than the fancy words my regular cardiologist uses leaving patients baffled or more confused . As I stated above about cholestrol (high) can interfere/ stop the nitric oxide production which is the main pre cursor for Prinzmetal Angina.... No other cardiologist had explained it to me as well as he did... My retired Cardiologist had diagnosed me with small blood vessels in the heart ( naked to the eye and in an angiogram procedure) going into spasms and that there is no cure and that I would have to learn to live with it but that's easier said than done when one hasn't experienced this kind of thing....ohhh the pain, If only they knew how painful it gets
Hi Sheri,
Technically there is a difference but a lot of cariologists put them both in the same basket, Prinzmetal Angina and MVD as we call it here are the type of Angina that differs from the other Angina,Prinzmetal Angina and MVD comes on while at rest usually between the hours of 8pm through to 8am, it's unpredictable where as the other Angina is predictable ( exercise etc induced) ...I think for better words Stable Angina ...activity induced and predictable, in this case cardiologists recommend you take one spray before going out in the garden or mowing the lawns, etc etc then you have unstable Angina...Prinzmetal Angina, occurs at rest, can come on during activity but mainly while at rest and totally unpredictable. Depends on the cardiologist they use different terms, stable, unstable variant angina, maybe a couple of others that I have forgotten about. If GTN doesn't help I dare say that it's not your heart acting up in the sense of having angina or MVD..unless you have like me built up a tolerance to it...after 16 sprays GTN only works for me for 5-10 minutes if I have a bad attack, Nicorandil has helped my night time spasms so no more late night visits to our emergency departmentfor me since I've been on them, however I still get a bad attack once a week , usually the GTN clears up my Prinzmetal Angina after about 2-4 sprays, the only thing that settles down my big once a week attacks is morphine or endone, because it's summer time here where I am I'm expecting less attacks as warmer weather seems to help,I still will get the occassional attacks but the GTN clears it up unless it's a real stinking hot day as really hot days and cold days can trigger Prinzmetal Angina/Vasospasms.
Samuel, thank you for that! there i was thinking roll on summer and i will be ok again, now i have to worry about hot days too..... nooooooooo 
Hey Andrew,
I thought the same bt have been digging around lots about this Prinzmetal Angina and found that extreme heat could well trigger spasms as well, Australia is well know at times for getting exreme heat in the summers. I'm not to fussed about our summer I'll just sit inside and adjust air conditioning accordingly...not to cold though
I started taking L-arginine about a year and a half ago. I took it consistantly for 9 months and didn't notice a change, so I stopped taking it. A week later I had a heart attack. I went back on it. That was my third heart attack, and I did have one while taking it. I can't say that I noticed an improvement in my symptoms, but I also don't ignore the fact that I had a heart attack shortly after stopping it.
The reccomended dose is 4.5 grams twice daily. If you go to a nutrition store, you'll end up taking something like 14 pills a day to get the required dose. However, you can order a powder form made by Nestle from Amazon (not sure if they ship that item everywhere, but they do to the U.S.). I think it is around $50 or $60 U.S. dollars (I have it on auto-order and my husband pays the bills, so I don't know the exact cost).
ST changes are sometimes present. I used to have all kinds of ST changes with attacks, but haven't had any for about 9 months. You can have a heart attack without having ST changes, which is why they also do the blood work in determining if a heart attack has occurred. They are called a NSTEMI (Non-ST Elevation Myocardial Infarction), verbally, they call call them "Non-STEMI" (as STEMI is the typical heart attack). A NSTEMI causes less damage than the other.
Hope this was helpful!
I agree if "they" knew the pain being felt it would change their views a bit!
During a cardiac cath they can inject nitro directly into the artery that is spasming. I've had it done too.
I've emailed with Dr. Gluek (I live in Canada and don't have insurance in the States so we did everything over the web). His was gung-ho about getting me started on L-Arginine and having the blood work done (which I did and payed cash for it). I tried a few times to contact him for the results. It's a year and a half later and I have yet to have my emails answered, let alone give me my results. Pretty frustrating when I had to make arrangements to have my blood drawn without an order from a doctor that practices in my country, pay $250 for the test, and then arrange for international transport of the specimen........Hope my experience with him is an isolated event, and you have better luck with him.
Thanks so much for your response. There is a dr in Cinn that is doing Prinzmetal research and did a blood test that revealed I had a mutated gene that most Prinzmetal patients have. He suggested exactly what you said but I was kinda nervous about starting it since it was such large doses and it is just research. I was wondering long term what it would do. Do you think when you just stopped without slowly reducing dosage that might have caused your heart attaclk...just wondering. I had a spasm attack Dec 30. It was pretty severe and lasted about an hour. Ever since I dont feel right. Now I keep having chest tightning and nausea. I went to the hospital and they ran blood tests, echo, ct scan, stress test and everything came back normal yet I continue to not feel right. For years I would have just the spasms and when they were over I felt fine. Something changed after that last attack. Did anything like that happen to you? I did read that the chest tightning is a sign of angina but my blood pressure is low 100/57 and I'm afraid to take the Nitro.
FFirst thing is make sure the Doc is nto makign the mistake I see form way to many of them. They have to compare your ECG to a baseline ECG NOT NOT to the last ECG when you came in with Angina. It is hard to believe but soem docs forget that if you compare ECG from this ER visit to the ECG from your last ECG visit he may see no change just because they are both during a spasms. I just one trn bright red when he had the OH DAH moment when I explaiend that to him. Second as explained otme at Mayo Dr. Prasad and can be found in documents ther are times for reasons one is opposing forces from multivessel spasm the ECG won't show a change. We reproduced me in cath lab and more then one vessel spasm and the ECG did not change but we could see spasm & flow deviation. The docotr I had explained oppositing forces to me then. Therre are alot of articles & research articles tht bear this out but many of the cardio & ER docs have not read them making gettign treatment when you do have those epsisodes hard. But you will run into way to many docotrs that flat refuse to believe what study's show is true which is at times due to things like multi vessel spasm , collateral vessel creation, etc there are tiems when Variant Angian is seen without ST elevation. In one study I read 12% of the patients in study showed this,