Chest Pain With No Blockage. What Can It Be?

I am a 58 year old woman and am experiencing pain in my mid-chest with the pain radiating to my back and shoulders plus trouble breathing. During intra-venous stress test, I experienced severe chest pain and a major drop in bp. Systolic was 30. My doctor sent me for an angiogram. I was told that the bp drop indicated probable blockage but it would need to be 70% or greater for stent to be placed. After test, I was told that no major blockage had been found and that I should follow up with my regular doctor. However I am still having the pains and breathing problems. Especially when I am more active or stressed out than normal. For example walking more than a half mile and I'll have an episode. Or disagreement with my husband and I'll have an episode. What questions should I ask my doctor at my follow-up to get to the bottom of this? I also have rheumatoid arthritis, hypertention and sleep apnea to name a few. My appointment is Thursday.

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Please type Prinzmetal's angina into the "Find It" box. Also look up vasospasms and coronary artery spasms and variant angina - all terms for the same condition. A lot of us in this community have this supposedly rare condition. It is just something to consider when you are having chest pain but no blockages are found. I am not the typical Prinzmetal's patient. My spasms can come on at any time of day or night, no matter my activity level or lack thereof. Most definitions of the condition say it comes on primarily at rest and at certain times each day. I have confirmed coronary artery spasms. Mine have been caught in action on multiple heart caths. So even thought I don't fit the criteria, I most definitely have the condition.

You might mention it to your doctor to see if he thinks it might be something to consider with you. It can be managed in most cases with calcium channel blockers along with long-acting nitrates when neeed for better control.

Most of us who suffer with this have certain triggers - stress, cigarette smoke exposure, etc. With me, extreme temperatures (either really hot or really cold) are a big trigger.

You will find a lot of discussions on these spasms in this community. I hope you find answers and relief soon.

Take care -

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Hi bsongbyrd,

Here is a link to an article where my cardiologist discusses both endothelial dysfunction and prinzmetals, as well as the different access approach she does to the testing during angiogram (wrist access = Radial). She teaches this access and the sex differences issue at Stanford. Sleep apnea is a significant risk factor and contributor for heart disease - and women often have their symptoms manifest in the smallest of the vessels (causing chest pain) vs the major vessels as in men or older females. I have small vessel disease and a form of apnea (hypopnea, low oxygen, shallow breathing). Your symptoms are identical to mine. Not all cardiologists do the extra challenges she speaks of in the article. If you want optimal treatment for this, you need an interventional or regular cardiologist (and programs) who keenly focuses on the sex differences. Leading locations: Mayo, Cedars Sinai, Stanford, UC Davis, Scripps, although the individual doctor may have that orientation.

All the best ~ Mary

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Mary & Dianna, your responses are extremely helpful. I am seeing my internist tomorrow and will surely discuss this new information with him. I will ask him to send me to a cardiologist who specializes in small vessel disorders. I must get to the bottom of this. Will look for other posted on the subject.

Thanks Again,

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Hi again, The cardiologist doesn't generally specialize in small vessel - they specialize in women(!!!) You will find regular cardiologists and interventional cardiologists. Mine is interventional and female - see if you can find that combo where you're going, and FYI, my first female cardiologist didn't figure it out(!!). I went to four cardies, one GP and two female internists over 10 years time before it was diagnosed. Part of it was research wasn't there yet.

If you can't find the female cardie, then bring some print out copies to ask your doctor to read and put your name (patient) and phone number on it. Don't presume to be the doctor - they don't like that very much! But you can mention a friend of yours who has the same symptoms and was diagnosed with endothelial dysfunction / Microvascular disease...and sent you these links... ;-)

the author of these physician papers (Dr. Noel Bairey Merz) headed the WISE study (Women's Ischemia,,something something) Physicians.aspx

(Just print the first one and write the site link on it) I'd say don't get all worried if you read it - you don't even know if this is what it is.

Good luck and keep us posted! Mary

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Saw my doctor today and since the angiogram revealed only a 30% blockage, he wants to be conservative moving forward. He prescribed cholesterol med. Also prescribed nitroglicerin tabs to use when I get the chest pain and shortness of breath episode. He said, if that makes the chest pain go away within 5 minutes, then it's probably microvascular. At that time, he'll send me to a cardiologist. He said my symptoms are not dead on for microvascular or vagospasms. I'll have to wait and see. Not sure what else to do right now.

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My Prinzmetal's started the same way. Good luck!

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it can also require some xanax for me...because if the stress doesn't stop, the tightness doesn't stop (always).

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For your sake, please take charge and tell your PCP that you want an immediate referral to an interventional cardiologist...NOW! If your PCP won't do it, contact your healthcare provider and talk with one of their nurses. If you were a guy, your primary care physician would have referred you already!

Breathing problems under stress or exercise is consistent with heart failure in women!

Been there, done that, have the 9" scar to prove it!

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BTW - the nitro spray is much much nicer. I vastly prefer it to tabs. Smoother, easier - but it's only meant for short term relief - not for ongoing pain or tightness.

Best, Mary

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So much fantastic information ladies, thank you so very much. I think I need to give some copies to my cardio. He is educated in this area but I still feel like he just doesn't "get it" at times. Fortunately my recent nuclear stress tests showed that my heart regenerated from my heart attack so that's great but I still suffer from the spasms which have only been detected with heart caths and a couple EKG's. All of my heart sisters make me feel so not all alone in this journey & for that I am eternally grateful! Bless you all!

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bsongbyrd, good luck on your journey to diagnosis. It can be stressful but this is definitely the place to get the love and support of women who have been down that road. I pray that you find the cause of your problems soon and please know that we're here for you whenever you need us. Keep us posted, okay?

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Hi Penny,

BTW - I do not take yet, but many with documented spasms swear by Calcium Channel Blockers, example, Cardizem. Others are not fans. They reputedly can be very helpful for spasm situations.

Best, Mary

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R U on an Aspirin therapy of any kind? I see that this helps me tremendously.

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Hi MaryLG,
I am on a multitude of medications including a calcium chanel blocker, beta blocker, aspirin & plavix. Renexa was just added to my regimen, so we'll see if that helps the spasms. Being told that everything looks good (after 9 stents and a heart attack) is great but doesn't address the on-going symptoms so I am a bit frustrated. I do know that things must change in the way us women are treated and we need to be taken seriously. Collectively I believe we are much smarter in this area than most doctors! :) Bless you all!

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Hi Penny, Hi Loveall6ofthem,

I am on .81 aspirin, but no other thinners other than fish oil. Honestly, I think women certainly suffer from the gender bias issue, lack of knowledge about female manifestations and symptom management. Once an accurate diagnosis is found (and the liklihood of female micro vessel disease is appropriately diagnosed),


I think our system suffers from a sometimes ineffective approach to medicine. My recent discussion post that requires an hour of listening, I think does get to the core of that aspect. It's about Palliative Care. it's not about giving up and waiting to die - it's about effective communication between doc and patient, cutting edge as we get with stents and electronics, and it's about better symptom management and more patient input and control.

I hope people check out that discussion. It's about using the best of both realities in the treatment and management of chronic illnesses.

Best, Mary

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