No blockage but still having tightness

Yesterday I had my first angiogram. I failed two stress tests so they sent me for the angiogram. Thankfully I think, it showed no blockage. However, I am still having tightening in my chest on and off and tonight I have a chest cold and its much worse. My blood pressure went to 207/120 and it was so scary before the test. After it came down to 133/76. No wonder they are confused. I am too. They say it was because I was stressed about the test. Therefore, I am home recovering from the poke in my groin from the angiogram and wondering what is going on. The heart nurse I had told me my notes show there are irregularities in my heart and they she wondered with me what is going on. It seems my heart does not work correctly or shows it is under stress. What could it be? Don't know where to go from here.Why would my chest hurt so much from coughing with a cold? I was also surprised they did the tests when I had a cold.

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I think this is a confusing issue for many women, we are not getting heart conditions or attacks for the same reasons as men or according to what doctors expect and work with (plaques, blockages). Our nervous systems are more sensitive. For example I believe angina/spasms are more common in women than in men. Did they dicuss possibility of spasms? Did they prescribe medication?

We are also more prone to autoimmune disorders, or some families are due to genetics. Temporary autoantibody reactivity to just a virus (or bacterial illness) is a possibility. Antobodies can harm any of the body's tissues (maybe the heart-arteries?) I learned this when my son developed thrombocytopenia after a cold, this happened twice. He developed spontaneous thumbprint sized bruises all over his trunk and legs b/c antibodies were targeting his blood platelets. Fortunately it was transient and what they call idiopathic. But it made me aware how our bodies can have unexplained things going on, and some of us are more sensitive than we or others realize. I often have more fluttering skipped beats and pounding in my heart after an illness.

Have you looked into reasons for unstable blood pressure, which is different than ongoing hypertension? Sometimes the parasympathetic nervous system that controls your body's reflexive and automatic functions, is irregular. Or maybe the endocrine system is releasing hormones irregularly. The adrenal glands release the flight or fight hormones.

My dad has a very rare type of cancer called neuroendocrine cancer, tiny to microscopic tumors releasing hormones(in his case digestive hormones in the small intestine esp serotonin) that circulate and cause systemic reactions. The tumors are not malignant and the danger is not fromt their growth but from the irregular hormonal effects (or if they spead to the liver or lungs). Over time the endocrine imbalance can overwork and enlarge the heart. Not saying this applies to you, but just that things go on that have physiological medical effects that can seem psychological when undiagnosed (my dad eventually had to go to Mayo-the condition also gave him painful esophageal spasms that no regular doctor could figure out ).

There is a condition called dysautonomia, the most common symptom of which is postural hypotension (drop in in blood pressure dizziness upon rising) but it could cause spikes in blood pressure too and pounding heart (and other things). It can also cause fatigue enough to stall a very successful person. I learned about this curiously enough when the lead singer of the "Wiggles" (extremely popular children's singers/performers from Australia) retired due to dysautonomia.

Some of what I learned seemed to apply me. It was always odd to me that my heart pounded and raced and caused me breathlessness just upon lying down (I never associated it with anxiety at all). My cardio noted this too and confirmed possibility of dysautonomia. You can diagnose it with tilt table test, but I did not feel it necessary as symptoms are not debilitating and sometimes not present. But could it lead to spasms, dissections over time? Or could those (unexplained heart conditions) be autoimmune in nature? I've wondered if dysautonomia might be affecting women hearst patients with spasms and seeming to have anxiety. Dysautonomia is also present with mitral valve prolapse or MVP (heart valves).

In my case I had what seemed to feel like ongoing heart attacks 8 yrs ago that were probably spasms, or possibly healed dissections. It all just remitted after two months or so (I was postpartum). Then just recently I had a heart attack caused by a dissection and then a spasm causing another MI in the hospital, which seems to indicate to me that my heart or nervous system in genreral is sensitized somehow, or periodically becomes sensitized?

The other possibility I wonder about are mini blockages in the smallest arteries, too small to be seen in angiogram, I think there are other procedures that can turn them up?

Just throwing out some considerations here as I have been trying to understand my situation, along with postings of others here who do not have CAD, but do have heart attacks.

I think my point is that women (maybe moreso than men/0 can seem to be experiencing psychological conditions if no doctor can diagnose them, but it may in fact be medical/pyhysiological. I don't think you should give up on trying to find out what's happening-Best wishes and hope this helps rather than just adding more confusion!

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I had my first heart attack in1994 at the ripe young age of 40, at the time they addmited me in hospital my bp was 180/124 they thought i would stroke out on them... then for the next 10 years most drs and cardo guys i saw insisted it was nothing...had a major attack in 2002 when they placed a stent.

I had been complaining for years that i was still having chest pains when the drs told me nothing was there i asked point blank if it could be on back side of heart or in smaller veins and artterys of my heart ... No they said... fast forward to this year 2nd major heart attck where they had to fire me back 3 times ,twice in er and once on way to cath lab, stent had blocked...need less to say i have changed cardo docs,new doc is a women and she is running a lot more test and has alot more to say...and listens to me.... just keep looking...



also when i go to drs and they come in and check me out then go to leave the room with out so much as really listening to me i stop them i tell them i happy they are done but i am no and still have questions i want answers.... I will keep praying for all of you on here.. Have a Great Day... Janie

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Hello Suzanne,
I can also sympathize unfortunately. I had my first cath wed. I didn't show any blockages which is great, but why am I still having the chest pressure, nasuea, and so very tired. All the cardio that did my cath (not my reg one, she is an electric specialist) (her husband an interventionalist) could tell me is my arteries are clear. Well after "coming to" a bit, I asked the nurse in the cath recovery area could it still be artery spasms and she said no not unless I was doing cocaine, which I am not. I intend to have a chat with my dr at my followup about that conversation anyway. I was rather pi**** off about that remark!
I am finding that although my dr's are willing to keep searching which is why I had the cath there are still many people including "health care professionals" that are still very clueless. I guess these types of type A people are simply for the most part not willing to say I don't know yet. Thankfully my dr seems a bit more caring. I guess the best part is although I may still be having the spasms or whatever they are, they haven't caused any damage yet. I am also on the CCB's (Cardizem 240mg) and now I suspect she will add a long acting nitrate in addition to my fast acting spray, at least that was what was discussed prior to my cath. I guess with all my ramblings, I am just trying to say I understand what you are going through and you are most certainly not alone. Just out of curiousity, after your cath, did you feel something like you could tell in your chest where they had put the line into your heart. It felt very similar to the chest pressure I have had all along. I likely should have called my dr, but I figured why bother, so I sucked my nitro and took a nap. Although I can't offer much more than commiseration, you are not alone.
Take care, Katie

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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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Nancy Grace,
Excellent post above. Great job of lilustrating that "heart problems" are quite complex and multi-factorial.

Songbyrd, what state/city do you live in (or close to?) Perhaps others might know of a good doctor/center near you to recommend.

Best, Mary

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