Prinzmetals heart attacks and angina

Hi Everyone... My name is Kim. I am 51 and I was diagnosed with Prinzmetals when I had a heart attack at the end of July 2006. My angi showed I do not have even a partial blockage .
They didn't have much to tell me about Prinzmetals , only that it was rare and that I needed to keep the stress out of my life. I had the usual intermittant pain and funny feelings in my heart and had to take nitro on a couple of occasions but I didn't have another heart attack yet. They gave me Isosorbide to take three times a day along with the sublingual nitros for any sudden onset of pain. They said it is just an artery that wants to go into a spasm and cut off oxygen to my heart until it starts to kill the heart. I guess I would really like to know what makes the artery want to spasm. i have heard triggers are stress, vaso-constrictors, such as epinepherine (so I had to stop using nose spray) cocoane, and cold weather. I do not use cocoaine altho I do have a stressful family.
Just two days ago I reached my 6 month mark and was able to get a root canal I needed. They won't touch a heart patient until its been 6 months. I told them no numbing medicine with epinepherine so they used a kind without it. later that night after I got home, I suddenly got sick and swetty and began to have spasms. It feels like a heat flush goes through my chest and it is so screy to feel it. I took a nitro and it stopped but then it happened again so I took another nitro and my sister called the ambulance. I felt so weak and nauseated and dizzy. In the ambulance they gave me more nitro and then i started feeling better and over the long night in the ER I began to feel better as they monitored me and ran my blood enzymes which were ok and they let me go home close to morning.
Does anyone else ever feel their spasms as a severe heat flush like that? And it makes me have diareaha too. When I had my heart attack, I got sick and threw up twice. I don't know what to expect or what anyone else goes through with this cause its too rare to find someone else who has it to talk to!
The doctor seemed to think that the carbocaine or whatever they used at the dentist should not have cause that to happen but I got the impression that none of them really understood or were familiar with Prinzmetals, and also one of the letters I read here said that doctors don't have much interest in a Prinzmetals patient because they aren't a surgical fix. I believe that is true! There is no excitement and blood and gore so they are mostly bored. Meanwhile, inside my chest, its anything BUT bored! How scarey a feeling!
And there are other things you can buy OTC like for colds, that have epinepherine or other vaso-constrictors in them ,...if I am not careful I could accidentally buy something and give my self another heart attack but nobody told me this, I found it out by reading about Prinzmetals online.
What I DON'T know could probably fill a book! I accidentally forgot and used nosespray once after my heart attack and within an hour or so My heart was pounding like crazy and skipping beats every 3rd or 4th time. It felt hideous. i couldn't lay back and relax. I finally had to take a xanax from my sister toget it to calm down so I could sleep. My doctor says she hates xanax and will not ever prescrible them. That makes me wonder what is a patient to do that has to control stress, and isn't given anything to help the stress.
I work as an in home care provider for my sister who has MS and coronary artery disease. Her grown children are bi-polar and cause us a great deal of stress and grief almost on a daily basis. We change phone numbers and live behind locked doors out of fear and exasperation.
Her doctor knows the situation and prescribes her xanax .
I don't know why my doctor thinks badly of it, or if theres anything else that she would approve of.
What symptoms do you all have and what do you do for the maintenance of the stress and
for the pain and the spasms? Has anyone had a bad experience beyond the 6 month mark? Does anyone else experience trouble with vaso-constrictors like epinepherine? what else do I need to know?!
What should I expect here?! I am a total newby at this! Anyone with any helpful advice and/ or warnings, I would love to hear from you. Tell me about your experiences so I can have something to compare to! I am .

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Hi, I'm Kim. You can read about my recent "event" under "I almost died on Wed. night."

My cardio thought it was a spasm, too. I also threw up. The whole event was terrifying.

You do have to be very careful about what you ingest, and take precautions such as walking daily to mediate stress. I also take fish oil. Imdur was too much for me.

I wish you the best. I'm kind of shell-shocked right now, so I'm not worth much in terms of writing anything profound. Just know that you're not alone. I'm 40 years old.


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Dear Kim... This is Kimberly. Thanks for your input. Wow....sorry about your ordeal. Sounds just like what I went through. Only you are younger. When you are feeling better and are up to it I hope you write again and tell me if your docs gave you ANYTHING in the way of don't take this or that, be careful with this or know... ANY idea of what we are supposed to do and look out for. I feel like we are memebers of some kind of exclusive club and they forgot to tell us what the password was! I'm pretty much in the dark. Hope you feel better soon. I know you are exhausted for sure and the first 6 months is supposed to be the most active period. I will send my gaurdian angel to be with you for awhile cause I'm past my 6 mo. point now. Take care, Kimberly

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Hi-sounds like you have been through a frustrating experience-hope it is going better. One thing I would say is that about six months after developing my heart problems (cardiomyopathy), I asked the Dr. for some antidepressants. I never thougt I would use such a thing, but it has made a difference. I am on lexapro, and one thing I have discovered is that it has really slowed down my rapid heartrates and flutters. After reading alot about it I discovered that some antidepressants, because they help you reduce stress, also are helpful in controlling heart responses due to stress. So maybe xanax isn't good for you, but it might be good to ask about an antidepressant to help control your stress, therefore some of your heart symptoms. It helped me. If your Dr. seems unwilling or uninterested in the idea, then I would think about seeing another Dr. for a second opinion, because there is alot of docuementation tying the amount of stress to the severity of heart disease. Good luck to you!

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Dear Kim,

Sorry you are going through this. Please, please try to use this site to find a referral to a cardiologist who sees many women. I, too, was diagnosed with spasm because all my arteries but one tiny one appeared crystal clear on the angio. I have recently been evaluated by Dr. Karol Watson, on the Advisory Board of WomenHeart. She is the head of the new Women's Heart Center at UCLA. She wants me--and ALL WOMEN--to know that the latest research findings by Dr. Noel Berry Merz of Cedars-Sinai in L.A. (among others) shows CLEARLY THAT WOMEN ARE OFTEN MISDIAGOSED BECAUSE THEIR ANGIOS APPEAR CLEAR. The reason for this is that the plaque that causes the clots (arteriosclerosis) distributes itself differently in women's arteries than men's. Rather than large clots clumping in the middle of an artery, the plaque in women is not only smaller; but it distributes itself evenly throughout the arteries--and CLINGS TO THE WALLS OF THE ARTERIES. Therefore OFTEN THE PLAQUE/CLOTS DO NOT SHOW UP ON THE ANGIO.

I notice that you mention you have a sister with coronary artery disease or arteriosclerosis. Well, while it is possible that you did have a spasm, true Prinzmetal sydrome is still VERY RARE. And what Dr. Watson told me may well hold true for you: it is very, very rare for an otherwise perfectly healthy artery to spasm. However, a tiny clot may well have triggered a spasm. No one can say for sure. The facts are that while it is possible you are having "spasms," it is far MORE LIKELY THAT YOU HAVE CORONARY ARTERY DISEASE, and clotting is involved. Therefore, I urge you to get a second opinion. For your doctor to "bet" on PrinzMetal and not treat you aggressively as though you do have coronary artery disease is, in my opinion, putting you at further risk.

Dr. Watson gave me another test: as simple non-invasive sonogram of the carotid artery. This sonogram measures the thickening of the walls of the carotid artery. Again, this may be even more useful in women, whose plaque "clings to the walls of the artery." My test, sure enough, showed a slight thickening on one side. Therefore, I am now being treated with Lipitor, Norvasc, beta blocker and Ace inhibitor--and yes, I do take 5 mg. of Lexapro a day. And of course, aspirin. Right after my heart attack I was on Plavix, but not now.

There is no cause for alarm here, Kim. I hope I have armed you with knowledge from someone who really knows women's hearts, the brilliant Dr. Karol E. Watson. Do not accept the diagnosis of Prinz Metal until you get yourself checked out by someone who is used to seeing women's "clear" angios; someone familiar with the latest research.

Everything Dr. Watson says makes such sense. Basically, "we don't know enough about women's hearts to make the certain call that it is spasm. It is far more likely to be coronary artery disease." Therefore, as long as you can tolerate the medications, why not be on the safe side?

Go for a second opinion and choose wisely. I don't know where you live, but I can put you in touch with Dr. Watson, and she might refer you to someone great in your area.

I also agree that you need and deserve something to help you with the stress. I agree with the other writer who suggested an antidepressant. I have found it very helpful, along with regular exercise. It sounds as if you have good reason to be stressed, and your doctors should be sensitive to that.

Stay well, and I hope you get another opinion.



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Wow, finally last wek I had a angiogram and it was confirmed my arteries appear prestine. My cardiologist then went on to tell me I was having spasms of the coronary artery. evedently because I am a nurse he assumed I understood everything about it..............not so here I am on the internet researching. The best knowledge and support always come from someone who knows first hand. I am lucky in that I have not yet been diagnosed with a MI yet thank god. But the statistics do not look so good. The doctor has advised me that calcium channel blockers and a anxiety medication may help....all this is relative the fear is the main aspect that a doctor can not fix. The uncertainty of what is next....

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Hi regnurse2004! It is scary that they really can't exactly name the trigger that brought on the spasm. I am almost a year out from my spasms and MI's and I am finally starting to let that fear go. I am on the right meds, I feel really good and no occurances since then, my echos look great and my doctor says that even with the bypass I received should expect a normal life expenctancy, short of acquiring any other disease of course. I never did go on an anti depressants, which I think probably would have been a good idea. But hind sight is 20/20. I'm just trying to get all the info I can on medications to avoid, some I was stunned that I should avoid, and wouldn't have given it another thought. It's really hard to get your head in the right frame of mind when your own mortality hits you in the face! But, I guess I'm just saying, it'll get easier, give it time.
Take care!!!!!!

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