Unusual angina responds well to medication
Dear Dr. Donohue: I have had, on at least five occasions, chest pains that made me think I was having a heart attack. All my tests have been normal, including a stress test. A heart doctor decided to catheterize me, and he discovered I was having heart artery spasms, which caused the pain. I carry nitroglycerin with me. Could I still have a heart attack? — T.D.
Answer: You have an unusual kind of angina — chest pain that comes about when heart muscle doesn’t get enough blood. Your angina goes by the name of Prinzmetal’s angina or variant angina. Regular angina arises when a person is active, bustling around. Prinzmetal’s angina occurs when people are at rest, just sitting.
In your angina, heart muscle is deprived of blood due to a sudden constriction of a heart artery. That kinks the artery, so blood flow to the heart temporarily stops. Pain arises during the phase of artery constriction and goes away when the artery dilates.
Prinzmetal’s angina is often hard to confirm. During an episode of chest pain, an EKG shows changes typical of the condition, but most people don’t have the good fortune of having an EKG running while they’re having chest pain.
To prove the diagnosis, a heart doctor often must catheterize the heart arteries. A catheter is a pliable tube that is threaded into the heart arteries from an artery in the groin. If Prinzmetal’s angina is suspected, the doctor gives the patient a drug called ergonovine, which causes the artery to constrict, something that doesn’t happen to normal arteries.
The most dangerous time for a person with Prinzmetal’s angina is the first six months of symptoms. After six months, the frequency of chest pains starts to diminish. The survival rate for Prinzmetal’s patients is high — 95 percent at the five-year mark. The threat of a heart attack is not great.
Nitrate drugs, like nitroglycerin, are standard treatment. So are drugs called calcium channel blockers. Some brand names are Cardizem, Procardia, Cardene, Plendil and Norvasc.
The booklet on coronary (heart) artery disease discusses ordinary angina. Readers can order a copy by writing: Dr. Donohue — No. 101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.