Prinzmetal angina

[Libbylevi]

Recently diagnosed with prinzmetal angina. Any information please. Was placed on medication and discaharged from hospital next day, notbreall informed, so dont know what to expect.

Thank you

[motley12]

HI ,look up posts CMVD , or another poster is milkfairy she can explain in detail and facebook search Prinzmetal angina (PA) support group (coronary artery spasm(( CAS) excellent as well . I wish you well regards Martin

[Libbylevi in reply to motley12]

Thank you

[Jacey15]

Hi I have prinzmetals too. It means your coronary arteries go into spasm cutting off the blood supply to your heart and causing severe angina pain. The usual treatment is calcium channel blockers (I'm on amlodopine) but the drug that's made the biggest difference to both me and my dad who has it too is isosorbide mononitrate. I have GTN to use during an episode. My triggers are the cold, resting following a stressful/busy time and pain although on occasions I can't see any triggers. I find some cardiologists and A&E Drs don't know a lot about prinzmetals so I have read a lot. If you have any questions I can try to answer them xXx

[Libbylevi in reply to Jacey15]

Thank you. Is yours under contril now? Xx

[Jacey15 in reply to Libbylevi]

I've not had an episode sun the beginner of December when I had my tonsils out. I didn't start fluvastatin until the middle of December. My episodes since starting isosorbide mononitrate are much shorter, less intense and respond to GTN much quicker. After my dad started isosorbide mononitrate he went from having episodes every couple of weeks to 2-3 episodes per year.

[Milkfairy Heart Star in reply to Jacey15]

Jacey it so encouraging to read that others have been able to have their Coronary artery spasms treated well.

Short acting nitrates work briefly and then I am hit by even worse rebound pain so I can't use a spray.

Unfortunately I still experience daily and nightly episodes of angina despite taking a ridiculous number of medications 😖

[Jacey15 in reply to Milkfairy]

Sorry yours is refractory Milkfairy. I can only imagine how awful it must be. I have used 20+ GTN sprays during episodes prior to starting isosorbide mononitrate and even then it didn't always help.

[Libbylevi in reply to Jacey15]

Thats amazing. How much isosorb are you taking and what other meds are you.on please x

[Jacey15 in reply to Libbylevi]

I have a number of long term health conditions and take more than 20 pills per day but the ones I take for coronary artery spasm (aka prinzmetals, vasospastic angina, variant angina) are 7.5mg amlodipine just before I go to bed, 60mg isosorbide mononitrate as soon as I wake up (I started on 30mg but it wasn't enough) and 20mg fluvastatin in the early evening.

[Milkfairy Heart Star]

Hi Libbylevi

I am sorry to hear you have joined us in the bizarre world of living with a condition that so few Cardiologists have much understanding about.

I have attached some information about Microvascular angina which was updated by the BHF last year. Microvascular angina and Coronary artery spasms aka Prinzmetal/ variant angina can be difficult to diagnose and tell apart.

The researchers into the conditions are tending to use the term Microvascular angina and vasospastic angina rather than Prinzmetal Angina as it is a reflection of what is happening in the body.

I have attached the up dated BHF information leaflet about MVA. The information about Vasospastic angina is about to be updated but I have given you the link to the old leaflet about Coronary artery spasms.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

It is important that you are under the care of a Cardiologist who has some knowledge and understanding of the conditions or is willing to work with you to find the best treatment that works best for you.

I was diagnosed nearly 7 years ago. It was bewildering as no one seemed to understand my vasospasms. I was told I couldn't possibly be having cardiac chest pain because my coronary arteries are clear.....

I live with vasospastic angina causing Microvascular angina and coronary artery spasms.

As Jacey says it is important to be aware if your triggers.

The common ones are the cold weather, emotional and mental stress. Also out of the blue angina for absolutely no reason.

No beta blockers they make coronary artery spasms worse.

I avoid caffeine, artificial sweeteners and local anaesthetic with adrenaline or cold remedies with decongestants as they constrict your blood vessels.

[Jacey15 in reply to Milkfairy]

Unfortunately I also have postural orthostatic tachycardia syndrome so have to have the beta blocker bisoprolol.

[Nathan53 in reply to Milkfairy]

The more I try and build knowledge on MVA the more confused I become at times. The BHF papers you helpfully highlighted indicates beta blockers may be useful in some instances yet most of the things I have read including a paper in the European Heart Journal suggest beta blockers should be avoided. It also mentions the protection ACE inhibitors can offer but other research J have read states calcium channel blockers are the way to go and stress the importance of nicorandil which is not mentioned by BHF. I am just trying to gain greater understanding and would value your thoughts as I think you have probably looked more deeply into this over a long period.

[Jacey15 in reply to Nathan53]

It's more difficult to treat when there are co-morbidities. I have hemiplegic migraines and bisoprolol reduces the frequency of these as well as keeping my heart rate at a manageable level. I've also been diagnosed with auditory artery spasm. Beta blockers are contraindicated in coronary artery spasm and did make my dad very unwell while he was waiting for his angiogram. Sometimes though you have to weigh up all the meds and all the illnesses and do what you have to to get by. There have also been some studies done that demonstrated low doses of statins (fluvastatin) can help and I started this six weeks ago. So far, so good.....

[Nathan53 in reply to Jacey15]

Thanks for the reply - I take your point about the co-morbidities. I hope your statin treatment helps.

[Milkfairy Heart Star in reply to Nathan53]

Hi Nathan,

As Jacey has already said it's complicated!

Microvascular angina can be due to blood vessels failing to dilate or unable to retain their ability to relax .

Then beta blockers are helpful.

The other cause can be due to the smooth muscle of the blood vessels constricting either the small vessels Microvascular angina or large vessels Coronary artery spasms.

Vasospastic angina.

Most people have one or the other. I have both along with spasms in all my blood vessels. I also experience neurological problems with my angina episodes and have Raynauds phenomenon.

There is active research going on. I have given some links to Prof Colin Berry's research he leads a BHF funded research into MVA and Vasospastic angina.

My London based Cardiologist is also BHF funded and is involved in research into Microvascular dysfunction and vasospastic angina.

If you need any more information just message me.

academic.oup.com/eurheartj/...

mdedge.com/familymedicine/a...

onlinelibrary.wiley.com/doi...

This a poorly understood condition but there is a growing interest in this area from younger researchers.

bcis.org.uk/news/bcis-resea...

3 of the 4 finalist were researching Microvascular angina.

[Nathan53 in reply to Milkfairy]

Thank you for that I really appreciate the links and your offer that's good of you. I will have a good look through the articles.

[Milkfairy Heart Star in reply to Nathan53]

No problem.

I have as they say had quite journey and hope nobody else has to endure my experience.

I forgot this article. It gives a really good explanation of the possible causes and treatments. See Table 2

heart.bmj.com/content/104/4...

[Libbylevi in reply to Milkfairy]

Thank you so much for the information. Is yours under control? X

[Milkfairy Heart Star in reply to Libbylevi]

I wish I could say yes but because I have spasms in my microvessels and coronary arteries it is difficult to treat.

It is possible with some trial and error to find the medication to treat Coronary artery spasms reasonably well. Calcium channel blockers such as Diltiazem are usually effective along with nitrates. It is also important to learn what your stressors are and have stratergies to avoid or manage them.

I suggest you go back to your GP take some print outs of the BHF information. Ask to be referred back to a Cardiologist who will be willing to work with you.

It is a bewildering condition as so few Cardiologists have much knowledge they have difficulty seeing beyond the blockages !

Good luck

[Libbylevi in reply to Milkfairy]

Thanks you. Really hope things improve for you

[Blue_Fisherman]

As I understand it Prinzmetal was the name of the guy that discovered there was a form of angina that was aggravated even at rest. This is commonly known now as gushing angina or unstable angina and it needs immediate investigation.

[Milkfairy Heart Star in reply to Blue_Fisherman]

The terms Vasospastic angina or Coronary artery spasms are used by the researchers into this condition.

Which as you say needs investigation in order to receive the best treatment to prevent any untoward cardiac events

[Nicky3]

Hi,

The discussion regarding beta blockers with this condition is valid. I had previously been on one then taken off after my CAS diagnosis then after a few years I developed Long QT. Therefore, I had to go one that shortens the QT called Nebivolol which has worked. Basically it’s a balancing act for the Cardiologist depending on what other heart conditions or medication you are on.

Only with more research will we hopefully get better medications and more training/knowledge for all Cardiologists, GP’s etc. This will result in better care and understanding for such an underestimated condition.