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What Next? - Prinzmetal Angina Sufferer

I'm from Australia, and my 25 yr old wife has suffered from whats been diagnosed as Prinzmetal Angina, or Coronary Artery Vasospasm for the last 5 years - and frankly we're running out of options on what treatment or opinion to seek next.  Our local 'guru' cardiologist has all but ceased any helpful input as he's stumped too...  Symptoms include frequent chest pain (lasting between 30 seconds to multiple hours), irregular heart beats, shortness of breath, loss of conciousness, Irritable Bowel and dizziness.

She is currently taking Verapamil (240mg night, 160mg morning) which up until a few days ago has prevented her from passing out.  She is also taking 20mg Pariet for Reflux.  The condition (Prinzmetal) became apparent a few weeks after the birth of our first child, and we've suffered fairly continually with it for the last 5 years.  One break of note is during her second pregnancy (6 months ago) - when she showed absolutely no symptoms for near 7 months carrying our daughter... Almost like a different person, full of energy, able to drive and go out alone.  All was great up until she developed a black spot in both her eyes - which was identified by optology as collapsed capilaries, and resultant dead patch of Iris, suspected cause is spasm.  Given the risk it could be permanent, they delivered our baby 6 weeks early.  Within 3-4 weeks of the birth the hormones stablised and symptoms began returning with a vengence too.

We've had multiple ECG's, an ECG chip implanted under the skin for 9+ months, stress test, pee test (over a week), Heart Catheter (All arteries perfectly fine), the whole box and dice and after all of the tests, needles, drugs etc... All they can tell me is - we think its Prinzmetal Angina, but we're not 100% certain.  So really, because its not any of these 10 things, it must be that...  Furthermore, your current health - (she hasn't been able to get out of bed for the last 2 days) - thats the best its going to get, sorry.

Well I hate to be a party pooper, but that response simply isn't acceptable.  I'm desperate.  I can only say lets see this new doctor honey, maybe they'll have something new to say so many times before she completely looses the will to try.  We've got young kids, 5yrs and 6 months.  I need things to improve, or at least stablise... Please anyone with any input, please - I'm begging you.  Help us....
10 Responses
Avatar universal
Might I suggest to stop the Pariet and any other medication except the Verapamil for a while?

Pariet can produce, as a side effects, hypomagnesemia, hypocalcemia, lack of Vitamins B.

If you get a blood test,, also check for Vitamin D.

Avatar universal

Thanks for your thoughts. Unfortunately, stopping the Pariet even for a period of 12 hours seems to result in the symptoms of reflux returning...

Personally, I don't suffer reflux - but if its even half as bad as she says it is (or carrys on about), stopping the pariet isn't really a viable option.

I was not aware of the side effects you've listed, so I'll have to do some research.  And just on the off chance, next time we see the doc I'll be sure to ask about stopping the Pariet - although I'm sure that will go down like a lead balloon.
1756321 tn?1547098925
The gold standard to diagnose Prinzmetal's angina is a coronary angiography (a test that produces an X-ray of the heart's arteries on a monitor) with injection of provocative agents into the coronary artery.

Provocation testing may involve substances such as ergonovine, methylergonovine or acetylcholine. If a focal spasm (a spasm at just one spot) occurs and you have ST-segment elevation on an ECG, you have Prinzmetal's angina.

Prinzmetal's angina is treated with medications, specifically nitroglycerin. An over the counter product is L-arginine which enhances nitric oxide (NO) synthesis so this is also helpful.

Pariet is a proton pump inhibitor (PPI) and works by slowing or preventing the production of acid in the stomach. This drug should only be used short term as stomach acid is vital for good health. High acid is rarely the cause of reflux/GERD so in most cases an acid blocker is the incorrect treatment.  An excellent article about the importance of stomach acid is "HCL - The most important supplement ever?"  An excerpt...

"Stomach acid is necessary for the following functions:

* Absorption of at least 8 nutrients are dependant on adequate stomach acid: calcium, B9 and B12, magnesium, zinc, iron, vitamin C and beta carotene

* Absorption of anti oxidant vitamins A and E, putting you at greater risk of oxidative stress and chronic inflammation

* Breakdown of protein for use in tissues and muscle synthesis

* Activation of enzymes, hormones, and neurotransmitters

* Prevention of bacterial pathogens from going into the lower GI tract, causing infection, and putting you at risk of disease and stomach cancer

Many people think gastric stress is normal. It is not. A strangely common misconception is that Westerns have too much stomach acid. This is rarely true!"

Oxidative stress, chronic (long term) inflammation and magnesium deficiency are listed conditions of low stomach acid. Interestingly, they are also listed causes of Prinzmetal's angina (variant angina).

An excerpt from the study - Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management. J Nippon Med Sch. 2011;78(1):4-12...

"Deficient basal release of nitric oxide (NO) due to endothelial dysfunction, and enhanced vascular smooth muscle contractility with the involvement of the Rho/Rho-kinase pathway are reported to play important roles in the pathogenesis of coronary artery spasm.

Other precipitating factors of coronary artery spasm include imbalance in autonomic nervous activity, increased oxidative stress, chronic low-grade inflammation, magnesium deficiency, and genetic susceptibility. The genetic risk factors associated with coronary artery spasm include gene polymorphisms of endothelial NO synthase (NOS), paraoxonase, and other genes."
976897 tn?1379171202
       I had this problem in 2009, my left artery decided to start having nasty spasms. I questioned having possible vitamin, mineral or metal blood level issues with my Cardiologist in London, but he said it would be a waste of time, there would be other symptoms too. He said there are just two approaches that he has found to work. Firstly is a squirt of Nitro spray under the tongue, to force arteries open. I tried that for 2 days, but couldn't handle it due to the headaches caused by a sudden drop in blood pressure. So we went for the second approach, calcium channel blockers. Smooth muscle in the body, such as that inside arteries, use calcium to operate. The absorb it from the blood, through tiny channels in the artery lining, hence the name calcium channel blockers. No calcium means they shouldn't be able to spasm. He put me on a low dose of diltiazem and within 2 days the spasms stopped. He said the plan was to use the medication for just a few weeks, then stop it, to see if the problem is cured. He said in many cases it seems to fix it. After a few weeks we stopped the medication and since 2009 I've not had a spasm.
Perhaps this is something you could mention to your Doctor. He may agree, or disagree, but it certainly worked for me. My spasms were that bad that I could actually feel the kicking of the heart when it happened, like a vibrating sensation, along with the angina.
Avatar universal
For Prinzmetal Angina it is recommended to take Taurine minimum 15 grams per day in divided doses
Magnesium, Vit. A, Vit. D Omega 3-6-9, Cayenne pepper, coQ10but only ubiquinol as ubiquin-one does not work, folic acid , arginine minimum 5 grams at one time , citruline 200-1000mg. There is also some research that high doses of zinc for 14 days (300mg) reduce angina pain but copper 5mg should be taken for 2 wks before starting such high doses of zinc.
I am on atorvastatin, clopidegrel, amlodopine and asprin. Nitro as needed . I recently started taking Rite-Aid brand Calcium, Magnesium and Zinc
I have only needed nitro yesterday and today. Could the supplements be causing problems?
Avatar universal
I was just diagnosed with prinzmetal. Last week. I am 57 yr. had problems since college.  I had an attack during nuclear die stress test. Clear followup on heart cath. My aorta spasms right below my sternum. For years I have been told it is severe heartburn, acid reflux etc. it is a severe burning and knife like pain. It feels like the alien is coming out. Found out that Jewish Hospital in Cincinnati is doing research as to genetic connection. They are prescribing l' arginine, an amino acid. I am going to try it as the side effects from heart medicine are too severe. Bruising nose bleeds and I couldn't think. Slept all day last 2 days. All this in just 1 week of being diagnosed.
Avatar universal
I also found out lack of nitric oxide causes it. This is what is genetically lacking. Also nitric oxide is produced by breathing through nose. I don't because I have a deviated septum. So I will probably have surgery.
Avatar universal
I am 46yrs and have just had my second heart attack due to Prinzmetal angina. It was only after my second heart attack that (I had predicted was going to happen) only then did my cardiologist take me seriously. I was told repeatedly by my cardiologist that my chest pain at rest could not possibly be angina of any sort. He told me to go away and see a psychologist! This was even despite having already having experienced a heart attack at rest aged 39. I am on Diltiazem 300mg in the morning and 120mg evening. Like the others nitrates give me awful migrains so I avoid them. One interesting thing that has been suggested to me is that I may also have microvascular spasms. This is the tiny blood vessels in the heart that keep going into spasm, depriving my heart muscle of oxygen hence the pain and shortness of breath and feeling jetlagged all the time.. I wonder if that may be a possibility in your wife? There are treatments such as TENs machine to control the pain or a nerve block in the neck that can block the pain receptors. worth asking your consultant. good luck
Hope you switched to a new Dr.
Avatar universal
I have the exact same thing. My pregancy's were just like that.  I felt great while I was pregnant , then after delivery , the worst spells ever. I have dealt with this for years. My Heart specialist put me on Metoprolol  25 mg x2. I have been praying a lot also. I'm not sure which one worked for me , but I seem to be a lot better. Stress is also very bad for this problem . When I was under stress it seemed  to happen a lot more often. I also use zanax when I feel it coming on . I helps a lot  also. I hope this helps. I know the hell you are going through . Good luck.
Avatar universal
Is your wife still having these issues... i see it was posted in 2013?
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