How many a time have my arteries closed, but an aliveness subsequently flowed
Speaking about all things rare related, I felt it important to elaborate and briefly cover one such topic.
An extensive report of my condition recently came through, where in particular it noted the following with regards to the angina – chest pain, spoken about from time to time in past chapters:
“Dr…. – Who says she has an element of Prinzmental’s angina, suggested 1/2 a tablet of Zildem twice a day. She is not on this. (I’m on an alternative)
She also complained about severe left anterior chest pain that has responded to Nitrolingual spray, but made her headaches, not unsurprisingly worse.”
A paramedic and I discussed this about 2 years ago. He said he is unsure which category of angina i fit into. Prinzmetal’s could be most likely but microvascular (a seperate topic altogether on the Heart Sisters blog) is also found in individuals with Dysautonomia.
To see that a term and explanations was given to these spasms made me jump with relief. So in future if the need arises to explain or i am asked about it, it can be explained more easily. Otherwise, I’m met with queer frowns.
You see, Prinzmetal Angina differs from “classic” angina in several important aspects. The cause, clinical presentation, as well as the diagnosis and treatment, tends to be different.
It’s an Atypical, uncommon and rarer form of angina produced by a spasm in a coronary artery.
Let’s clear out the false notions!
Angina is not always caused by blockages. Especially when it presents in a young case like mines or even others – who’s coronary arteries are entirely clear of plaques. It can occur because of a sudden spasm in one of the coronary arteries — the arteries that supply blood to your heart.
Coronary artery spasm can also cause ischemia (oxygen starvation) in the part of the heart muscle supplied by the affected artery, and chest pain thus results.
While PA can have important consequences, including heart attack and life-threatening cardiac arrhythmias, it can also be managed well, if correctly diagnosed + treated – which is an extremely difficult process due to multiple factors mentioned in the past; lack of knowledge, expertise, age and gender discrimination
PA is most often brushed away as hysteria / anxiety attack.
How is it diagnosed?
Prinzmetal angina occurs when an area within one of the major coronary arteries suddenly goes into spasm, temporarily shutting off blood flow to the heart muscle supplied by that artery.
Now, during these episodes, the electrocardiogram (ECG) shows Nitrates usually relieve the spasm very quickly, returning it back to normal.
So the things doctors search for are:
🔹Typical chest pain, accompanied by changes on the ECG
🔹Relieved by nitrate administration,
🔹Demonstrates as “normal’ coronary arteries on a cardiac catheterization.
In many cases, a professional is not present during an actual episode of angina. So a person will come in for evaluation after the angina has dissipated. In these instances, diagnostic testing may include ambulatory ECG monitoring for a period of a few weeks (looking for spontaneous episodes of angina accompanied by ECG changes) or cardiac stress testing.
(While Prinzmetal angina usually occurs at rest, about 20% of people may experience theirs being provoked during an exercise test.)
Sometimes, a cardiac catheterization with “provocative testing” is necessary to make the diagnosis.
But because Prinzmetal angina is not the only type that can be seen with normal coronary arteries, making a correct diagnosis may require a demonstration where the spasms can be provoked.
Two types of “provocation” are often used to attempt to induce spasm:
1) Hyperventilation testing is a noninvasive test.
Usually conducted early morning, when a spasm is more likely to occur. The patient is instructed to breathe deeply and rapidly for a full six minutes — much more difficult to do than it sounds — while an ECG is being continuously recorded, and echocardiography is done to look for signs of coronary artery spasm.
This test is especially useful in people who have frequent episodes of severe PA. Not nearly as useful in those whose episodes are more sporadic, or infrequent.
2) Testing with drugs is performed during a cardiac catheterization.
In this test, a drug is injected intravenously or directly into a coronary artery. In people with PA, it often provokes the same localized coronary artery spasm that causes their symptoms. This localized spasm can be visualized during the catheterization procedure.
Outlook and consequences
While in general the outlook can be good depending on whether it’s managed correctly. It can also trigger dangerous and potentially fatal cardiac arrhythmias, especially ventricular fibrillation.
Heart attacks (infractions) are uncommon, but they can indeed occur, causing permanent damage to the heart muscle.
Essentially, it all stems down to skill, knowledge and education:
Recognition of the signs – believing an individuals concerns – understanding they are authentic
Proper diagnosis – lifestyle management – knowing your triggers if episodes occur while not asleep.
Medicinal administration in the event of a sudden emergency, is of utmost importance and greatly reduces the risk of the aforementioned complications.
An important note:
Drugs that can trigger it which we generally ought to avoid, include many beta-blockers and some migraine drugs — in particular, Imitrex (sumatriptan).
When I heard this I almost felt like yelling:
Didn’t i tell them that! I know my body! I said if it happens in the midst a deep sleep HOW CAN it be a provoked anxiety attack.
However, Rizatriptan also triggered more frequent and intense episodes.
The Dr was indeed wise to not administer beta-blockers until further assessments are done and they are certain it does not clash majorly with the other symptoms of my condition as suspected.
Firstly it would lower my usually low blood pressure and I’d have NO quality of life due to being constantly dizzy.
Secondly, it could trigger these episodes which we try out best to avoid.
So that’s one entire jumbled complication in itself.
This heart endures anguish and bears more strength than I possibly thought it could
But “wondrous is the affair of a believer, for in every matter of his there is good”
So beyond everything, affliction comes in different forms to cleanse
These coronary arteries that jeopardise my life, also strike a rebirth of goals
(Links to the previous chapters where i addressed the same topic 👇)
Diagnosis of PA
Lateral infarction – partial heart attack