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Can Coronary Vasospasm Cause Atypical Angina?
Question: Hello good Sir! Hope you are still doing good!
My question to you this day is as follows:
I have been struggling with some form of pressure in the middle of my chest. It's not pain, but heavy feeling, pressure, feeling heavy. Went to see the doc, and she sent me to the hospital. There they took ECG showed RBBB pattern. Bloodtests were Troponin T, cholesterol, etc. Included was a blood-gas bloodtest which showed p02 13,9 pC02 5,7. Also on a bike an cycled. 175 watts XXXXXXX heartrate was 164, bloodpressure 160/73. No ST-elevation or depressions during that.
Now - I still have this pressure in chest on and off. And I have been thinking this actually might be spasm angina after I saw a video done by dr XXXXXXX XXXXXXX explaining this. It was scary how I recognized my symptoms.
I have not done a CT WITH contrast, but one with NO contrast that showed 0,5 score of calcium.
Any advice? I feel that spasm angina is very similar to what I feel.
My doctor dismisses it, and say that this is some stomach thing, like reflyux related or something.
I however feel my heaviness, and shortness of breath MUST be related to clogged arteries or spasm in them.
Here is the link to the video from cardiologist. For me too, I get this while resting, or just sitting still. And the pressure.
My question to you this day is as follows:
I have been struggling with some form of pressure in the middle of my chest. It's not pain, but heavy feeling, pressure, feeling heavy. Went to see the doc, and she sent me to the hospital. There they took ECG showed RBBB pattern. Bloodtests were Troponin T, cholesterol, etc. Included was a blood-gas bloodtest which showed p02 13,9 pC02 5,7. Also on a bike an cycled. 175 watts XXXXXXX heartrate was 164, bloodpressure 160/73. No ST-elevation or depressions during that.
Now - I still have this pressure in chest on and off. And I have been thinking this actually might be spasm angina after I saw a video done by dr XXXXXXX XXXXXXX explaining this. It was scary how I recognized my symptoms.
I have not done a CT WITH contrast, but one with NO contrast that showed 0,5 score of calcium.
Any advice? I feel that spasm angina is very similar to what I feel.
My doctor dismisses it, and say that this is some stomach thing, like reflyux related or something.
I however feel my heaviness, and shortness of breath MUST be related to clogged arteries or spasm in them.
Here is the link to the video from cardiologist. For me too, I get this while resting, or just sitting still. And the pressure.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello,
I reviewed your recent history and your medical tests and would explain that your negative exercise cardiac stress test result was expected because you have a low pre-test probability (because you have atypical chest angina and absence of coronary risk factors).
Coming to this point, an important coronary artery disease is excluded with a high probability.
Nevertheless, I agree with you that atypical angina may be also due to coronary vasospasm, but in such case, certain triggering factors may be angina related such as psychological stress, cold weather, physical activity, etc.
In addition, specific ECG patterns are present during spastic angina (monophasic ST elevation on ECG).
In order to detect or to provoke spastic angina, special tests can be performed such as Ergonovine stress test or Hyperventilation stress test.
These tests could help rule in or out possible vasospastic angina.
To conclude, in my opinion, in order to definitely exclude a possible implication of a coronary artery disease to your clinical symptomatology, special tests may be required:
- a coronary angio CT scan
- a cardiac SPECT.
Only if these tests result totally normal, we could definitely exclude any cardiac issues and recommend other tests to investigate for other possible causes that may mimic this clinical situation (cerviko-thoracic MRI, fibrogastroscopy, inflammation tests, pulmonary function tests, etc.).
You should discuss with your doctor on the above tests.
Hope I have answered your query. Let me know if I can assist you further.
Take care
Regards,
Dr Ilir Sharka, Cardiologist
I would recommend as follows:
Detailed Answer:
Hello,
I reviewed your recent history and your medical tests and would explain that your negative exercise cardiac stress test result was expected because you have a low pre-test probability (because you have atypical chest angina and absence of coronary risk factors).
Coming to this point, an important coronary artery disease is excluded with a high probability.
Nevertheless, I agree with you that atypical angina may be also due to coronary vasospasm, but in such case, certain triggering factors may be angina related such as psychological stress, cold weather, physical activity, etc.
In addition, specific ECG patterns are present during spastic angina (monophasic ST elevation on ECG).
In order to detect or to provoke spastic angina, special tests can be performed such as Ergonovine stress test or Hyperventilation stress test.
These tests could help rule in or out possible vasospastic angina.
To conclude, in my opinion, in order to definitely exclude a possible implication of a coronary artery disease to your clinical symptomatology, special tests may be required:
- a coronary angio CT scan
- a cardiac SPECT.
Only if these tests result totally normal, we could definitely exclude any cardiac issues and recommend other tests to investigate for other possible causes that may mimic this clinical situation (cerviko-thoracic MRI, fibrogastroscopy, inflammation tests, pulmonary function tests, etc.).
You should discuss with your doctor on the above tests.
Hope I have answered your query. Let me know if I can assist you further.
Take care
Regards,
Dr Ilir Sharka, Cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks!
So these tests, are they invasive?
I fear i dont tolerate the contrast fluids. Are there any way of avoiding reactions to that?
I will talk to my doctor about what you say. I feel it may be what is wrong with me.
Hopefully not but it seems very similar.
So these tests, are they invasive?
I fear i dont tolerate the contrast fluids. Are there any way of avoiding reactions to that?
I will talk to my doctor about what you say. I feel it may be what is wrong with me.
Hopefully not but it seems very similar.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello,
Unfortunately, almost 95% of the cardiac tests are performed by the utilization of contrast agents or radiotracers (including the above-mentioned tests).
Anyway, before performing these tests in allergic persons, premedication may be done (starting 24 hours before the test) in order to avoid possible allergic reactions.
A test that does not require contrast agents and is not invasive is a Hyperventilation stress test.
You should discuss with your doctor on the above test.
Hope I have answered your query.
Take care
Regards,
Dr Ilir Sharka, Cardiologist
I would explain as follows:
Detailed Answer:
Hello,
Unfortunately, almost 95% of the cardiac tests are performed by the utilization of contrast agents or radiotracers (including the above-mentioned tests).
Anyway, before performing these tests in allergic persons, premedication may be done (starting 24 hours before the test) in order to avoid possible allergic reactions.
A test that does not require contrast agents and is not invasive is a Hyperventilation stress test.
You should discuss with your doctor on the above test.
Hope I have answered your query.
Take care
Regards,
Dr Ilir Sharka, Cardiologist
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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