Re: 44 yo. male with muscle tissue constricting coronary artery (long post)

From: Dr. Andrew B. Chung, MD/PhD (andrew_at_heartmdphd.com)
Date: 07/22/04 

Date: Thu, 22 Jul 2004 08:05:59 -0400

mnbhahn wrote:
>
> A couple of months ago I went to the Doctors office (HMO) for chest
> pain and shortness of breath. My EKG looked normal, resting pulse was
> high (100/bpm). They did a bunch of tests and sent me home. They
> scheduled a treadmill test and a cardiologist appt. Here are the
> series of events…
> * Treadmill test. Other than mild "squeezing" at 9 minutes I did
> fine. They said I reached my target heart rate. They said the test
> was inconclusive and that I should really have a thallium test.
> * Thallium test (positive). They said the something about the "tip of
> my heart wasn't getting enough oxygen." They told me it wasn't "life
> threatening" based on my symptoms and my medical history. If symptoms
> worsened or changed call ER. They prescribed atenolol & lovastatin.
> (plus, 1 aspirin a day).
> * ER visit. I went to the ER a couple weeks later for moderate chest
> pains. I was now having 2-3 episodes a week that were requiring very
> little exertion. (climbing stairs) They admitted me and scheduled an
> angiogram the next morning.
> * Angiogram. The angiogram showed that there was no plaque build up
> (yeah!!). However, there is a problem in the Left Anterior Descending
> artery. The LAD is being pinched (or contracting) in two areas. It
> looked like the muscle or scar tissue was contracting (and then
> relaxing) with each heartbeat. The cardiologist performing the
> procedure was a bit stumped. He decided to get a better look by using
> an ultrasonic device (IVUS??). He was reluctant to angioplasty /
> stent believing this muscle/scar tissue would actually pinch the
> stent. Since the blocked areas were only ~ 50% he decided to do
> nothing. (I guess 50% blockage doesn't warrant intervention)
> * Cardiologist appt. I finally had my "scheduled" appointment and
> talked with my cardiologist. He wants to control the symptoms with
> drugs. He started me on 30mg of IMDUR. I asked him, "what if the
> drugs don't work?" He said, "Lets just give the drugs a chance." I'm
> not real sure if he was interested in saving $ for the HMO or really
> interested in my long-term care. At this point, I'm giving him the
> benefit of the doubt.
> * Questions. Has anyone ever heard of this condition?

Yes.

> If so, what is
> it called?

Prinzmetal's Angina.

> Is it classified as CAD?

Yes. But not the more common atherosclerotic variety.

> What causes it?

It is congenital. You were born with it.

> Is there
> surgery that can fix this problem?

Yes. Coronary artery bypass graft surgery.
 
> Thanks

You are welcome.

 
Servant to the humblest person in the universe,

Andrew 

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
**
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