What is Prinzmetal's Angina ?

by Jackie D. Kimball

I've been thinking about old Fred Sanford today  and how he would grab his chest, look to the heavens, and call to his deceased wife, "Elizabeth, I'm comin'. This is the "big one" Elizabeth!"

Fred Sanford may not have been such a put on after all about those "big ones". That's right. I said maybe not. Maybe, just maybe, old Fred was not always trying to get sympathy. Maybe he was having acute chest pains ! I know, I know, it's a broad stretch. Here's how I got there .

Fred, I understand! I do! Sometimes I stumble and reel and grab my heart just like you did. It always feels like the" big one"!

Okay readers ,here is the clip.

If I let you watch this, will you promise to finish reading my article?Okay,then.......watch this! Then (you promised) back to my story!

If you want just the facts on Prinzmetal's  angina , skip this part and scroll down, as I wax eloquent about my mysterious ailment.

I was still in my twenties when my first prinzmetal attack struck me as I was walking into the new Sears store for the grand opening. I was in a good mood. It was Saturday, and like most of us, I love a good deal. Free hotdogs, chips, and a coke meant not having to fix lunch, and the paper announced loads of bargains. Suddenly I was feeling the most acute pain in my chest,to the left just under my breast. I literally stopped in the middle of the street near collapse . I tried to sit down on the street, but half way down I couldn't move another inch!

My (then) husband was unaware that I had bent over and finally crouched on the street, and I was unable to move or speak. Nausea flooded over me in waves, and I thought I was going to die right then. My dad had a serious heart condition and had an attack once on a railroad track with us kids in the car. He couldn't move or speak, so Mama steered the car across the tracks and stopped the car. Oh,yeah. I had seen a heart attack close up....and this was it! I was having a heart attack at my young age.

Only......maybe not. As my husband came running back to me ,I begin to get just a small amount of relief. The pain was subsiding, albiet slowly.We made it back to the car. We were less than a mile from the hospital, but I decided not to go. Ten or so minutes later, I felt fine and concluded that that was the worse trapped gas in my chest cavity that I had ever felt.

We went in and browsed Sears for a few minutes, but I neither wanted a hotdog or wanted to shop. The only way I can describe this is that I felt no pain, but an overwhelming feeling of impending doom came over me. I just wanted to go home. I felt fine. For a short while.

After a few more days of more eposides of some sort of frightening chest pains, I went to my family doctor. This was 1969 and medicine was nowhere near what it is today.My doctor concluded that I had heartburn, and put me on a bland diet which really didn't help.Of course he or the next few doctors really didn't believe me as to how debilitating the pain was, especially after the new doctor in town just starting his practice had hospitalized me and found nothing . Nothing in my upper and lower GI report showed any problem, so at least I got off the nasty bland diet! My heart was not the problem I was told, though no tests were done to verify that.

Women with heart complaints were not taken very seriously in that time. I gave up my quest to find the problem. I diagnosed my self with an "unknown heart condition" and just learned to live with it, expecting like old Fred Sanford, that the "big one" would eventually happen. I'd show them. I was right all along!

Finally in my forties(yes,twenty years later!) after a heart cath,a wonder cardiologist at Saint Francis Medical Center diagnosed my problem. I had Prinzmetal's angina. I was given a beta blocker, nitroglycerine tablets, and a pamphlet about this type of angina. From my doctors,the pamphlets, library, internet, and personal experience I have learned much about Prinzmetal's angina. I am no expert, but I have dealt with this condition most of my life and I , by experience , have learned the symptoms, causes of onset, and treatment options.

There are basically two types of angina:

Stable angina- Mainly occurs when the person is experiencing emotional or physical stress. Other triggers are smoking, consuming a large meal, intense physical activity especially not in the regular daily pattern,and cold weather.

Unstable angina-Occurs at unexpected times during sleep, at rest, exposure to cold,or with even light activity. A doctor should be consulted immediatlely if pain or discomfort lasts more than more than a few minutes.

Prinzmetal's angina is unstable angina and the patient should be under the care of a cardiologist.

SYMPTOMS

Prinzmetal angina is most often described as a very often severe painful tightness with squeezing, pressure, or a crushing sensation. The pain may sometimes radiate to the neck, and jaw, shoulder, or down one or both arms.

Though not sure of all of the causes for prinzmetal angina episodes, doctors know that extreme stress, being exposed to harsh cold temperatures, and activity can bring on the angina. For me, winter is a doozy as the cold causes many episodes at the most inconvenient times, such as recess duty outside.

It happens without warning, and may occur about the same time each day.(Though mine is sporadic.) It is said to often occur at night while resting. One study showed that the most common times were between midnight and eight A.M, though mine is more often in the morning.

While it lasts, it is painful, but the usual duration is five to thirty minutes. Occasionally prinzmetal angina can cause fainting. There is about a 2% chance of sudden death. It sounds bad, but that means there is a 98% chance that you will quickly recover. The episodes are most often occuring in clusters meaning that they may continue for a few days or months followed by long or short periods with no occurences.

DIAGNOSING PRINZMETAL'S ANGINA

After examining you , the doctor will take your complete medical history and even your family's medical history. Your doctor will ask questions about your lifestyle. It is important for the doctor to know if you smoke, drink, and even how much sleep you usually get a night.

There are tests that might be ordered to see if you have coronary artery disease and you may need more than one.

The first test that is usually done in the doctor's office is the EKG , which is an electrocardiogram to record your heart rhythm and rate. This may or may not show important information. A normal EKG does not mean that there is no problem.

Usually what follows the EKG will be a scheduled stress test. There are two types. One test involves monitoring your heart while walking on a treadmill. If it is felt that you should not or can not walk on the treadmill, you will be given a nuclear stress test. This test uses an injection of medication that will stimulate your heart. The dye will help indicate blockages. ( This is what I had, and I found the sensation to be a feeling of flushed skin and tiredness .)

After this test, if a blockage is suspected,you will probably be scheduled for an angiogram, more commonly called a heart cath.The doctor uses a camera . A catheter is inserted into the groin and guided using the camera to the heart.Upon reaching the heart, a dye is injected so that any blockages, blood flow, or other problems can be observed. To determine Prinzmetal's angina , this is considered so called "gold stndard" . ( I slept during the whole thing, I guess, because all I remember is seeing the monitor and hearing my doctor say,"That's a wrap.")

TREATMENT and LIFESTYLE

Your doctor may prescribe medications such as nitrates, calcium channel blockers,beta-blockers and an aspirin regimen.

You will probably be directed to change ceratin lifestyle behaviour that are risk factors.

Once you are prescribed your medications, you can take your nitroglycerin at the onset, and get much quicker relief. I have a very small stainless steel medicine cylinder on my keychain, and therefore my nitroglycerine is always available when I am out without taking the whole bottle.

Do you think Fred Sanford had Prinzmetal's angina?