Peter Reyes, MD, Cardiologist, The Heart Center at Mercy, Baltimore talks about prinzmetal angina and how it presents.
Interview conducted by Ivanhoe Broadcast News in April 2019.
I wanted to ask you about prinzmetal and coronary artery spasms. It’s something that I had never heard of before. Could you explain for our viewers what’s essentially going on?
REYES: What’s essentially going on is that your coronary arteries, they’re the main blood vessels that give blood to the heart, will intermittently spontaneously spasm and the muscles will contract constricting these arteries and then limiting blood flow to the muscle that it supplies.
Do patients have symptoms when this happens? Can they feel it going on? Are there warning signs before something happens?
REYES: Unfortunately there are no real warning signs and it can happen out of the blue. There might be stressors that create it or make it come on that people seem to either stress at work or sometimes exertional stress might bring it on. And the other unfortunate issue with this disease is that it mimics heart attacks or angina. But in a sense it is angina and it can cause heart attacks if you constrict the artery long enough and severely enough. You can limit the blood flow where it will actually damage the heart muscle.
Are there different levels? Is there a more severe form of this? Can some people just have a mild form?
REYES: Sure. It all depends on how bad the constriction is and what vessel it is. If it’s a major vessel that supplies a huge territory of your heart and it constricts severely, those are the ones that cause the severe symptoms and can cause heart attacks.
Do we know what causes this condition?
REYES: Unfortunately, we don’t. And it’s a relatively new area of research and investigation but there are people especially at Cedar Sinai in San Diego which are looking into this and trying to elucidate exactly what’s going on and how to treat this because right now our treatment has been limited.
When you have this condition is it a surgical fix? Is it controlled by medication? What kind of treatments are there?
REYES: That’s a great question. We address it with medical therapy. They have tried putting stents in and that doesn’t seem to help and can exacerbate the situation.
So it’s just a matter of what kinds of medications. We were talking to Deb and she said for her situation she’s on a host of medications.
REYES: She’s tried them all. And she always has them with her. There’s a limit of effectiveness but she has never been able to effectively get rid of any symptoms entirely. But there are these medicines that usually dilate the vessels or decrease the workload of the heart and they seem to help and sometimes they can not cure, but maintain this symptom free.
More common in women or men? And is there a normal age of onset or could it be at any age?
REYES: It’s a great question. When people present with heart attacks, upwards of 10 to 15 percent of these heart attacks, the coronaries won’t have severe disease and this is this type of person and almost twice as many of those people will be women. And we don’t know why? But it is the case.
These people as you said are presenting with no blockage in the arteries.
REYES: Right. And prinzmetal angina is just one of those reasons people can clear themselves of the clot before they get to the cath lab and that can be one of the reasons. But other ones is a spasm or there’s another issue called micro vascular disease. And women seem to be more prone to that as well.
You said these can cause heart attacks. I wanted to talk about that a little bit. Is that what is happening in her case?
REYES: Well unfortunately Deb has suffered two heart attacks from this and probably three. But we don’t know on the last one. And she is on the severe end of the spectrum and she has failed multiple medical therapies and now she would be maxed out on medical therapy. But she still has symptoms intermittently.
What does she do to control it?
REYES: She’s very compliant with her medicines. She limits the stressors that bring these on that she’s figured out on her own and it seems to be a personal issue with different people. And she also exercise and it seems to help her and she’s very compliant with that and she’s able to control it with those aspects.
You can’t tell from looking at a patient whether or not they are sick or whether they’re struggling, can you, because she’s tiny. She looks fit. She looks like she would not be someone who would struggle with a cardiac condition.
REYES: Right, when she’s not having an episode she looks completely healthy and that’s the danger of this disease is that it will affect people like that. And then when they present it’s very hard to get the diagnosis, incredibly hard.
What about this condition would you want our viewers to know? What is the bottom line with this?
REYES: It’s that you take any symptom or sign that you might consider to be heart related especially in women. Yes they’re similar in presentation but women present with chest pain at a less frequent rate than men do when they have a cardiac issue. And you should take it seriously.
What are the symptoms again?
REYES: Non classic symptoms that could be jaw pain, it could be upper abdominal pain, it can be arm pain, shortness of breath, decrease exercise tolerance. These are signs that we know can be heart related but they’re more so with women than men.
And don’t ignore it.
REYES: Don’t ignore it.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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