Heart artery spasm caused heart attack

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DEAR DR. DONOHUE: I recently was diagnosed with coronary vasospasm. Bloodwork indicated that I had suffered a mild heart attack. Follow-up tests showed no coronary artery disease. Could you expand on the cause of this condition? Am I at risk of a more serious heart attack? — J.W.

ANSWER: Coronary (heart artery) vasospasm is a sudden constriction of one of the heart arteries to such a degree that it shuts off blood flowing to part of the heart. Other names for this condition are variant angina, vasospastic angina and Prinzmetal’s angina. The spasm lasts for only a matter of minutes. Chest pain — similar to the kind of pain caused by clogging of a heart artery by a buildup of cholesterol on the wall of the artery — is the prominent sign. A somewhat distinguishing characteristic of this kind of chest pain is its onset when a person is resting or even during sleep. However, it also might appear when a person is active.

Examination of heart arteries with X-rays often shows no buildup in the heart arteries, as was demonstrated in your arteries. That’s definitely a good sign. A single episode of coronary vasospasm has a good prognosis. The development of a full heart attack is uncommon. However, people with your condition usually are put on medicines to prevent such spasms. Nitroglycerin and Isordil are two such medicines. Cardizem is another. Often, this is not a lifelong commitment to medicine treatment.

The cause of the artery spasm is debated.

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Your doctor undoubtedly will examine you for other risks of heart disease and decide whether you need long-term care. If your cholesterol is high, you might have to alter your diet and increase your exercise time. Since your arteries are clean, it’s most probable that you will do very well.

TO READERS: Questions about vaginal infections are most common. Those questions are answered in the booklet on that topic. To obtain a copy, write: Dr. Donohue — No. 1203, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: You mentioned controlling the pain of pseudogout with colchicine. We were informed that it is no longer available and is not being manufactured. Why? — K.B.

DEAR DR. DONOHUE: You say colchicine is good for gout. I cannot get it in the U.S. What should I do? — R.C.

ANSWER: Colchicine is still being manufactured and is available in the U.S. as Colcrys, a brand-name drug. The Food and Drug Administration stopped the marketing of generic colchicine because those generic drugs had not undergone the required testing for safety and efficacy, even though they were marketed for many, many decades. It’s the law. That’s all I can say.

Realizing the increased cost of their brand-name colchicine, the manufacturer Mutual Pharmaceutical/URL Pharma has provided a patient assistance program for those without insurance and a co-pay program for those with insurance. You can find further information at www.colcrys.com or by phone at 888-811-8423.

DEAR DR. DONOHUE: I am a 46-year-old woman who eats a diet of fresh fruits, vegetables, whole grains, lean meats and little sugar. I would like your opinion on my routine annual lab test results. My doctor says my labs look good. I requested a copy of my test, and some results don’t look good to me. — A.P.

ANSWER: The lab test that merits further explanation is your eGFR, estimated glomerular filtration rate, an indication of how well your kidneys function. Glomeruli are the kidney’s filters. A woman of your age should have a value in the 90s. Yours is 55. You should ask the doctor why it’s so low.

It might be a fluke of the testing. Or it might be that your kidneys aren’t working as they should be. An explanation needs to be forthcoming.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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