Heart pain possible with normal heart arteries


DEAR DR. DONOHUE: I am a 35-year-old father with two young children. Two times in the past month, I had bad chest pain while sitting and watching TV. After the second time, my wife insisted I see a doctor. The doctor did an EKG, which was normal. He then arranged for me to have an exam with a cardiologist. He thinks I have something called variant angina. Will you explain? Does it cause a heart attack? — M.J.

ANSWER: Variant angina has another name, Prinzmetal’s angina. It’s heart pain like the heart pain of regular angina, but with some big differences. It comes on when at rest, not with activity. It’s caused by sudden constriction of a heart artery. And it often happens at younger ages. The involved heart artery can be free of any cholesterol buildup. The artery spasm is so intense, however, that it cuts off blood supply to a section of heart muscle and produces chest pain that occurs with artery blockage. Sometimes, however, there is buildup in the artery, and that complicates the picture. Proof of this condition lies in finding the typical EKG changes of variant angina during an attack. That’s not easy to do, because the attacks are unpredictable. If the heart doctor feels it necessary, he or she can provoke an artery spasm by giving drugs. The EKG is running during the procedure. If you do have variant angina, then medicines like nitrates and calcium channel blockers can prevent spasms or terminate them if they arise. One of the cholesterol-lowering statin drugs Lescol (fluvastatin) can ward off attacks of variant angina. The outlook for this condition is good. The chances of having a heart attack are quite small.

DEAR DR. DONOHUE: This past January, I saw a doctor because I had sore joints. The doctor’s impression was rheumatoid arthritis. I have three small children, and I have a part-time job. I don’t have time to have rheumatoid arthritis. The pain left in February. Now the doctor says I could have had a viral infection. Is this possible? Don’t doctors blame viruses for everything they don’t have an answer for? — J.S.

ANSWER: The viral diagnosis makes sense. Hepatitis viruses, echoviruses and coxsackie viruses are but a few of the viruses that cause joint swelling and joint pain. The names might not be familiar to you, but they are common viral infections. Since you had no other symptoms, the hepatitis viruses are not a real possibility. Lyme disease, a bacterial infection, is another illness that targets joints. If I had to pick a viral cause for your joint pain, I’d pick parvovirus B19. It causes an illness called fifth disease in children. Infected children have bright-red cheeks. In adults, painful joints are the primary sign. It almost always resolves on its own. The doctor has given you a reasonable explanation.

DEAR DR. DONOHUE: I’ve thought of this many times. In my childhood, we were told not to smoke because it would stunt our growth. I know plenty of people who are 6 foot plus and who have smoked since their teens. I never hear about stunted growth in anti-smoking campaigns. If it is true, why don’t they use this as a deterrent anymore? — C.N.

ANSWER: I have to admit. I can’t find any reliable information that proves smoking stunts growth. It’s OK by me if youngsters believe it does. Anything that keeps them from smoking is not a bad thing. If anyone has evidence that growth stunting is a side effect of cigarettes, please send it to me.

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.