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Doctors' Answers to "Frequently Asked Questions" - Angina

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Treating ngina [posted 11/6/98]

Question: I suffer from severe angina, rather than take morphine I am given a drug called Nubain (the spelling of this drug may be wrong I am not sure). Also, I would like to know is this drug addictive.

Answer: What else are you taking? Morphine during angina was a treatment in the 1920s and although it works would be most unusual with other drugs available. Nubaine is a narcotic agonist which has much less potential of physical dependence;but, has been reported. This is a very bizarre way to treat angina.

Vasospastic Angina

Question: I was traumatized by my employer and as a result I developed angina like chest pain two months ago, and I still continue to have it. I have seen two cardiologist, a pulmonologist, a gastroenterologist, and a psychiatrist. Iíve been on Verapamil with no relief, Norvasc with some relief, and Prozac and Ativan which seem to help me. My Psychiatrist tells me that my chest pain is from Clinical depression, but my cardiologist says it is triggered by depression, but it is Vasospastic Angina. He wants to do an angiogram, nuclear imaging, etc. I donít want any of it and am tired of taking drugs. Here are my symptoms: Chest pain, dull-achy-sometimes burning-sometimes sometimes-stinging, inframammary over the pectoralis major sometimes radiating to the armpit and down to the left deltoid muscles, rarely also to the left and right scapula. The chest pain starts or gets worse with cold beer and or exposure to cold wind, even the A/C in my car. My EKG at rest during stress had 2mm st depression but my 2D Echo after 10mins on the treadmill was normal, the EKG improved during the treadmill exercise. Chest Pain is also triggered by re-living the horrible things my employer did to me. Chest pain is not relieved by NTG 2 to 3 doses 5-10 mins apart, drops my BP and gives me a headache.

Answer: I would proceed with testing for two reasons. First, if it is not angina on top of coronary disease you need to know this to look for other sources. Second, you may need to document the problem for future legal issues.

Question: I am a 57 year old white male and I have some blockage in my left carotid 15% - 60% in the right also have some blockage around my heart. I had a stress test in 1991 and at 1 1/2 minutes it showed up positive. In 1996 I had it done again and it showed up at 8 1/2 minutes. I have had treatments for the last 10 years of chelation. I suffer from what seems like angina, but to the neck left side, however, it is different than a normal problem as it is always associated with an upset stomach, stomach cramps, and gas. I some times get it when I walk a few feet. I then burp and then I can walk 2 miles and swim 40 laps and nothing happens. I have been taken to the hospital twice, but both times I have been told it was not a heart problem but a stomach problem. I have a small hiatus hernia, as well as gallstones. I stoped smoking 15 years ago and stoped drinking 2 years ago. I take 50 mg zorcor. I feel the stomach acting up followed by the pressure. What else can it be?

Answer: The vagal nerve is the nerve which is responsible for the sensation of angina. This nerve also goes to the esophagus, stomach, gall bladder and pancreas. Consequently, any disturbance of these organs may be perceived as similar to angina. Does your gall bladder function correctly? You'll need a HIDA to determine this. Many patients think they are having angina when they are having ulcers, gastritis or gall bladder disease.

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