Ever Hear of Printzmetal’s Angina?
(Skip to Managing the Fear)
In September 2009, at age 36, I was diagnosed with skin cancer, stage 3 malignant melanoma. I had surgery to remove it, as well as the lymph nodes closest to the cancer site. No further treatment was needed except skin checks and biopsies every six months. Those have presented a few scares, and I constantly worry about it coming back, but this wasn’t the worst thing I would go through.
In August 2010, after 17 years of marriage, I divorced my husband and the father of my three amazing children. I thought divorcing him was the worst thing that I would ever go through, but I was wrong.
On March 3, 2015, I was taking my nightly shower before bed, and as I rinsed off, my left ear started to hurt. ‘Great, I’m getting an ear infection,’ I thought. Getting out of the shower, I reached for my towel and my left jaw started to hurt. I didn’t know what to think about that, except sometimes a bad ear infection can possibly make your jaw hurt.
As I was drying off, I felt a sharp pain in the middle of my chest — a pain I had never felt before: ‘Heartburn?’ I wondered. I took some TUMS and went to my bedroom and sat on the bed, still dripping from my shower.
I felt very strange, so I called my mom to see what she thought. I live close to the local hospital, so she told me to drive up there to get checked out. As soon as I hung up, both arms starting tingling and feeling funny. I decided to lie down and blow it off — maybe I was making it worse by dwelling on it.
Still not dressed I googled all the symptoms together— ear, jaw and chest pain with tingling arms. What I read, that I was having a heart attack, was just nonsense. I am only 41 years old and don’t have high blood pressure or bad cholesterol levels, but something was definitely not right.
I called my 19-year-old daughter, Ally, and asked her to come give me a ride to the emergency room: I knew I couldn’t drive as my arms were practically useless. I managed to get dressed before she got to my apartment.
I was feeling pretty bad when we walked into the ER — I was scared and crying. The nurses rushed me to a room, hooked me to a bunch of machines, gave me a baby aspirin and told me to put a nitroglycerin pill under my tongue. Nurses were rushing around asking a lot of questions as they poked and prodded me. Ally was worried and scared and called older sister Averey to come be with her. The doctor came in and told me they were transporting me to another hospital that had a cardiac unit. It was in Rock Island, Illinois, about 40 miles away. At that point I didn’t know what was going on and thought they were taking me there to be monitored.
I was loaded into the ambulance, and they gave directions to my daughters, advising them not to try keeping up with the ambulance. They had given me a lot of morphine at that point, so I wasn’t asking many questions. As we left the hospital, one of the EMTs yelled to the driver, “This is a hot ride!”
“What is a hot ride?" I asked.
“We are going to drive as fast as we can. The cardiologist is waiting for you, and they’re prepping the cardiac cath (catheterization) lab for your arrival.”
“Is this serious?” I asked.
“Ma’am, you’re having a full-blown heart attack. They didn’t tell you at the hospital?”
“No,” I said.
He proceeded to explain that the cardiologist was going to be putting a stent in my coronary artery. I started to get teary-eyed. “I should’ve called my parents,” I said. He said if he saw my daughters, he would tell them to call. It seemed like a long bumpy ride; he apologized for rushing around but time was crucial and we needed to get there quickly.
At the hospital, they rushed me to the cardiac cath lab for surgery. Things were really moving fast, with lots of nurses rushing around asking me questions, hooking me up to a heart monitor, taking my blood pressure and putting in yet another IV. They undressed me and saw that I had stitches in my hip. I explained that I had just had a skin cancer check-up, and they had removed a suspicious mole, but just the day before the pathology report had come back negative. There was still almost a week before the stitches could come out, which one of my daughters or I now take out at home — after all, we’ve had six years of experience removing stitches.
The doctor came in and explained the cardiac catheterization procedure and began. I remember him saying, “You are way too young to be having a heart attack, especially with no high blood pressure or high cholesterol.” Preparing to put in the stent, he got a look at my heart and said I had no blockages and a stent was not needed. He said he could see I was having a spasm in my artery. He said it is uncommon and very rarely leads to a heart attack, but in my case it did.
The syndrome consists of chest pain at rest that occurs in cycles and is called Prinzmetal’s angina. It is caused by narrowing of the coronary arteries that is the result of a contraction of the smooth muscle tissue in the vessel wall, rather than the buildup of plaque as in hardening of the arteries.
The only thing you can do for it is take medication to prevent the spasms and try to keep your stress level down. So now I take amlodipine, a calcium channel blocker. I also take a low-dose aspirin every day to keep my blood thin and lisinopril to keep my blood pressure nice and low so the damage caused by the heart attack can heal. After two days in intensive care, I got a regular room, and a day later I finally came home to rest.
At my follow-up appointment I asked a lot of questions, but there’s just not much information on Prinzmetal’s angina leading to a heart attack. Theydon’t know what causes the artery to spasm nor how to prevent it, except for medication. I am supposed to avoid exposure to the cold and high stress situations, as these can trigger a spasm. I also have to carry nitroglycerin pills with me at all times.
In the months since, I have had a lot of anxiety and stress about this: every time I feel a weird pain, I am fearful it is happening again. I work in a call center, and when I have a particularly stressful call, the anxiety comes back big time. I have started going to a counselor to help control those feelings.
It is seven months since my heart attack, and it has taught me that even though you are healthy, have normal blood pressure and cholesterol, that you can still have a heart attack. I am writing this to educate and warn people. I hope someday there is more information on Prinzmetal’s angina and what causes it. I live in constant fear of not only my cancer coming back, but now also having another heart attack.
Any serious medical diagnosis will likely generate arrange of emotions as described by Amy Finn in her story. “The primary emotion is significant anxiety— fear about the future, what does this mean for my life and longevity, what does this mean for my family and the people I care about,” said Diane Amstutz, Ph.D., a psychologist at the Rehabilitation Institute of Chicago.
Anxiety, fear and constant worry put the body into fight-or-flight mode: heart rate and blood pressure go up, the blood vessels constrict, digestion changes, stomach acid gets secreted. When those things are short term, they’re fine. “But when those fight-or-flight symptoms become chronic, it wears your body down,” Amstutz said. “It puts you in the position of having an illness and then worrying about the illness, which makes the illness worse. It becomes a vicious cycle.”
Given that worry can be tenacious, Amstutz counsels adopting a mindfulness approach — staying in the moment, disconnecting as much as possible from the future or the past. “We also talk about being aware of those worries and thoughts,” she said. “What are those thoughts doing to you? Is the worry helpful? Almost everyone is able to say, ‘No, of course it’s not helpful.’ Then we try to direct them to things they could think that would be helpful.”
This is difficult but I can manage it.
There are ways I can handle this.
I can get support from my medical team.
I can get support from the people that I love.
I can get through this.
Another strategy is for patients to remind themselves of obstacles they’ve faced in the past and how they’ve overcome them, affirming that they can do that again.
There are definite steps to take that will help neutralize anxious feelings:
- Talk with your physician, ask specific questions: What are the signs and symptoms to watch for? I’m going to see you every three months, what would bring me in to see you sooner? What should I be worried about?
- Get guidelines from your physicians about things you should be monitoring.
- Focus on what’s going on now. Try not to get consumed by worry about the future so that you can’t enjoy what you’re doing now.
- Participate in a support group.
“I think support groups can be extraordinarily valuable for people who have chronic illnesses in terms of educating them about their illness and helping them understand how to be proactive with their physicians, how to seek out the right resources, how to get the support they need,” Amstutz said.
“You want to make sure that the group is making you feel supported and you’re not leaving feeling more anxious and distressed,” she said. “I think support groups are great when the critical issue is support: ‘I hear what you’re feeling. I know what you’re feeling. Here’s how I cope with that. Here’s what I can offer you,’ versus a pity party.”
Family caregivers have a crucial role to play. First, as listeners, hearing what their loved one is concerned about. Second, by reassuring the family member of their support. “Sometimes people with chronic illness get worried that they’re a burden on their family, so it’s necessary to reassure your loved one that they’re not a burden and that you’re there for them,” Amstutz said. “Reassure them that we’re on this journey together.”
Patients and caregivers should work as a team to manage fear and anxiety. This means if the patient gets information from the medical team, he or she needs to share that with the caregiver: “So I talked to my cardiologist and he said that I’m doing well and that I shouldn’t have to come back for three months, unless I have these signs and symptoms, and then I come see him.” That helps the caregiver be objective when the patient is anxious about something and the caregiver can say,“Let’s look at what the doctor said.”
The caregiver and the patient need to work together to identify things that help the patient. What can the caregiver do to be a coach for the patient? What does support look like to them? Do they want to do something to distract themselves? Do they want to go for a walk and get some good exercise? “It’s helpful to come up with a plan that meets the patient’s needs and also reflects things the caregiver is able and willing to do,” Amstutz said. “It helps to agree beforehand on how we’re going to approach this as a team.”