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What Causes Severe Chest Pain With Abnormal Arteries?

Posted on Thu, 12 Jun 2014

Question: Hi - my 58 yr old husband had a cardiac event. Severe chest pain. Angiogram showed abnormally large arteries with no narrowing or blockage. Day 3 and he is still having pain. He is in hosp. with pain meds, blood thinners and nitro. Docs are doing tests, but are puzzled. Do you have any knowledge of this condition?

Answered by Dr. Sukhvinder Singh (3 hours later)

Brief Answer:
PLEASE SEE BELOW.

Detailed Answer:
Respected Ma'm
There are two aspects of this problem. One is that your husband is suffering from coronary artery disease (CAD) and second is that there is some other non-cardiac cause for his pain.
The unusual enlargement of coronary arteries is either congenital (from birth) or is associated with atherosclerosis (Fat deposition in wall of arteries). When it is associated with fat deposition and there are significant obstructive lesionsm management is same as that for obstructive CAD. Pure ectasia (enlargement without luminal obstruction) may also be associated with heart related pain but prognosis is better and medical management is not well established. Anti-platelet (aspirin like drugs) agents are recommended.
Sometime ectasia is secondary to collagen vascular diseases like lupus, scleroderma etc.
The cause of pain may be unrelated to coronary arteries. If they have got cardiac biomarkers like troponins done. Troponin positivity strongly indicates coronary artery disease. The typical chest pain is behind breast bone, it does not increases by touch or pressure, it is increased by exercise/ exertion, does not lasts for hours to days continuously. Other causes may be a pain originating from lungs, food-pipe, large vessel aorta and nerves.
Hope this gives some insight into issue. Feel free to discuss further.
Sincerely
Sukhvinder

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sukhvinder Singh (16 hours later)

He is in a hospital and they have run tests. There is no narrowing or blockages, just the opposite, arteries are very large. Apparently blood flow is not normal - slower. They are saying there are no procedures that would help. He is being treated with blood thinners, blood pressure meds, pain meds when needed. His EEG was not normal when admitted Tues, but has been improving. Pain has lessened, but is still there, behind sternum and little to the left.
My question - do you have any idea what could have triggered the incident? Do you have any suggestions after this info, for treatment?

Thanks

Answered by Dr. Sukhvinder Singh (8 hours later)

Brief Answer:
please see below.

Detailed Answer:
Respected ma'am
As I detailed earlier I still have suspicion that it may be a non-cardiac pain, unless cardiac biomarkers are positive.
There are no well established markers for acute events in ectatic CAD. It may be high blood pressure or any event which increases demand of blood in heart like exercise. Psychological stress may be a precipitant.
Unlike obstructive CAD, treatment is also not well established. Blood thinners are indicated.
Overall outcome is much better than obstructive CAD
Sincerely
Sukhvinder

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Sukhvinder Singh (22 minutes later)

Thanks you for your answer. The issue that remains problematic for me is - if he has had enlarged artery problem over time, why would he have a an acute onset of pain and why is the pain still lingering. It has lessened, but still flares up at times. He was just watching TV when the initial event happened.

Thanks

Answered by Dr. Sukhvinder Singh (1 hour later)

Brief Answer:
please see below

Detailed Answer:
Respected Ma'm
The mechanism proposed for angina in such cases is slow flow due to excessive dilatation leading inadequate removal of waste products and decrease supply of oxygen. This slow flow and dilated vessel invite formation of small clots which leads to heart attack and anginal pain. So these patients can have exertional chest pain because of slow flow and demand-supply mismatch or they can have heart attack like acute symptoms (as in your case) due to formation of small clots and their migration in smaller distal circulation. Localized spasm of dilated vessel may also produce coronary ischemia.
As I told in previous answers too, isolated dilated coronary artery disease has no definite pharmacotherapy, so the problem may not have a well defined course in a given case.
sincerely
Sukhvinder

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar