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prinzmetal angina surgery options

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Dear doctor,
I m a 29 yr old girl diagnosed with prinzmetal angina since 5 years ago. I m on nitrates and ccbs since then and have been for a coronary angiography in 2005 which diagnosed me with fixed stenoses of the LAD an ECHO that said my EF is 50-55%. currently I still experience squeezing chest pains early morning ESP if I have had a long hectic day. But recently I am having chest discomfort if I over exert myself or if I have a heavy meal. It is associated with palpitations. It feels like a ton of bricks on my chest and subsides if I rest but lying down doesn't help. Physiian recommended angiography with ergonovine for a more definite picture. Can prinzmetal angina with fixed stenosis mimic coronary artery disease? Is it reversible? The chest discomfort is very bothersome and sometimes I have It on a regular basis in the early morns. Will this cause a permanent effect on my heart? If the nitrates are not helpful, what other drug do h recommend?

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replied June 19th, 2014
Chest Pain Answer A35541
I am somewhat baffled by a diagnosis of prinzmental's angina in a lady only 24 years of age. The ejection fraction you give is within normal range, but I am surprised at a diagnosis of "fixed stenoses of the LAD." You describe morning squeezing chest pains and chest discomfort after a heavy meal, but don't define the pain geography or pain characteristics.
I am concerned by your story and recommend that your previous angiogram be reviewed by an impartial expert. It is true that one can see coronary artery stenoses after certain childhood diseases, but it would be most unusual for you to have coronary atherosclerosis causing LAD narrowing at your age. I don't understand the rationale to give ergonovine in the presence of a previous diagnosis of coronary artery stenoses?
Please be aware that I am unable to made medical diagnoses online.

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