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Tests unable to detect heart attack

When Airoli-based businessman Surendra Bibra, 60, complained of unbearable chest pain for the second time within a span of 20 days, doctors were unsure of what was causing him the discomfort.

mumbai Updated: Dec 16, 2012 01:35 IST
Menaka Rao

When Airoli-based businessman Surendra Bibra, 60, complained of unbearable chest pain for the second time within a span of 20 days, doctors were unsure of what was causing him the discomfort.

They had already conducted all necessary tests including an angiography and electrocardiography (ECG), only to find that Bibra had no blocks in the vessels of his heart.

However, it was later revealed that Bibra had suffered a heart attack (a condition where blood flow to a blocked heart stops) of a rare kind that then led to a cardiac arrest (causing the heart to stop beating).

Only 2% of angina or chest pain patients are afflicted by this condition which also known as Prinzmetal’s angina or variant angina or a coronary artery spasm. During this spasm, the coronary artery stops or reduces blood flow to the heart.

Surprisingly, the angiography conducted on Bibra did not reveal either abnormal cholesterol levels or a block in his heart. “We managed to document his condition in an angiography only after he suffered a cardiac arrest inside the Cathlab. His angiogram showed a serious spasm in the coronary artery. It is very difficult to document this condition when the patient is in spasm,” said Dr Kalyan Dutta, consulting cardiologist, Fortis Hospital, Mulund.

Doctors claimed that Bibra’s smoking habits -- about 15 cigarettes a day—may have triggered the spasm, which could occur in cases of emotional stress, exposure to cold, alcohol, and smoking.

“We had to ventilate him for a day and give him medications to control the symptoms,” said Dutta. He added that doctors ought to exercise caution while diagnosing such cases, especially when the angiogram was normal.

“This condition is common among females. In India, the prevalence of high cholesterol, diabetes and blockage is so common that doctors require a high index of suspicion to detect this problem,” said Dr Ajay Chaurasia, head of cardiology, BYL Nair Hospital.