I have had Coronary Artery Spams multiple Arteries since I was 41. I also have Coronary microvascular disease. since 2010 I have been having many Episodes. It took until 2015 with many months spent at Mayo AZ & MN, then University Colorado and National Jewish. The University determined I have fibromuscular dysplasia (FMD) complicated by renal artery spams. The FMD causes my blood pressures to go up to high levels at times up to 250-260 over 90-120's. The high blood pressue in turn kicks in the Coronary Artery Spasm (CAS) causing Variant Angina. After Angioplasty of renal arteries I was still having issues because of hypoxia. National Jewish determined I have tracheobronchomalacia (TBM) Surgery for Trachobranchoplasty Dec 2015. I had MI Dec 2016 due to ER taking 2 hours to get my IV Nitroglycern going during an attack we could not stop at home by taking 2 Liquid Gel Nephedipine 15 min apart and 3 Nitro spray 5 min apart in between. But I still have intermittent hypoxia and that gain sets off the CAS. This year I then went into intermittent heart block which causes intermittent Bradycardia as well and it also caused increased CAS. We had to lower my Calcium channel blocker. My Statin caused muscle issue so they placed me on CoQ10 unfortunately it had an additive of piperine that helps absorption of Coq10 but it reduces absorption of both Nephedipine & Verapimil so taking Coq10 with piperine again affected the CAS. My Cardiologist has me carry a letter stating what my issues are and that it causes cardiac flow deviation proven via multiple heart caths at mayo with reproduction. The letter also tells them that at times I will present with severe angina with ischemia with no detectable biomarkers or obvious ECG changes. I shoudl be managed with a high index of suspicion for ischemia and be terated appropriately with IV Nitroglycern to resolve the angina. This works at most hospitals. But as I said Dec 2015 ER delayed treatment & MI resulted. Then this spring ER did great put me on the IV nitro but when they tried to titrate it down I went back into Angina. This has happned in past and I have been in ICU on Nitro 85mics for 5 days. But when the ER doc called cardiac to put me in hospital the cardiac physician said 'This is my hospital and I do nto think the Nitro is needed I am yanking the IV and discharging you." Fortunately ER Doc did not do so he called National Jewish talked to on call cardio and my Cardiologist both said to leave me on Nitro as long as I have angina. The mater was worse in that my FMD had kicjed in BYS in 250-250 range and up to 195/100 on 65 mcs nitro. The Bp's came down next day when both Cardaic and Renal arteries stopped spasms. The next am 7am I was at my Cardiologist & went in again. I was admitted and left on IV Nitro until the next Monday when they could to angioplasyy of Renal artery. Needless to say I ahve filed a complaint with the state on the Cardiac physician. I tell you all this to demonstrate just how many things can affected the COroanry Artery Spams. And to point out that you must be your own advocate for proper medical care.

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