Does Ischemia show up everytime you experience Angina?!

Does Ischemia show up everytime you experience Angina?

I feel I suffered an Angina attack about a week ago. However I had some testing but there was no signs of heart disease or ishemia. I had been drinking the new Diet Pepsi Max for about four days and I feel it made me have a coranary spasm which caused my Angina. Is this a good assumption? Please give me some insight. Thanks

Well...
First, Angina (angina pectoris, that is) is chest pain that is due to ischemia. Therefore, if there is no ischemia, then it is most definitely not Angina.

Second, Ischemia just means a lack of blood supply...and therefore, a lack of oxygen. It does NOT mean that heart cells have died, it just means that cells are "hungry" for oxygen. And this oxygen "hunger" in heart cells manifests itself as chest pain that is called "Angina".

When the heart cells actually DIE (angina that "goes on too long", so to speak), this is called Infarction. When this happens, a person is said to have a "Myocardial Infarction"...which is just medical mumbo jumbo for "Heart muscle cells dying" or in laymans terms, "Heart attack".

When heart cells actually DIE (infarction), they release all these chemicals in the blood stream that can be measured. These are called the cardiac enzymes (Troponin, CK-MB, CPK, etc). Based on the levels of these enzymes in the blood, a doctor can see that infarction has occured (i.e. it "shows up").

During Ischemia, the heart cells are "hungry" for oxygen, but they aren't dead. Therefore, their cell walls are still intact and the cardiac enzymes are not released into the blood stream. Therefore, by blood tests, Ischemia does not "show up".

Subtle signs of "ischemia" may "show up" during ACTIVE ischemia on an EKG, but later (after the chest pain has gone away) these changes go away. This is why doctors order "exercise stress tests". They make you run until you are out of breath...to make your heart beat really fast...in order to increase the demand for oxygen in the heart. If the heart can't keep up...and the cells become "hungry" for more oxygen (ischemia), then some subtle changes will show up on the EKG. This is what dictates a positive excercise stress test.

As for drinking all the Diet Pepsi Max, it is very unlikely that this caused you to have a "coronary spasm" leading to angina. It is MUCH more likely it is all GI related - acid reflux from the caffeine that decreased your esophageal sphincter tone...or possibly an esophageal spasm.

However, I'd talk to your doctor to make sure cardiac disease is completely out of the question, especially if you have any risk factors (male, smoker, diabetes, high blood pressure, high cholesterol, family history of heart disease).

The "gold standard" for ruling out cardiac disease is a cardiac catheterization - where they stick a tube up your femoral artery (in your groin area), shoot a dye through your coronary arteries, and snap photos via x-ray to visualize the flow (or blockage) of blood in your coronary arteries.

But if a person has a negative "thallium stress test" or an negative "stress echo" (both less invasive tests), then cardiac disease is unlikely and a cardiac catheterization is usually not even required.

In any event, I hope this gives you some added insight.