Hello! This is my first post. I’ve just discovered this website.
I experienced intense chest pain during the night last weekend and I stupidly didn’t get medical help until Tuesday as it resolved after around 5 minutes and I fell back to sleep and felt fine in the morning.
4 days later then went to hospital and they confirmed I had a T wave abnormality on ECG and troponin was in the 60s. Angiogram was normal so no blocked arteries.
I am a fit, healthy middle aged female, normal BMI, metabolic age of 34, regular gym go-er and runner with normal cholesterol and BP so this came as a massive shock. The working diagnosis was MINOCA and I am waiting for a MRI to rule out myocarditis.
So this has been a big wake up call. I lead a busy life of juggling work, kids etc and despite me thinking I don’t have a stressful working life, I now realise perhaps I do. The week before the episode was particularly busy at work with an important deadline (I met it!!).
So I’m re-evaluating. I’m worried it could happen again and not knowing the cause makes me nervous.
My husband and I wonder if I should take a break from work. I’ve often thought it’s too much and our family life would be better if I didn’t work. But we need to consider finances and we are open to downsizing to make it affordable.
I have some critical illness cover which would help towards making this move but I’m not entirely sure if MINOCA is considered a heart attack and if there is likely to be a way they can wiggle out of paying. The policy states the evidence must show a definite acute myocardial infarction. Not sure if MINOCA meets this criteria…
Anyone have any experience of this?
Thanks for any insights you can share.
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Gymlover1979
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A Myocardial Infarction non obstructive coronary arteries MINOCA isn't a diagnosis as such it is a description of an acute coronary event which caused a heart attack.
MINOCAs are responsible for about 10 % of heart attacks and disproportionately effect women.
The possible causes are microvascular dysfunction and coronary vasospasms, these are types of ischaemia/ angina non obstructive coronary arteries INOCA/ANOCA.
Other causes are a spontaneous coronary artery dissection SCAD, a blood supply demand mismatch which can occur with arrthymias.
A small piece of plaque breaking off or a blood clot blocking a coronary artery.
Over 11 years ago I was admitted to hospital with a suspected heart attack, at the time I was told incorrectly that I couldn't have angina or a heart attack because my coronary arteries are unblocked.
I was later diagnosed with vasospastic angina following an functional angiogram using a chemical acetylcholine which induced my coronary vasospasms.
Functional angiograms can also test for microvascular dysfunction using another chemical adenosine and guidewires. The way the blood flows through the small vessels can also be assessed by a perfusion MRI and in some cases microvascular angina is diagnosed this way.
I suggest you ask your Cardiology to team to consider whether microvascular or vasospastic angina were responsible for your heart attack.
It means you can be offered the appropriate treatment for the underlying cause of your heart attack.
The knowledge about these types of heart attacks has increased in recent years.
The BHF has this information about microvascular and vasospastic angina.
Thank you for your helpful reply. The vasospactic angina sounds very interesting and aligned to what I may have experienced. I’ve added it to my list of questions for the cardiologist.
Some people are also born with a myocardial bridge, which is when the artery runs through the heart muscle and this can be associated with coronary vasospasms. I believe Tos and Fanfab1 both have myocardial bridges, maybe they will share their experiences with you too.
I had a very emotionally and physically demanding profession which lead to my early ill health retirement, I unfortunately don't respond well to my medication.
I have various strategies to help manage my stress.
Tai Chi, yoga, Mindfulness Meditation and exercise.
I walk my dog everyday.
It's positive to see that your Cardiology team are aware that it's possible to have a heart attack without blocked coronary arteries.
You may find this recent article helpful and it may be worth taking a copy to your Cardiology appointment.
Where in the UK are you based? Functional angiograms are not, as yet, routinely offered and you may need to travel to have the appropriate testing carried out.
Thanks for the links. I will have a read and save to my reading list. I’m based in West Sussex and happy to travel if needed. Cardiologist has been great although in hospital I had limited time to speak to him and obviously the time I didn’t really ask the right questions. Hoping I will have a follow up appt soon.
I’m sorry to hear you’ve experienced a MINOCA. A MINOCA is a heart attack. Its prevalence is lower when compared to a STEMI and an NSTEMI, however, it still requires immediate medical attention like with any other heart attack.
I had a MINOCA at 29 years old. This was 2 years ago now whilst on holiday. Like yourself, I was very much committed to my work and kept myself busy by choosing to work two jobs. I had a deadline at least every week to meet for work, but I enjoyed the thrill of it. Aside from that, I was also busy with family commitments. I did realise at the time that I was stressed, and started experiencing chest pain towards the end of 2020 almost on a daily basis. This was put down to a lot of things such as anxiety, long-covid and pleuritic chest pain as I simply did not fit the description of a typical cardiac patient.
I eventually let one of my jobs go after the heart attack, despite not wanting to as the idea was that I would take on as much stress and work as I could whilst being young if that meant that later on in life I could spend it relaxing and pursuing things that I enjoyed without having to worry about finances and so on. I quickly realised after the MINOCA that the stress of working two jobs, as well as trying to juggle everything else was not helping me.
Since quitting one of my jobs, I have more time to process and plan things which helps alleviate my stress a little bit.
My MINOCA was as a result of a coronary artery spasm and my angiogram was clear of blocked arteries. As well as having coronary artery spasms (CAS) or vasospastic angina (VSA), I also have microvascular angina where my smaller blood vessels go into spasm whilst resting and also fail to dilate on movement or exercise sometimes.
You may find the below link useful in addition to the ones already given.
Thanks for your reply. Sorry you’ve experienced the same. We sound quite similar…I didnt notice the stress in my life because I almost feed off it and enjoy the thrill and success! I’m going to ask them to investigate for spasms. I don’t usually get any chest pain day to day although in hindsight I occasionally (perhaps 2/3 times a year) get what I call heart pangs which only last a couple of seconds. No idea if there’s a connection.
The “heart pangs” might be related, or it might not be. I found over the years of trying to obtain a diagnosis, a lot of different things were thrown around until I saw a specialist in my condition. You may have better luck consulting a specialist in INOCA/ANOCA as opposed to a general cardiologist.
I found that my age, unremarkable medical history, and having zero heart problems in the family would often work against me. As a result, it may save you time in the long run and maybe quicker in obtaining a diagnosis when seeing a specialist. I was able to obtain my diagnosis from a world leading expert in these conditions in the end.
There is a patient support group for the conditions I mentioned which you might want to take a look at. You can find useful information on other people’s experiences with it, and share yours, in addition to the names of specialists and other resources.
Welcome to the Forum. Just wanted to say, I had a MINOCA heart attack diagnosed 3 years ago. It was a lot to take in. I had low blood pressure, did not smoke or drink alcohol, was fairly fit, so this seemed to come out of the blue.But looking back, I had chest pains on and off for a few years. I'm lucky enough now to be treated by a great cardiologist who specialises in MINOCA heart attacks. I'm on Isosorbide Mononitrate 10mg one a day, and my chest pains are less. It took me 3 years to get to this place, as in my experience MINOCA heart attacks are not that well known.
I'm on a MINOCA support group too on Facebook, and like on this forum, I get lots of help and advice.
I hope you get a good cardiologist who listens to you. All the best xx
Thanks for your lovely message. I agree, it’s a lot to take in and weirdly my first was feeling was embarrassment, having just told the cardiologist how fit and healthy I am. Felt like a liar!! But now I realise about this different breed of heart attack. Do you mind sharing the name of your cardiologist who specialises in MINOCA? No problem if you’d rather not.
Might want them to ask for a bubble echo but that would be up to the doctor. You might not have this at all but sometimes (occasionally/rarely) it can be caused by a clot travelling through a hole in the heart (PFO or ASD).
If you have no plaque in your arteries as others have mentioned it is probably artery spasms or SCAD.
The spasms can be diagnosed with an angiogram with a medication that diagnoses it. They will want to rule out other things first as an angiogram is a safe but more invasive test. If they can use MRI and exercise stress tests first I imagine they will.
They weren’t keen on doing it for me to be honest but I know it is a potential test. I do know that they will do other tests first as that test seems to be last resort option and their flow chart wants to rule other stuff out first. I know everyone’s experience is different and there is a real postcode lottery
Thanks your your reply. I will definitely ask about the angiogram to investigate spasms. I’m having an MRI but I think that’s to rule out myocarditis. I believe my blood results made them think it wasn’t related to a clot, but I may have misunderstood that.
whether your diagnosis is MINOCA, myocarditis or something else (possibly Takotsubo) I hope that you are taking it easy - your heart has suffered some damage from your episode and while it recovers you should be taking it easy, particularly if you have myocarditis
chest pain is a sign that your heart can't keep up with your body's need for fuel and oxygen, pushing it before you know the cause could delay recovery and make things worse
this might be a good time to consider ways or reducing some of the demands you make of yourself - do you really want to go back to a life which may have triggered this?
I have ANOCA - official diagnosed as recurrent chest pain syndrome with a confirmed myocardial bridge with a confirmed diastolic pressure drop. That’s the best they can say as there is no formal diagnostic protocol. I have angina on physical exertion (minimal will do it) and emotional triggers (communicating loudly with a teenager will do it😉) with no treatment options or surgery option.
I can’t speak on matters of microvascular and coronary vasospasms nor MI / heart attack but you INOCA/ANOCA lot are my closest “allies” otherwise it’s a lonely hearts Mycardial bridge club. 😊 like yourselves it takes specialist testing / cardiologist. And I travelled to be seen / tested.
I’d like to pick up on the critical illness insurance and job front as I have been through this process last year, hoping I can offer some experience.
Critical illness - do your homework and really read your policy and see what the full description of the “heart attack” clause is. As far as I know a MI is a heart attack (just a posher name I think) so worth pursuing a claim. Worst is they say no. Make sure they go far enough to refer your claim to the specialists in the background, not just the initial people who field claims queries. I was put off twice by these people until I got a conscientious one who linked my situation to a particular clause.
Have as much hospital / GP documentation you can to submit with your claim that confirms you had a MI / heart attack and to what extent.
Sometimes unfortunately “extent” is in the small print like you are identified. But key would be is if they specify anything about causes or do they mean a heart attack is a heart attack regardless of cause. Then I’d just refer to it as a heart attack - the NOCA bit is the cause as such and might be irrelevant. They will still contact your doctors but it’s worth the effort to send in what you can.
See if you have the total disability (not able to do your job) clause in case it comes to the situation where you are no longer able to work as a result of your heart issue. I came under this clause.
The claim process can take a few months and you might want to gauge when is right time to ensure you have clear documentation / letters and reports - if they are not clear speak to your doctors.
Work wise there may be options of temporary adjustments in hours while you cope with all this obviously there will be a financial impact. This might be good way to see if you can cope with a more permanent change or look at career change regards something less stressful.
Thank you very much for your really helpful reply. It’s interesting to hear your experience of claiming and I suspected they would likely not make the process simple. I will definitely try to claim, but will wait until I have a bit more documentation behind me.
You’re right; a heart attack is a heart attack and hopefully the cause is irrelevant (from what I can tell the prognosis and impact is about the same regardless). But I read things about it depending on the severity and I’m not sure if this type of HA is considered less severe. It’s less well understood…hopefully we aren’t penalised for this!!
Then i think as experienced people have suggested a specialist will be very helpful in clear diagnosis and impact of your heart attack so you don’t loose out due to a less knowledgeable cardiologist. Good luck with it all, it’s hard work all this stuff - money, jobs and daily life - on top of dealing with impact of the actual heart issue itself 👍🤞
I had such stress before my ha that I just thought it was a panic attack. My son who is only 16 was in hospital for a week very ill with pneumonia and I think everything just got on top of me as it was a week before Christmas. I was in hospital for a week and after the angiogram the cardiologist told me that my pain would still be there as the clot wasn’t the cause hence why they have sent me for an mri. It just concerns me that this pain is still frequent. The shooting electrical kind of pain is new and is making my chest really hurt even though it last for a second when it comes and goes. All my blood tests have now come back normal but my chest doesn’t feel normal at all. It really scares me when the pain is frequent. I am on 2 beta blockers, blood pressure tablets, cholesterol, aspirin and a tablet for my stomach. It’s can really get you down living with pain daily and not knowing why. My chest is constantly feeling heavy and feels like something is stuck and needs to be dislodged. I’m trying not to worry but the more I get the pain the more anxious I get. I hope you get sorted soon and we can finally find out and be treated properly x
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thank you 
My husband has heart failure at 49 and was otherwise fit and healthy ! So worried about the future with severe LVSD 
Pacemaker to be fitted 
Pains after stents fitted
Heart rate and fitness 
