Hi And welcome. I think it’s really important to see your GP and hopefully you will get referred to a rapid access chest pain clinic especially as you have had 2 in the week. Also when you are having them it maybe wise to seek help immediately rather than wait especially whilst you’re waiting for diagnosis. In this heat it is also wise to keep well hydrated. I hope it gets sorted for you soon. Best wishes Zena
Mutley, if you have angina but healthy coronary arteries, it is possible (likely?) that you have either microvascular angina - where the small blood vessels to the heart do not function as they should - or coronary artery spasm (Prinzmetal's angina), which most commonly occurs at night. In coronary artery spasm, the arteries go into spasm for a period and constrict blood flow to the heart. My understanding is that GTN (previously known as nitroglycerine) will normally relieve spasms, so it may be worth asking for GTN spray. But GTN does lots of things and is not a reliable diagnostic tool.
Incidentally, it seems that spasm of microvessels is one mechanism of microvascular angina.
Unfortunately, most cardiologists are ignorant of these potentially debilitating disorders and you may have to do battle with the NHS to obtain a referral to somebody who knows about them. Do not be surprised if you struggle to be taken seriously but do not give up.
Was your heart scan an ultrasound (echocardiogram)? I don't know that they can detect atherosclerosis (furring up of the arteries) and you may need an angiogram to determine the condition of your (big) arteries. One of the problems with microvascular angina and coronary artery spasms is that their episodic nature makes it difficult to catch them on ECG: note also that the ECG changes with microvascular angina tend to be subtle, such as T-wave flattening or minor ST-depression, and my experience is that hospital staff are not impressed by minor changes and ignore them. If you have ECG's ask the staff to look out for such minor changes.
Ischemia can cause arrhythmia, so if you have occasional palpitations or rhythm disturbances, it is possible that this is caused by ischemia, presumably whether blockage of main arteries, spasm of main arteries or dysfunction of small blood vessels.
Incidentally, if in doubt dial 999. It is better to call an ambulance and find that you didn't have a heart attack than not to call an ambulance and find that you did have a heart attack. I have found paramedics and A&E staff universally supportive on this issue. One possible benefit of calling an ambulance quickly is that the paramedics' ECG recording may pick up an abnormality that would not be observed at other times.
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