Coronary artery spasm?

[Rob6868]

May the 23rd I had my angiogram and one stent in my LAD

And just two days ago I finally had my first appointment with my cardiologist even though I have constantly complained of ongoing chest pain since my procedure in may.

I pushed and pushed for more investigation into my chest pain and eventually got a cardiac MRI profusion scan at guys and St Thomas hospital in July. Not a nice experience. I then waited over a month for results....while I'm still getting chest pain daily and at rest and now and again during some kind of exercise. Finally was told scan was "Normal" what is normal supposed to mean I constantly ask myself..since July to this day In November I've had recurring pain in chest...I've carried on working in a job that's very physical..I've had this pain for days at a time...or 10mins here and there or 30mins or so...day and night and while sitting at rest...Again I've suggested MVA or prizmetal angina ..lots of screaming down the phone to be seen etc fell on deaf ear's until last week when I finally saw my cardiologist I saw he's registrar then him for under 5mins...after expressing my concern and worry that I feel I have angina daily he suggested another stress test and lipid test that I have just done....mainly because I want to come of these dreadful statins and my cardiologist has basically said I would be stupid to come of statins or I would be back in hospital within a year...hence my lipid test being ordered to see my cholesterol score...Will update you all on that soon.

My question is..What will they be looking for during the stress test to diagnosis "Angina? Or Coronary artery spasm? Can a stress test indicate these?

I'm worried for the future and believeevery day I'm a ticking time bomb.

I must point out I have lately during the last month been experiencing neck stiffness radiating from middle of back of neck and downward to my shoulders. It's now become almost impossible at times to tilt my head back and fourth and sideways.

Could this be part of angina or meds?

I must also point out I do have two herniated discs in my neck...but I feel it's strange that I've never really had neck issues until the last month or so...even though my disc issue was picked up on an MRI 5years ago...so could the neck issue be discs or statins or something else?.

I'm also at a complete loss as to why I was told to have a cardiac profusion scan for mva when it won't diagnose angins.

I feel I'm going mad with worry and to some degree am worried I won't see my kids grow up if the chest pain I'm experiencing every day is unstable angina or coronary artery spasm.

I have been working through the daily pain and just carrying on even though some days I will get it for an hour or so then again 5mins later...and at rest and early morning and especially if I'm emotionally upset or angry or cold seems to set it off too.

Please please any suggestions or knowledge from you wonderful people would help...Including your good self "Milkfairy" I admire your input

[AlibaliM]

Has pericarditis or costochondritis ever been discussed with you? After my heart attack in March I developed both of these and due to severe chest and shoulder pain can not tolerate statins. I am currently waiting on an appointment at a lipids clinic. I’m finding it stressful that my cholesterol is creeping back up!

[Rob6868 in reply to AlibaliM]

Hi AlibaliM

I went for a lipid test a couple of days ago and am seeing consultant in 6weeks so I expect he will have blood results then.

I think he's done the tests to prove I need to keep taking statins.

I wouldn't say at the moment I can't tolerate them...it's more that I'm noticing weakness and the odd unusual pains like in ankle and near kidneys etc

But I'm concerned for the future if I have what I strongly feel us either unstable angina or Micro vascular angina or coronary artery spasm...one of those..

I can walk for miles with moderate pain

Yet I can be sitting at home and the next minute it hits me and can last minutes or hours or the whole day..

I never smoked or drank and my diet wasn't good or bad...avid gym goer

But now I think why me? I feel I won't see my kids grow up and every day I get the chest pain I think is this it??heart attack

When all I want is to get on in life.I'm only 50 and I don't plan anything anymore.

I got over the stent procedure and moved on very quickly as I'm usually a positive person but when my consultant keeps saying it's all muskular skeletal then after several arguments with me then agrees it could be angina...it hardly feels me full of hope I'm afraid

[Prada47]

Hi Rob

You ever been given a GTN spray to see if it alleviates your chest pain ? High Cholesterol I believe takes years to build up to a Heart problem !! An MRI stress scan will reveal an awful lot it can actually show if a % of your heart is working ( not just Ejection Fraction ) they are a gold standard + test

Regards

[Hidden]

I have microvascular angina/ spasm secondary to a rare auto immune disease. I have no Cardiovascular risk factors other then my auto immune disease and the diagnosis came as a bit of a shock although I was pleased to get an answer for my symptoms.

Thankfully I was diagnosed via a specialist angiogram as part of a clinical trial. It involved running extra tests such as adenosine and acetyl choline infusions to induce spasm and measuring pressures with a fine wire. All my tests had been negative up till that point including numerous ECG’s and treadmill test.

My understanding is that patients can have a mix of macro vascular and microvascular heart disease, unfortunately the microvascular is much more difficult to diagnose as recognition of this problem is in its infancy and they are just developing sensitive diagnostic tests.

I can have chest pains for days at a time which come on at rest and have increased shortness of breath on exertion. It’s very frightening but I try and reassure myself that it is my small coronary vessels going into spasm and whilst it’s painful there is still a decent blood supply to my heart and it’s not causing the damage that a myocardial infarction would.

I have had trouble finding medication to help my symptoms as there has been very little research into what medications work for microvascular disease. My blood pressure and heart rate are naturally low which has made me intolerant to most cardiac medications. Have you tried different statins, I couldn’t tolerate simvastatin but am ok on atorvastatin.

I do think part of the issue here is that cardiologists are used to dealing with macro vascular heart disease via PCI etc. Microvascular disease doesn’t cause the same damage to the heart in the short term but can have a massive effect on our quality of life which is poorly recognised. Hopefully in the future more research will take place and more emphasis placed on quality of life as an outcome as opposed to just 1and 5 year survival rates ( not saying they aren’t importnat too! ).

I hope you get some relief from and understanding of your symptoms soon. I am taking a small dose of beta blocker ( Nebivolol ) which is cardio selective and supposed to help endothelial inflamation and am currently titrating isosorbide mononitrate slowly to try and prevent the prolonged angina attacks. It’s a work in progress unfortunately.

[Milkfairy Heart Star]

Hi Rob,

Like Tynemouth I had my vasospastic angina confirmed by an angiogram with acytelcholine and adenosine.

I also have spasms in my large arteries as well as small vessels which is unusual.

I do not have an autoimmune disease which is often associated with Microvascular angina.

Tynemouth has some very wise words about the challenges of living with our condition. All my tests were ' normal ' though my ECGs always show T wave and ST wave abnormalities. I have had ST elevations too which confirm coronary artery spasms. My troponin levels are only slightly raised.

There are 2 places in the UK at present that perform angiograms with acytelcholine Glasgow and St Thomas's in London.

Since Prof Juan Carlos Kaski has retired we have lost a very caring and compassionate expert into Microvascular and coronary artery spasms.