ACS (Nstemi) aged 35 and no cause

[emma1210]

Hi,

I think I’m just soul searching tbh. I am a female and aged 35, I had what has officially been written on my fit notes as ACS (Nstemi) on 22nd Sept. Troponin levels were 30 and 270.

After ECG, CT, angio etcs came back clear, I was discharged after a week without any advice or medication. I was told I’d require an MRI as a follow up. 2 weeks later, my employer (long haul airline) wanted to know when I would be back to work. With no definitive information I contacted both GP and tried to chase cardiologist. I was given conflicting info and in the end prescribed Bisoprolol and Ticagrelor then advised I must not fly till after successful MRI.

Had MRI 16th Nov and await results. Scan was lost in system and only booked after I had chased.

The meds are making me feel hideous, does anyone else have experience on this combo? My chest feels tight and I feel bloated and exhausted.

I have heard nothing from cardio rehab (should I?). I have a follow up appointment 7th Jan 2019. I feel let down, uncared for and like my age and sex is having a discriminatory effect. Have been brushed off several times since initial event and it’s like just left to deal with the aftermath and work it all out alone.

I wonder if there is anyone else who has had a similar experience and may have some advice as to whether this lack of communication is normal.

It is unclear is my episode was just a random spasm or caused by PE. No valve tears, cholesterol etcs.

[Nathan53]

Hello Emma That all sounds very frustrating for you and unfortunately a familiar story (your experience of getting relevant information I mean). Did you know that you can speak with a BHF Specialist Nurse by calling 0300 330 3311 and they may be able to talk over your initial diagnosis. Bisoprolol can make you feel very tired and if this is still debilitating after a few weeks you can ask if there is another beta blocker you could try. I couldn't tolerate bisoprolol even after sticking with it for months I felt totally exhausted at times. I changed to Nebivolol and had no ill effects. Cardiologist told me Ticagrelor could cause chest pain and feeling of being short of breath but I continued with it and these effects went. Are you on a statin as they can cause some bloating. I would have thought you qualified for rehab and you could try calling the Physio rehab Dept of your local hospital as it seems records are not always passed on to them. You could also try calling the Secretary of the Cardiologist to chase up MRI results. Keep positive you will get sorted and don't give up on chasing things up you have to persist

[redcarpet123 in reply to Nathan53]

I pad a heart attack in June and had my follow up appointment on 24 October. The cardiologist told me I had a weak heart and I was to come off clipodogril as it could be that medication which is causing my blood in wee. He told me I was to have a pacemaker and asked could I have cardioversion he went to see lead in cardiologist came back in and said your to see the other dr she will have a chat with you then turned around and said you've got a weak heart and your discharged. I couldn't believe what I was hearing. I saw the other dr and she told me that she didn't know if pacemaker would work and she would out me on a 24 hr heart monitor and she would decide which was best. I got a letter in post 2 was later for 20 December. I was a bit worried as nothing had been said about rivarauxaban I had to phone my dr for a birthday check and spoke to the triage nurse who told me I should have a chat with dr when I saw the dr he said your on clopidogril and taking rivarauxaban 2 x a day I said no as I'd marked a list of my medications and taken that to see the cardiologist who ticked it and x clooidogril I had taken this to show my dr there was nothing I. The letter saying I was taken off ckopidogril. My dr told me he would have to ring the cardiologist but as it was fri couldn't do it today as it was 4.30 that he would phone On Monday if the cardiologist got back to dr that day he would ring me but if not it will be fri as he was having a few days off. Dr did ring and what he said to me flabergasted me he said everyone got mixed up and they didn't want me off the clopidogril as it protects your stent and ask the urologist when I could go back in the clopidogril I did that and he is right in what he said I can't tell you when to go on the clopidogril that's the cardiologist dept. Everything in ct scan came back healthy and I had camera up bladder and urologist said it is very healthy. When I got home I rang the Drs a couple of days later spoke to nurse who said she'd have to speak to dr and she would get back to me which she did and she said dr had said yes take the clopidogril I said but urologist is putting it down to secondary anticoagulant she said no at the bottom if the page it says you've to see your dr about cream I replied but look at the diagnosis and she said I would protect the stent. I'm not at all happy about it at all. These are supposed to one qualified Drs. If you can't trust them who can you trust.

If I was you I would phone secretary if the dr and explain and get a second opinion. Don't worry it will be sorted. My cousin said you can always get a second opinion as she was a nurse and husband a dr.

[Sususulio]

Oh Emma how awful for you, Nathan gives wise words and whilst I haven’t had your experience I can empathise with the frustration and anxiety you must be feeling.

Who is your follow up appointment with?

How long is your current fitnote - absence from work?

I wonder if some help could be given through Occupational Health and your work...

The cardiac rehabilitation made initial contact with me whilst in hospital and followed up with a phone call and visit on discharge. My GP has managed meds that were prescribed on discharge.

It is quite a cocktail and the sudden introduction of a few at once can make it very difficult to determine what’s causing what. Bisoprolol makes me very tired and lack lustre I think and I have had chest discomfort (checked out OK) but I had a stent. It must be such an upsetting time for you and I hope someone comes along soon to give you some more helpful information

Take care

[Milkfairy Heart Star]

Hi Emma,

I am really sorry that you are having such a bewildering experience.

There was research published last week about how women have a poorer care following a heart attack.

There is a bias within the cardiology world if you are a younger woman without obstructed arteries. If a Cardiologist sees no blockages unable no insert stents to fix the problem they are outside their usual comfort zone of knowledge.

It is possible to have a heart attack without any blockages so your angiogram looks clear .

It is known as a

Myocardial infarction non obstructive coronary arteries MINOCA

It is a poorly understood and recognised condition just as are the possible causes.

Coronary Microvascular Dysfunction, Coronary artery spasms, Spontaneous coronary artery dissection and Takostubo syndrome.

Beta blockers can make Coronary artery spasms worse.

You need to ask to be seen by a Cardiologist who has some knowledge of non obstructive coronary artery disease or is willing to work with you to gain the appropriate knowledge.

The MRI is probably to check that your heart muscle is okay.

Below is a link to the latest universal definition of a heart attack published in August by the European Cardiology Society in conjunction with the American Socities too.

academic.oup.com/eurheartj/...

I hope you manage to get the information and treatment you need.

[bantam12]

Try and find a female Cardiologist so you avoid the problem men have with communicating and treating women patients !! sadly it's a common issue.