Latest cardiology (pic) of letter sent this morning!

[Rob6868]

Latest pic

[jimmyq]

Did you have to stand on your head to read that?

[Rob6868 in reply to jimmyq]

Yep...

I walk around doing hand stands all day😃😃

[jimmyq in reply to Rob6868]

What happens now? Are there any other tests you can do?

[Milkfairy Heart Star]

It is certainly possible to have Microvascular angina as well as coronary artery disease

See Table 1 for the classification of the different types of MVA

heart.bmj.com/content/104/4...

This is an article about someone living with both Coronary heart disease and Microvascular angina.

bhf.org.uk/informationsuppo...

There is a diagnostic test for Microvascular angina and Vasospastic angina causing Coronary artery spasms ( Prinzmetal Angina is old school) .

mdedge.com/cardiology/artic....

There are 2 centres in the UK one in Glasgow the other in London that carry out angiograms with acytelcholine.

Ask your GP or Cardiologist to refer you for a second opinion.

Just because you can't see something doesn't mean it doesn't exist. You just need the right test and know what you need to look for.

[Rob6868 in reply to Milkfairy]

Thank you milkfairy

I absolutely agree with you.

It's trying to get both doctor and cardiologist to listen.

It's like talking to a brick wall.

Your right! Just because you can't see it doesn't mean it's not there.

And I know my body and know what I'm feeling and going through.

Sadly it takes months before I get the opportunity to see him again.

So may book an.appointment with doctor to take it further or even write to the cardiologist in question. Can I do that? I'm not actually sure 😶

But u can't carry in not knowing that's for sure.

P's where in Italy do you go during the summer? Like you I now find the warmth helps and cold really affects me.

[Milkfairy Heart Star in reply to Rob6868]

Hi Rob,

Your GP can refer you to another Cardiologist for a second opinion.

You can't refer yourself unless you see a Consultant privately even then the Cardiologist may well expect a letter from your GP.

As for next summer I have no idea were I'll be going there is a little hurdle of Brexit to get through first..

Keep your fingers crossed for a mild winter😉

[Hidden]

The effects of inflammation within micro/small/even medium vessels aren't well considered in clinics except very, very few. In my own experience (not just Cardiology), mainstream medicine tends to look out for large artery diseases as these are medical emergencies and easy to identify in their imaging modalities (read "a quick diagnosis, bob's your uncle."). They like that.

If they do not see large artery problems besides some "mild problems" even though these still mean "something extremely important" to patients i.e. ongoing symptoms/diminished quality of life/affecting work i.e. job losses/financal hardship etc), you are not their immediate priority. You are not dying tomorrow, in other words and they wouldn't lose sleep over it (as they have enough workload to lose sleep over it). They might even think what's the fuss about?

However, in your case, Rob, you have the main artery issues as well. So the consultant's focus is on those (as described in his letter). the Cardiologist does not sound dismissive. He outlined your concern extremely well. He is probably not used to dealing with small vessel diseases as they are considered "minor" as some Youtube video had demonstrated (read, Dr G. Cardiologist's comments on that, for example).

That is/appears to be within their consensus except for one or two Drs, who can think outside their box. The most cardiologists listen to what other colleagues had to say and what is written in their guidelines (as expected by the general medical council).

Your angina might be coming from the disease process, not exclusively in smaller vessels but including smaller vessels. What Cardiologists (who have healthy hearts themselves) do not seem to understand is that even minor "glitch" in their tests *that they dismissed repeatedly*) can cause severe symptoms. But they continue to ignore these as their focus is not on these "outlier" patients.

I have seen a big thread on cardiologists hiding "minor/moderate" findings away from the patients (possibly to avoid "wasting more valuable clinic time" on these patients. That was not on this hub. Patients were outraged, unsurprisingly.

Useful thread, indeed. It would be useful to raise more awareness on this front, but medics do hate spending extra time over something "obscure" as their life is busy as it is.

In my case, I have other small vessels diseases, my cardio commented in his letter. But I could see he is going through the motion as I am under some eminent doctors and he can't simply tell me to get out of his office as my case bores him to death and he has a lovely dinner to catch in South Ken!

[Milkfairy Heart Star in reply to Hidden]

Some very good points well made, Autumnsonnet.

The British Cardiovascular Intervention Society's prestigious Young Investigator award has beed awarded to a BHF funded researcher....he is like 3 of the other 4 finalists researching Microvascular dysfunction.

The research of the year award was won by Prof Colin Berry who with his Glasgow team are actively researching into Microvascular and vasospastic angina.

bcis.org.uk/news/bcis-resea...

[Fortepiano]

It's good you don't have further critical stenosis, but it souds as iif you really need statins.

Hope the diltiazem helps.