Any advice please

[70garden]

I experience episodes of chest pain at rest, often waking me up.definitely not associated with anxiety. Pain lasts 20 + minutes and vary in severity. All cardiac investigations and GI tract investigations are normal. An ECG taken during an episode was normal and blood Troponin level 1-2 hours after the episode was 8. It would appear no cardiac cause for the chest pain can be found, but no one can give me a diagnosis. Any thoughts from the community would be most welcome.

[Plantome]

Do you have any other symptoms? Nausea, shaking, sweating? I too have unexplained chest pain but do have a history of AF but have been in normal sinus rhythm for over a year. If it’s not due to heart rhythm or angina, it could be muscle related - pericarditis, pleurisy or myocarditis? Did you have an echo?

[70garden in reply to Plantome]

Thank you. When the pain has been very bad I do feel shakey, but I am sure that is just a reaction to the event . I am not sweaty, but the pain can be so bad I find it difficult to breathe, at other times it is less severe. I had a CT Anglo and as that was normal the echo was cancelled. I never have had pain on exertion .

[70garden in reply to 70garden]

Mis print I meant CT angio

[Plantome in reply to 70garden]

Could be a rhythm issue. This would only be picked up during the tests if you were exhibiting symptoms at the time. You could ask your GP for a Holter monitor. Otherwise, if all the heart tests are clear it may be lung related. Good luck and hope you feel better soon,

[70garden in reply to Plantome]

Thank you again. I did have a holter monitor for 7 days , but in that time didn’t have the chest pain. It can be spasmodic , or come in clusters.

[Grayjay]

Do you have a GTN spray and use it when you have an episode? I had Unstable Angina which had the same symptoms. I was told to take it , but after 3 times it didn't ease ring for an ambulance. If you do go down that route and go in to A&E they will more than likely look into the problem more thoroughly. Anyway I'm still here 20 + years later, lots of other things have gone on since but hey. Good luck.

[70garden in reply to Grayjay]

Thank you. Yes I do have a GTN spray which I do use.

[Grayjay in reply to 70garden]

Good. Does the pain ease after taking it?

[70garden in reply to Grayjay]

Yes, but sometimes have to take it a couple of times

[Grayjay in reply to 70garden]

Great if it works, but if it doesn't go after 3 doses within about 15 minutes call an ambulance.

[JonathanH]

Your symptoms sound like microvascular angina or Prinzmetal's angina (coronary artery spasm) but these in principle would have shown up on an ECG. That said, my impression is that MVA can produce minor ECG changes that might be missed.

I have MVA and it wakes me most nights, whilst its response to exertion is variable, i.e. I think it possible that MVA wouldn't cause pain on exertion. It is these observations that cause me to wonder if you have MVA. I do think that it's a possibility but equally it may be something else. I had intermittent symptoms for 10 years before I obtained a diagnosis.

Do you experience changed sensations relating to breathing? Are you certain that you experience difficulty in breathing due to pain or are you experiencing something else, e.g. a sensation of being short of breath? You say you feel shaky: do you actually shake?

I believe that a normal CT angiogram is, or can be, consistent with MVA but I am of course no expert.

Unfortunately, there are very few experts in MVA/Prinzmetals and the probable best consultant in England, Prof J-C Kaski, has retired from his NHS practice. It might be worth seeing him privately if you can find the money. He can see things in ECGs that others can't: do you have the ECG you mentioned? If not, can you get hold of a copy?

[70garden in reply to JonathanH]

Thank you, I do have the ECG so that might come in useful sometime !

[craftbella]

Hi, I used to get chest pain when I was sitting doing nothing, but I could move furniture and not get pain, I was put on a treadmill and did fine, The pain , when I did feel it, only lasted a couple of minutes, but was quite severe at the time. I was told it was spasms of the arteries, and was given mononitrate isosorbide, which I have been taking for over twenty years, this pill relaxes the arteries. I also had a spray for under my tongue when I felt the pain,I haven't had to use it for years. hope you get to the bottom of this please let us know hoe you get on

[70garden]

Thank you. I think getting a diagnosis is seeming to be impossible, but I live in hopes. I will post one day when I have that result.

[Oviston]

Check for variant angina (Prinzmetal angina). Often takes a while for Drs to diagnose

[70garden]

Yes, that is what I have thought, but didn’t like to mention it in my original post. I was waiting to see what response I got. Cardiac doctor and GP don’t think so. However I am clutching at straws to get a diagnosis so hanging on in hope ! However do you know if after an episode of chest pain ( even a less severe event ) would Traponin levels be normal ? Mine was 8.

[JonathanH]

After my severe MVA attacks, my troponin levels have always been normal or just slightly elevated.

When you had your ECG taken, was it when you were in hospital or by a paramedic? My experience is that hospital staff tend to disregard or miss the subtle ECG changes that MVA causes (presumably because they are looking for heart attacks etc) but that the algorithms on the paramedic machines pick up that my ECG's have irregularities indicating ischemia (oxygen deprivation). I have learned that these irregularities are typically ST-depression and T-wave flattening.

As your holter monitor didn't catch an episode (no surprise), you might if you have the money buy a hand held ECG from Amazon so that you can check your ECG when you have an attack. I bought a Heal Force Prince 180B and downloaded onto my laptop software that can convert the ECG waveforms into pdf format, enabling them to be printed or emailed. The machine incorporates software that is programmed to detect arrhythmia but it does not flag up ischemic changes (e.g. ST-depression and T-wave flattening), so you have to get onto the internet to learn what these changes look like so that you can spot them yourself. I had to undertake do-it-yourself cardiology until I diagnosed myself and then sought an expert consultant able to confirm my self-diagnosis. You may have to do something similar as so many cardiologists are hopeless in relation to MVA and Prinzmetal's.

[70garden]

Thank you for that, food for thought. The paramedics did an ECG as did the hospital.