Just wondered if there are people here with similar issues. Will try to make it short. I am a bit at a loss as doctors not really giving me answers. Maybe people can direct me what else to look for.
So i am a 36 year old female. My alleged heart troubles started about 10 years ago. At that time i have been quite active physically and incidentally there was a lot of stress in life. I noticed i started getting breathless, getting weird feeling in my chest and throat like it is tight, and felt like i cannot fully inhale or it takes so much effort, all after long exercise (like running 10k). All this was a new exercise regimen. I considered myself normally fit, i was a semi proffesional gymnast until the age of 14, as a child i trained about 2,5 hours 5 days a week frim the age of 8 or 9. Ok fit but obviously not fit for endurance sports then. So after my runs I would also get very anxious feel like i am going to die! Had echo, stress test done and holter monitoring. All was uneventful apart from a congenital mitral valve prolapse. I also have anxiety, depression and occasional panic attacks. Anyway 11years later, have had a child and not been exercising not as vigorously as before, maybe short runs or bike rides twice a week. Recently i`ve had some scary episodes during or after exercise so i can say i have practically stopped exercising, maybe i go for a longer walk once a week which i mix up with a few minutes jogging here and there (not taking into account 30 minute walking each day to/from work). It is much worse than it used to be, now chest discomfort, fatigue and palpitations start during running not after. Went back to doctors my echo is apparently normal, my stress test results basically ok, just a reduced lung function but still within norm, low vo2 max of 20 but this is possibly because ive finished the test somewhat prematurely (misunderstood instructions). Oh forgot to mention in the past ive had a couple episodes of passing out, one was when i was on my bike! But no arrythmias discovered during all those test. In the last few weeks ive had some chest pain at rest and at night which woke me up. I put it down to anxiety and panic attacks as well as acid reflux but i still worry if this could be heart related especially ive not had chest pain with panic attacks previously. Any more tests i can ask for? or is this conclusive enough? Thank you.
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baha-3
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Take it easy. A lot of surveys show that an hour a day of brisk walking a day is enough to keep you fit. investigate having a scan to look at your coronary arteries (CAC scan ?) to check the state of your arteries. What's your diet (consumption of sugar) like?
Hi! thanks a lot for responding. My cardiologist would not schedule this for me, this is on nhs. My diet is mostly healthy! Not much meat, lots of veggies fruits etc, try to avoid too much sugar.
As you have had episodes of passing out you need to persist with the Drs, they are notoriously good at ignoring female patients, brushing everything off as stress, panic, anxiety !!
I have previously had all the tests but after talking to my Cardio again I'm about to repeat them.
If I were you I would ease up on the strenuous exercise until you know if anything is going on. I know if I push myself I'm in trouble so I don't do it !
Bantam12 thank you for reply. Yes, i have nearly stopped exercising now apart from walking. It is too stressful. With regards to passing out this was long time ago. Looking back at the 2 episodes, they were a bit ominous as in no warning on the part of my body, just a pure blackout. So i thought could this be arrythmia. I had a couple of episodes last year and went to ER but this was when i had a stimach bug and got really dehydrated so dont think it was related.
Hello, and thank you for your full and useful description of what has been happening to you. I am really sorry that you are experiencing these distressing symptoms, especially at such a young age.
I suffer from microvascular angina (MVA) and I think it possible that you do as well. It is notoriously difficult to diagnose chest pain, as it can have many causes, and I may be completely wrong, but I do think that MVA is a possibility worth considering, at least to exclude it as a potential cause. There are two symptoms that you have mentioned that are particularly suggestive of MVA: pain after exercise and pain at night. By the way, as its name implies, MVA is a disease where you experience angina because your small blood vessels to your heart don't work properly. MVA cannot be diagnosed by classic angina tests, it doesn't perform to order, it can't be found by an echocardiogram and won't necessarily manifest itself in a stress ECG. There are specialist tests available. Most cardiologists know little about MVA and some don't believe that it exists; you may in due course need to consult one of the handful of MVA specialists but, so far, there seems to be no evidence that there is any malfunctioning of your heart and my own thought is that the first step for you is to see if your heart is playing up during your attacks. And, of course, speak to your GP.
MVA should create irregularities in ECGs taken during an attack. I have on too many occasions suffered severe attacks at night and dialled 999. The ECGs then taken by the paramedics almost always said (thank to the algorithms in the machines) that there were signs of ischemia (oxygen deprivation caused by lack of blood supply to the heart). What I often found in hospital, though, was that the subtle ECG changes produced by MVA were not observed or were disregarded, presumably because the staff were looking for more dramatic changes that would come with a heart attack etc. I therefore don't trust interpretations of ECGs by hospital staff; in fact most medics that I have seen have been completely useless. I therefore recommend that you keep copies of all ECGs in case they are later useful for study by, say, an MVA expert.
If you have been attended by paramedics but their ECGs have not reported irregularities, that might be a pointer away from MVA. But I don't think it all satisfactory that you have a disorder that causes you to black out and that has not been diagnosed.
It took me 10 years to obtain a diagnosis, and in the first instance that diagnosis was by myself before I then found an MVA specialist who confirmed my self-diagnosis. You may be in for a long battle to obtain a diagnosis and you may have to undertake do-it-yourself cardiology. A tool that you will need is a hand-held ECG machine. I bought a Heal Force Prince180B off Amazon for something over £100 and downloaded onto my laptop from the manufacturer's website the processing software necessary to convert the ECG waveforms into pdf format. The Heal Force machine is programmed to look for arrhythmia but not ischemia, so you have to learn how to spot signs of ischemia like ST-depression and T-wave flattening. Dr Google can help with this. If you can also afford to buy a blood pressure monitor, that might be worthwhile also.
The reason that you need to take your own ECGs is that you must take them during an attack and that it might be too late to wait until one is done in A&E or at your GPs. As I have hinted, though, if you haven't called an ambulance in response to an attack, it might be worth doing so in order to obtain an ECG as soon as possible. For example, if you have a severe attack at night, it would surely be reasonable to dial 999 - and don't delay as you want the paramedics to attach their ECG machine while you are still having the attack.
The blacking out seems rather serious and I think not normal for MVA. On just one occasion I got half-way to blacking out. There is another condition that might be worth mentioning in relation to the black outs, which is Prinzmetal's angina or coronary artery spasm (CAS). Like MVA, this disease is a disorder of dysfunctional blood vessels: what happens is that your cardiac arteries (or one of them) go into spasm, thus constricting and reducing blood supply to your heart. Many people seem to have both MVA and CAS.
You mention acid reflux and panic attacks: for a long time I thought my night time pain was due to reflux and I have been accused of suffering panic attacks. I am sure that it is possible that these are involved but you cannot know whether they are the cause without investigation and these two disorders can be entangled with MVA. My MVA attacks can be associated with panic attack-type symptoms. One doctor explained to me that, when your body doesn't work correctly, it can respond by producing adrenalin, and this induces both panic attack symptoms and - I think but without certainty - the feeling of impending doom that you describe. An adrenalin surge seems to me to be potentially both a response to and a cause of anxiety. Acid reflux can do all kinds of things: it can upset your vagus nerve and by that means induce heart irregularities; conversely, heart irregularities can induce oesophageal disorders and there is a known association between MVA and oesophageal disorders. (You can read all this in the scientific literature). The picture is therefore complex.
Does your chest pain respond to Gaviscon? If it does, that would indicate reflux, of course.
The "feeling of impending doom" that you describe is a known thing: it might be worth Googling it.
By the way, you haven't said how long these attacks go on for, including those at night and at rest. I would be interested to know the answer.
You have given a very full picture of what has been happening to you. Is it possible that you have missed out anything else that has been going on?
I am not a doctor and I may be barking up completely the wrong tree. However, as nobody has jumped in with any better ideas, it seemed right for me to give you mine.
Hi Jonathan. Thank you for responding! You have such an amount of knowledge on the subject! The attacks after exercise i had it depends how vigorous exercise was. They can last from 15 min to a few hours. The attacks at rest - i did not have that many. I might have had a random bad night with chest tightness and other vague symptms if i exercised intensively that day but the attacks at night and not preceeded by exercise, they are quite recent. I had maybe 2 in the last month. I have not tried gaviscon, maybe i should have. Luckily i did not have many episodes of passing out and they were actually not connected to any attacks. The only thing that really bothered me about these syncope episodes is that one of them happened in the middle of exercise so google brought up Long QT syndrome. But then this episode was ages ago, 10 years ago so...Basically i was mostly concerned with how safe it is for me to exercise at first...Just didnt want to literally die in the middle of exercise or something. Wow, buying one of those machines you mention seems like an option! I might do that if i run out of other options. It seems a bit expensive though. Not sure if they are available in the UK, i will have to do research. But i will definitely seriously think about it if other diagnostic options fail.
PS: Bantam12 says that doctors are notoriously good at ignoring female patients. Indeed, statistics do show that female heart patients do better with female cardiologists.
Hi, thank you again. I randomly measured my blood glucose a few times. I think it is within the norm. Actually quite low in a good way. My daughter used to have hypoglacemia episodes (not diabetes related), so we keep a blood sugar monitor at home. I just naturally like to eat healthy to be honest
I have lived with vasospastic and Microvascular angina for over 6 years.
Mine was confirmed with a very specialised angiogram with acytelcholine. I have received all my care in the NHS. I have written Admission Plan to help the staff care for me when I go into hospital.
I have been very fortunate and seen some of the world leading specialists in Vasospastic and Microvascular angina.
There are a few in London the other is in Glasgow.
Vasospastic angina is the term now being used by specialists into this condition rather than Prinzmetal or variant angina or Coronary artery spasms.
The BHF will be in due course updating the information on the website about Vasospastic angina. It is being written with input by Cardiologists, a senior Cardiac nurse and an expert patient by experience .
In the meantime you may find this information helpful.
It can take sometime to get a diagnosis and as the others have already stated there is a unconscious bias in cardiology about women and heart conditions.
Thank you, Milkfairy! There is a lot of useful information! But it seems like getting this diagnosis can be challenging. I did see a cardiologist who referred me for a stress ECG test and for echo. I have not really heard from him. He was supposed to write to me with a follow up.
It certainly can be a challenge getting a diagnosis of vasospastic or Microvascular angina.
Mine journey as they say has been a bumpy one. However my care has improved. It's really important to establish a good relationship with your Cardiologist.
My local Cardiologist diagnosed my MVA over 6 years
My MVA was along with vasospastic angina confirmed by my angiogram 5 years ago. I have worked together with my Cardiologist to find the best treatment for me. He is actually a Heart Failure Specialist
I suggest you contact the Cardiologist who ordered the tests secretary and ask for an appointment.
There is such a poor knowledge about Vasospastic and Microvascular angina amongst Cardiologists that some of them think it doesn't exist. It is though we are asking them to go to fairy land and believe in unicorns!
This research is recent. It describes using an angiogram with acytelcholine to diagnose vasospastic and Microvascular angina.
If you get no joy. Contact PALS and ask to be seen by a Cardiologist who has some knowledge of VA and MVA if not they are willing to learn and work with you to find the best medication to treat you.
The BHF is a respected organisation by Health care professionals. Print out the BHF information leaflet about MVA and give it to your GP and Cardiologist.
If you are in pain it should be treated and it is not appropriate for a Cardiologist to ignore your pain just because they don't know how to treat it....they should find out. They have a professional duty to do so.
Feeling breathless rather than pain is a common symptom of MVA in Women. As Jonathan has already said chest pain at rest at night is also very common.
Thank you, you are being really helpful. I hate dealing with doctors by this point, when you try suggesting something or asking a question about this or that condition they just behave like i am questioning their authority or trying pick on them and teaching them how to do their job. Ugh. I am actually hoping i can do some tests and see a cardiologist abroad in Europe (my husband is EU, hopefully will be covered by insurance) but maybe not immediately.
I would keep an open mind on your symptoms at present - I think it unwise for an internet forum to try to diagnose you. Becoming convinced of a particular diagnosis which you then try to get confirmed can be counterproductive. Bear in mind your symptoms may not be cardiac at all, particularly since your only abnormal result was your lung function.
A VO2 max test is an unusual one, but sometimes it is done to try to distinguish between the cardiac and pulmonary elements of exercise capacity.
I suggest you go back to your GP for advice on where you go from here and any further investigations: he should have heard from your cardiologist.
If your stress test was Ok with no ischaemia or arrhythmia that should reassure you that you can exercise up to a similar heart rate - ask your GP's advice on this and start slow. Have your palpitations been identified? If not, another Holter monitor might be useful, hopefully to reassure you.
Fortepiano, hi! I love your nickname. Are you a musician? Thanks for a useful piece of advice! Yeah, i am trying to keep my mind open actually. Will definitely go back to GP and will try to follow up with a cardiologist as well. At least i want them to explain what my results mean. I really want to have another Holter as well.
Exercising with a Holter would be useful to identify your palpitations. Trying an antacid would also be a good idea . I hope your tests end up reassuring you that you can go back to exercise.
I'm not a musician but I do love playing the piano!
Thank you!!! I don`t know if i can go back to exercise on the same level as before but yes, would actually be very illuminating if i had an episode and it was recorded on ECG. I would finally know what happens after so many years.
I appreciate you live with the situation you describe, Milkfairy, but I was responding to baha-3's situation , which is not the same.I think it is premature to advise baha-3 to ask to be referred to a cardiologist to treat MVA, when this diagnosis is simply one of many possible ones. Advising her to go to PALS and demand her pain be treated by a cardiologist is also premature and indeed a bit over the top since we don't even know whether her 'chest discomfort', as she describes it, is heart related at all.
I can quite understand how your own very difficult history and pain has led you to this advice, my point is that you are seeing her situation through the prism of your own experience.
Of course doctors are human and make mistakes, but the same goes for patients, and in baha-3's case I consider doctors are in a better position to diagnose precisely because their knowledge is inevitably broader and the range of possibilities here is pretty wide. I think it's better to stand back and look at all her results with her GP at this stage.
All the best with your own difficult condition, which I'm sure you do understand more than most doctors.
Perhaps consider why are assertive women told they are being demanding?
I note that you have also expressed your own views about valve surgery through your own prism too.
I have received many messages from individuals thanking me for my support which meant they have felt empowered to access the Cardiology care they need and had their condition diagnosed correctly and treated appropriately.
Chronic and acute pain that is not treated well can have a devastating effect on an individual . The Patient advice and liaison service ( PALS) is there to help patients access the care that need. I have often found them very useful. I do not use it to demand care but to help me navigate through the system.
Whenever a patients pain is not acknowledged or reliably treated in an timely and appropriate manner they are not being treated with respect and dignity nor with kindness and compassion.
Anyway now time for dignified silence as they say😉
Goodness, Milkfairy, this is unnecessary. I am very happy to acknowledge the enormous help you have been to posters on this site struggling like you with MVA, and have never suggested otherwise. However I was responding to baha-3's situation, and I do not think she is in that situation or that the action you suggested was appropriate for her at this stage, however appropriate it may be for you and people in situations similar to your own.
You are describing a situation of devastating chronic and acute pain for which you truly have my sympathy and I absolutely agree with you that such pain must be acknowledged and treated - but this is not what she has described. And how can she ask through PALS that her cardiologist deals with her chest discomfort when she doesn't even know it's cardiac? First things first.
Everyone has their preferred method in negotiating the NHS system.
I have found an open and co-operative discussion with the GP to be the most useful step when the best diagnostic way forward is uncertain, particularly since the GP is the key to specialist referral. This is what I suggested to baha-3 and I still consider it the most productive approach in such circumstances.
Yes of course I told my story in the recent valve thread - that was what the poster asked for. However I pointed out that valve choice is strongly personal and varies dependent on the individual's feelings about reoperation and warfarin. But the thread was about a poster with a diagnosis of aortic stenosis! The present thread is not about a poster with a diagnosis of MVA.
Anyway, I agree enough's enough: this is not about you or me, but about a poster with a problem where we disagree about the way forward for her specifically - that's all. You seem to think there's a much more fundamental disagreement between us - I assure you there isn't.
baha-3, really sorry about this digression, not of my choosing, and all the best to you. You are of course completely free to take or ignore all our advice, but I very much hope things are soon sorted for you and everything turns out to be reassuring.
Whilst you are pursuing answers from your GP. Have you thought about looking at learning to manage your stress levels? Yoga; Pilates and Mindfulness are supposed to be very good at helping you to manage and cope with stress/anxiety. Whilst I am in the very early stages of learning/understanding what will help to keep me ticking. One thing the medical staff and cardiologists acknowledge is that stress and anxiety can contribute to Heart related problems. Even now if I get worried or upset over something/someone; I can feel my heart palpating... feels like a dozen butterflies are in there. I am the worlds worst over thinker and can sometimes wake during the night feeling the same. Whilst I am not purporting that this is the answer to your problems but it may in some way help. You don’t mention if there is a history of heart problems within your immediate family. I hope you find an answer/s. Don’t be afraid to challenge anything that you are told, it may also be useful to take someone with you to appointments (another set of ears and moral support). Best wishes .
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