Heart attack with no clear cause?

[Dexter6565]

Hi i had a heart attack just before Christmas , after numerous tests echo, MRI, AngiogramAnd bubble test it seems to have been caused by a blood clot. My arteries are clear, I’ve worn a haltor monitor for a week with only a run of an extra beat showing here and there and only lasting approx 8 seconds. I am very breathless but there is no clear explanation for this . There is definitely sign of myocardial infarction but it seems to be for no clear reason. The cardiologist thinks the future should be good with no reason for it to recur. As a precaution he is putting me on a low dosage of beta blockers but nothing more. I should be pleased and relieved which i am of course but without having a proper diagnosis i also feel a bit lost. Has anyone else had a heart attack caused by embolic episode with similar lack of explanation ?

[Milkfairy Heart Star]

Myocardial infarction non obstructive coronary arteries MINOCA . It is a poorly recognised cause of a heart attack.

nursingcenter.com/ncblog/oc...

ahajournals.org/doi/10.1161...

Common causes are Vasospastic angina/ coronary artery spasm, Microvascular angina, and Takostubo syndrome. Clotting problems or break down or even a small plaque rupture are also thought to cause a MINOCA.

Holter tests are not a reliable way of picking up vasospasms in the microvessels or larger coronary arteries.

Aspirin and antiplalets medicines such as clopidogrel and statins are helpful in reducing the chance of clots forming or plaque rupture or erosion.

The underlying cause of your heart attack is important. I live with clear coronary arteries but because all my coronary blood vessels constrict or spasm I am at risk of a MINOCA.

I cannot take beta blockers as they make my vasospasms worse.

Breathlessness along with chest pain are both symptoms that some people feel.

I suggest you make an appointment with your Cardiologist and ask to discuss these issues further.

[Dexter6565 in reply to Milkfairy]

Thank you so much for your reply. I am seeing him again in a few weeks so i will definitely ask about this

[Milkfairy Heart Star in reply to Dexter6565]

Cardiologists are human beings and can't always keep upto date with the growing knowledge about in particular under recognised and poorly understood conditions. You can give them some help.

I share any new research articles about my condition with my Cardiologist. I send the article a week before our consultation by email.

If you don't have your Cardiologist's email address perhaps send a copy to their medical secretary or take a printout to your appointment.

The AHA article provides a useful discussion of MINOCA for your Cardiologist

Good luck

[bee2]

I too had a heart attack just before Xmas with no clear cause, and the previous two xmas's before that plus the one that started it all off. You know your body better than anyone if you are not feeling as you used to write it all down, and follow Milkfairy's advice for when you next see your cardiologist. What was written on your discharge letter?

[Dexter6565 in reply to bee2]

The discharge letter from my stay in hospital said basically query myocarditis i then had my MRI and the result came back that it was a myocardial infarction ive not had a discharge letter yet from this cardiologist but he said he wont put atrial fibrillation down as the readings only showed an extra beat here and there and only short duration like 8 seconds each time. So i feel a bit lost but will definately be asking him about MINOCA . Thanks to you both for responding

[not2worry]

It seems like the majority of heart attacks give no warning signs, even after you have had a cardio consult. Some are the results of bad diet, no exercise. Others are just the DNA that we can do nothing about.

I agree with Milkfairy, if a blood clot was involved you likely should be prescribed some type of antiplatelet medication. Clots are the one cause of strokes and medication to prevent them is available in a number of forms.

Check with your Doc if you are not taking one.

[Dexter6565 in reply to not2worry]

Hi i probably should have said that last year i had a spontaneous bleed on my liver which resolved itself and again they never got to the bottom of it but as a result the cardiologist is reluctant to leave me on more than an aspirin a day given the history of a bleed.

[not2worry in reply to Dexter6565]

Yes, cardiologist here in the States no longer recommend aspirin for anything because of the problems that have been discovered with even the lowest dose causing internal bleeding.

There are drugs that are specific to prevent clotting that don't have the affect on the body like aspirin. Clopidogrel is a medication that rather than "thin" your blood coats your platelets (think of Teflon coating them) so they don't clump together and clot. Then you have blood thinners like Eliquis which thins the blood so it can't clot (this medication needs no monitoring) or the old standby Warfarin where you need to regularly test your INR.

Ask your Cardio doc if there is something better than aspirin to avoid the potential of clotting.

[Dexter6565 in reply to not2worry]

Thank you for yoyr advice i will certainly ask him about alternatives

[chevidaniels]

A few weeks ago my uncle had a sudden cardiac arrest in the gym, he was down for a while before they got him back. His tests were all inconclusive his arteries were clear, no arrhythmia nothing. They then said it was most likely blood clot and sent him on his way after a few weeks as an inpatient, no ICD fitted nothing. It's been hard because he has never had that reassurance that it won't happen again or even had a definitive diagnosis but I think over time he has healed and realised he is very lucky to be alive and well now. We never know when health doom will strike and we just have to live for the moment. Time is the number one healer.

[Dexter6565 in reply to chevidaniels]

Hi thanks for your reply, im glad to hear that your Uncle is doing well. I feel the same i feel lucky that it wasnt a stroke but would just have liked a more definate diagnosis but i think without having test after test i possibly wont get one

[Nicky3]

Hi,

I had a Heart Attack Nstemi but with clear arteries only after several admissions did they diagnose CAS and MVD later on. My Cardiologist believes that a spasm caused the HA which is supposed to be rare! I had not had any problems with my heart before having a heart attack. What came first the chicken or the 🥚!

[Dexter6565 in reply to Nicky3]

Hi thanks for your reply, sorry to be vague but what is CAS and MVD ?

[Milkfairy Heart Star in reply to Dexter6565]

CAS Coronary artery spasms the term now being used is Vasospastic angina

aka Prinzmetal or Variant Angina.

MVD Microvascular dysfunction is thought to be one possible cause of Microvascular angina also known as Coronary Microvascular dysfunction

CMVD

Both are also referred to as Non obstructive coronary disease. NOCAD

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

I live with vasospastic angina causing Microvascular angina and Coronary artery spasms.

I nearly had a heart attack over 6 1/2 years ago but a very clever Cardiologist guessed I had vasospastic angina and started an infusion of nitrate and stopped the spasms.

He is still my Cardiologist.

These conditions are perhaps not as rare as thought just unrecognised.