Microvascular Angina & Heart spasms

Hi as yet I haven't been diagnosed but have been suffering with chest pains & tightness for the past 4 months, I've had 4 ecg's, blood tests, x-ray & blood pressure all normal, but I have worsening symptoms which intensify at night with spasms. I am waiting on a cardio ct scan but I feel this will also be clear & won't detect Microvascular angina. I lead a healthy life style & wonder if this is caused due to dropping oestrogen levels I am 53 & recently started hrt?? Following a particularly bad attack of chest pain I went to A&E over the weekend again all tests were clear & I was told the symptoms are all in my head & I should take painkillers & carry on as normal. This is what I tried to do & thought seen as there's nothing wrong me I'll have a glass of wine which I used to enjoy prior to all this starting. After going to bed I woke after an hour with intense pain lasting about 15 minutes which I'm guessing was a spasm aggrivated by the alcohol. This is all getting quite scary now so I've made a private appointment to see a cardiologist tomorrow. Any tips on how to deal with this would be really appreciated. Thank you.x

[Milkfairy Heart Star]

Hello Hels1303

I have lived with microvascular and vasospastic angina for nearly 7 years.

It took quite some time to diagnose. I had an angiogram with acetylcholine which confirmed my diagnosis. My cardiac MRI was normal.

I have a very good relationship with my local Cardiologist and see a Cardiology Professor who is an expert in the condition too. I have a written Admission plan to manage my inpatient episodes.

It is a case of trial and error finding the best combination of medication that will work best for you.

MVA and VSA are poorly understood and recognised conditions and sadly very few Cardiologists are around with any expertise in this area of Cardiology.

Are you seeing a Cardiologist who is experienced in caring for patients with MVA and VSA?

I suggest you read the information on the BHF website they are regularly updated and research based.

The MVA information sheet was written with input from a leading researcher into the condition and an expert patient.

I would also printout the latest research papers I have included and take them to your consultation. If the Cardiologist is unfamiliar or dismissive of this information it maybe better to seek a second opinion.

Learning to manage your stress and anxiety is really important however also very challenging when you are in this unsettling and bewildering situation of not knowing what's wrong with you. Also being made to feel the pain is in your head reflects the lack of knowledge and awareness of the condition by the Healthcare professionals.

Learn your triggers too.

Mine are the cold, mental and emotional stress.

Also beta blockers can make vasospasms worse as can adrenaline found in some local anesthetics so tell your dentist.

Caffeine

I carry printouts of the BHF information for all the healthcare professionals I encounter and they frequently take copies.

Good luck. There quite a few of us about. Doctors are human and don't know everything and you do need to advocate for yourself in this situation.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

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

mdedge.com/chestphysician/a...

[Hidden in reply to Milkfairy]

Thank you so much for the information. I will have a proper read tonight & perhaps see if I should be consulting a cardiologist with particular expertise in this area. Thank you.

[BARTLETT1965]

Get them to try u on GTN Tablets.

I've been like it since been a child over 40 years ago, like yourself all test have come back clear. I've had heart attack / stroke over 10 years ago and they still can't make up thier milk ds what's up.

But I get relive from GTN Tablets for pain and water tablets for breathing.

Good luck

Jeff

[JonathanH]

Hello,

I hope that your consultation goes well. I agree absolutely with Milkfairy that allegations that it is all in your head prove only the ignorance of the doctor who said this. You may have to face a battle with the medical profession and, since it is difficult to be your own advocate, I would recommend taking your partner or a friend/family member with you to argue your corner.

I have been diagnosed with MVA (microvascular angina) and what I understand to be your fairly continuous pain with attacks at night sounds suspiciously similar to my experiences and you may be on the right track in suspecting MVA or spasms. As you may know, peri-menopausal women seem to be at particular risk of MVA - as well as at particular risk of being poorly looked after by male cardiologists (Milkfairy previously sent me some data on this).

If you have a bad attack, it might be sensible to dial 999, since you do not know what is going on. I did this on numerous occasions before I saw a good cardiologist who started managing my disease with a calcium channel blocker (amlodipine) which was later supplemented with another calcium channel blocker (diltiazem). One benefit of calling an ambulance if you have a prolonged attack is that the paramedics may be able to take an ECG while an attack is in progress and, if you are like me, the ECG would show indications of ischemia (poor blood flow leading to oxygen deprivation). By the way, if you should see an MVA expert, he (I think they are all male) may have particular expertise in interpreting ECGs and be able to see things that are missed by other medics, so keep all your ECG printouts if you can, in case they turn out to be useful later.

One issue I have found with ECGs is that often hospital staff are not interested in or don't notice the subtle changes indicative of ischemia that MVA can bring, presumably because they are looking for more dramatic irregularities indicating a heart attack etc. The algorithms on the paramedic ECG machines were better at spotting my ischemia!

Bartlett1965 recommends GTN: GTN helps some people with MVA (Milkfairy, are you one of these people?) but GTN spray makes me feel worse, which is apparently a characteristic of one group of MVA patients. GTN dermal patches don't have any very evident effect, although when I am suffering badly I find it at least psychologically helpful to apply one - I told my GP this and she was happy to keep them on my prescription.

Sorry this is a bit of a long ramble.

Good luck.

Jonathan

[Hidden in reply to JonathanH]

Hi Jonathan, thank you for the information, as I haven't been diagnosed yet I could be completely wrong with my self diagnosis, can I ask what tests you had done to get a definite diagnosis?

I have got a GTN spray only prescribed yesterday by my GP to try and give some relief whilst I'm waiting for the next tests, so it's a bit early to say whether it's helping yet.

I am seeing the cardiologist tonight as a private patient to try and get some answers as to what's happening with me. I've had the symptoms since Christmas which seems like forever, but after the comments on here I could be with this for a while longer!!

Thanks again for taking the time to respond.

Helen.

[JonathanH in reply to Hidden]

Hi Helen,

When I said that I had been diagnosed with MVA, that was a shorthand version of a longer story, since I have not had diagnostic tests that definitively confirm MVA. But, two specialist cardiologists have confirmed that my symptoms are consistent with MVA and I am fully satisfied that I suffer from the disease having regard to my symptoms, my ECGs and my response to drugs .

Do you want to hear the full story? I suffered 10 years of intermittent disease without diagnosis but, when the disease became permanent early last year, I became frankly desperate for diagnosis and treatment. (By the way, I saw at least 3 cardiologists in this period, none of whom could say what was wrong with me). I diagnosed myself primarily on the basis of my pattern of angina and subsequently saw two MVA experts (Dr Robin Roberts and Prof J-C Kaski) who confirmed that my symptoms were consistent with MVA. So also were my responses to drugs (favourable response to a calcium channel blocker - amlodipine - but GTN made me worse, which I mentioned previously is characteristic for some MVA patients). Both cardiologists made the suggestion of further diagnostic tests but neither they nor I could explain how a definitive confirmation of MVA would benefit me and I certainly saw no advantage in a possibly unpleasant diagnostic procedure.

Along the way, I indulged in do-it-yourself cardiology by buying on Amazon a small hand-held ECG machine (a Heal Force Prince180B) and downloading onto my laptop from the manufacturer's website software to enable me to convert the ECG waveforms into pdf format. I learned of ischemic indications on ECGs like T-wave flattening and ST-depression. On one occasion, I caught the rather more dramatic irregularity of ST-elevation and my local cardiologist awarded me with an angiogram!

Dr Roberts offers at considerable expense a treatment called external counterpulsation (ECP). I have found this to be extremely helpful but I did exchange e-messages with an MVA sufferer who did not respond to 50 hours of ECP as compared to the standard course of 35 hours, so it doesn't work for everyone. I sometimes felt extremely unwell with all kinds of strange symptoms before the ECP and, though I remain symptomatic, the improvement I experienced was life-transforming. Evidently you would need your own money or insurance to access this treatment. My understanding is that ECP is notionally available on the NHS at a unit in Bradford but it isn't NICE-approved and I can't see a cash-strapped ccg (assuming you are in England) paying for it.

My experience of seeing consultants privately has been mixed, to say the least, and I hope that you will have (had) a good experience.

In adversity, believe in yourself and believe in the pain that you feel, as nobody is in a position to deny it. Come to this site to rant or to receive support and advice.

My very best wishes to you.

Jonathan