DOBUTANINE STRESS ECHOCARDIOGRAM

[Red18]

HI having this stress test done tomorrow to see if I have microvascular angina. Has anybody had this test and more importantly did it show up the presence of microvascular angina? I have reason to believe that this type of angina is very hard to diagnose. Many thanks all

[Yildez]

Had this test done today, and thankfully, they got good pic and info, but from what the cardiologist and radiographer said thankfully came back clear

[Red18 in reply to Yildez]

Hi Yildez. So if test came back clear then if you are like me with pain across throat and indigestion type pain in chest what could this pain be down to? Btw good news!

[Yildez in reply to Red18]

I have not had chest pain my go referred me for light headedness to rule anything out, then my go said I needed to see a cardiologist, just had the worse 6 days of my life, but had tests done today, and there’s nothing they can find, so said no more further investigation, very mild hf.not upping my Ramipri from 1.25 . Or statin. Been tol to watch my diet, and do exercise, even though I am active, I don’t exercise. I feel so relieved. But good luck

[Red18 in reply to Yildez]

Well done you! Having tests done are always worrying..... Brill news for you

[Yildez in reply to Red18]

Thank you so much, hope you get a good outcome tomorrow . I was i nervous reck

[Red18 in reply to Yildez]

I hope I do too... I have been told that microvascular angina is very hard to diagnose. Not that I want angina!! But I suffer with indigestion type chest pain on and off usually after eating or when cold. Also pressure felt across my throat sometimes. It is very worrying indeed. I'm very nervous

[Yildez in reply to Red18]

I can honestly say the test is not bad at all, and if you get a excellent radiographer, like mine, and consult, they talked me through everything, plus gave there clear findings straight away, they did say they would take a closer look later, but there was nothing they could see

[Red18 in reply to Yildez]

Hopefully tomorrow good for me. Thanks for replying

[Healthyheart1 in reply to Red18]

Good luck Red18 👍

[Milkfairy Heart Star]

Hi Red18

Good luck for your test tomorrow.

You are spot on Microvascular angina can be very elusive and difficult to diagnose.

It depends whether your small blood vessels can dilate in response to extra demands such as exercise.

Most of the tests are designed to pick up angina due to permanent blockages so pretty poor at picking up MVA.

I had a very specialised angiogram which showed I have spasms in my coronary arteries and microvessels so vasospastic and microvascular angina.

I get most of my pain at rest.

A good Cardiologist should be able to diagnose MVA by listening well to their patients symptoms. It is then trial and error to find the right combination of medications.

It great that your Cardiologist is acknowledging that MVA is a real condition many don't!

Good luck with the test. The drug they give you speeds up your heart rate which can feel uncomfortable but the staff will talk you through everything.

[Red18 in reply to Milkfairy]

Hellooooo Milkfairy. Had dobutanine stress test done today. Was weird feeling you're heart bounding.. results came back everything ok. I did mention that possibly microvascular angina to blame for discomfort he replied when you see the cardiologist he may well diagnose you on symptoms alone so that I have no more radiation exposure. Do you know if the heart could be getting damaged by the microvascular angina (if it is that) if it isn't being treated?? Thankyou

[Milkfairy Heart Star in reply to Red18]

There is growing evidence that Microvascular dysfunction leading to microvascular angina may cause other heart problems.

It is good that Microvascular angina is recognised at the hospital you are receiving your care.

The awareness of the condition is growing.

[Red18 in reply to Milkfairy]

Yes it is. I can go maybe 9 days and have no symptoms whatsoever. I find when I'm in the cold and at work it can effect me at times. I am following a mainly plant based diet and have lost 2 stone. Go walking quite a lot after work and have found a little improvement. Just wondering when I go back to see cardiologist if I should take meds if offered for microvascular angina or see if with diet and exercise it will get a little better?

[Milkfairy Heart Star in reply to Red18]

Hi it's great that you are exercising as this does help with MVA.

If your angina is affecting your quality of life it may well be worth considering possible treatment.

Most medications used are to help the blood vessels to relax.

I got the message loud and clear from my Cardiology Prof that I must avoid developing Coronary heart disease too.

Keeping your weight down, care with your diet, keeping your cholesterol levels low are all really important. You have done alot already.

Learning your triggers and managing stress are a good idea.

I have over the time gradually increased my exercise capacity so keep walking!

[Red18 in reply to Milkfairy]

Well done you with the walking. Why did professor say not to develop coronary heart disease too? Obviously nobody wants too but I just wanted to query

[Milkfairy Heart Star in reply to Red18]

Because it will increase the risks of a heart attack even further for me.

A permanent blockage with coronary vasospasms could lead to a clot forming or a rupture or erosion of plaque.

I take statins and chlopidogrel to help prevent this along with calcium channel blockers to help prevent spasms.

I do however live with spasms in my large and small vessels.

[Red18 in reply to Milkfairy]

Thankyou for reply. I do have coronary heart disease. Have no stents. Have a 70% blockage in LAD. I am truly worried as I have a disabled daughter. That's why I do focus so much now on my diet and exercise. I have never smoked,took drugs or even drank really. But diet admittingly was dire! Now all change. I do try and stay positive as I see it as a big massive wake up call.

[dunestar]

Good luck with the test Red18. I was dreading mine but it wasn't too bad. It will undoubtedly give your team more information about what might be going on. However I don't think it can by itself show a diagnosis of microvascular angina, which as you say is difficult to diagnose.

I had a stress echo which was interpreted as "fairly global ischaemia", so the thinking was my main coronary arteries were in bad shape. But when it came to the next step of an angiogram, lo and behold, they were clear apart from mild atheroma in one artery. Only at that stage did the diagnosis of microvascular angina hove into view. So the stress echo results can be misleading.

The diagnosis of "probable microvascular angina" was made by the interventionist cardiologist on the basis that the state of my main arteries could not explain the ischaemia, so the problem is likely to lie with the micro vessels. This was confirmed later by a consultant who specialises in the condition.

[Alison_L in reply to dunestar]

Thank you, dunestar, for saying the test wasn't too bad. I've got one on 23rd May for mitral valve regurgitation and blocked arteries, and am getting so stressed about it that they won't need the dobutamine!

[Milkfairy Heart Star]

Ah that depends whether the lining of the blood vessels are playing up.

Microvascular endothelial dysfunction.

Some blood vessels fail to dilate others constrict instead.

Our favourite Glasgow Cardiologist believes there is a relationship however some people just have MVA or VSA a minority. They are discreet but in some cases related by the same underlying disease process.

The endolethlium is a very important organ it regulates the function of the blood vessels, producing all sorts of chemicals including platelets, nitrates and many many more. It is very precious being effected by pollution, smoking, diabetes, inflammation, rheumatoid arthritis and other autoimmune diseases.....I could go on....

[Milkfairy Heart Star]

Let's throw altered pain perception into the mix too!

You can have a silent heart attack, we all feel pain in a different way.

If you have chronic pain you develop a super speedy nerve pathway. Any slight spasm or change in blood flow will trigger a pain signal to your brain it travels faster and signals pain more easily and intensely

I know the difference between the pain in my large and small vessels. I felt my typical chest pain when they saw my ST elevations. I feel the classic angina pain with upper back pain. Pressure breathlessness. Pain in my lower left ribs

My other pain feels like a cheese wire cutting through my upper chest that's my microvessels which show up as T wave inversions on my ECGs.

All my pain is at rest in the evenings and into the wee hours and then a rude awakening in the early morning.

[Milkfairy Heart Star]

Diabetes is associated with endothelial dysfunction and increased the risk of Microvascular angina.

I do not have coronary artery disease my coronary arteries are clear.

I do not have pre diabetes or diabetes my HbA1c is 3.6, BMI 21.

I am just unlucky to have developed microvascular endothelial dysfunction.

Pollution? Stress? Genetic? Bad luck?

Who knows?

[Milkfairy Heart Star]

I do not have coronary heart disease!

Forgot to mention waist 28 inches

My fasting blood sugar normal.

[Milkfairy Heart Star]

We will have to agree to disagree.

I relay on peer reviewed research of substance and of robust scientific vigour.

Not all heart conditions are due to insulin resistance or diabetes which you seem to imply.

I agree avoiding sugar, eating a balanced diet exercising etc and taking responsibility for our well being is important.

A child born with a structural problem with their hearts or women who develop pre eclampsia during pregnancy have heart conditions unrelated to diabetes.

Other peoples hearts are damaged by chemotherapy, infection, valve damage, aortic aneurysm, clotting disorders and autoimmune diseases nothing to do with diabetes.

I live with disorder of my blood vessels which mean my risk of a heart attack, stroke and heart failure are increased.

I have no plaque lining my arteries my cholesterol normal no clinical indications of insulin resistance. I do not have coronary artery disease.

Time I believe for us to end this discussion.

[MichaelJH Heart Star]

A number of people that are not overweight are diagnosed with Type II diabetes as it is a convenient label. A friend (6' and 12 stone) became quite ill because of inappropriate treatment (ever increasing doses of Metformin) until a proper diagnosis of Type 1.5 was made and insulin treatment started. He is now 70, fit and works out regularly.

When I developed angina and subsequently needed a bypass this was blamed on my diabetes (Type I over 50 years) by some medics but once I saw cardiologists it was agreed it was hereditary (all males on the make side dying of HAs prematurely) and diabetes was a complicating factor not the cause. The various types of heart disease are extremely complex with no one cause. Sweeping statements are unhelpful!

[Deanosbeano]

I'll be honest I think some hospitals use this test to justify the expense of the gold standard angiogram .

I had the stress and at rest gets before angiogram, not sure what the film they take with the scanner takes for 30 minutes doesn't show that the angiogram does but I had no feedback about it was just old to go for the angiogram a month the later

The cynical me says it's a waiting time beater for the correct path from ECG -Angiogram to operation in my case the trust is known to be skint and has a poor reputation

[Milkfairy Heart Star]

No, fasting blood sugar very low.

Random blood sugar good.

Glucose tolerance test normal.

No insulin resistance here.

[Milkfairy Heart Star in reply to Milkfairy]

Reasonable surrogate marker for insulin levels though😉

[nilmonisikdar40]

I have not heard about this very upto date echo test either as a patient or as a G.P. I had many ECHO done in the past with the ejection factor being the important factor. It sounds like a myoview scan involving injecting a dye and taking a scan along with measuring the left ventricular function. I don't thing you have anything to worry about. Would be exciting to know the results. Good luck.