I’ve been back to my GP as I was put on Bisprolol for a high heart rate by cardiologist after echo (heart scan fine) but 24 hr ecg showing high hr and a couple of abnormal ecgs. I went back as I’ve been having chest pain & shortness of breath after too much activity, getting cold or in the evenings. Anyway the chest discomfort worse since the bisprolol so we’ve agreed for me to try ‘pill in your pocket’ he’s ordered lung function test but he says third option is to try anxiety medication. Now (in my opinion I’m not anxious) I understand anxiety & differences with stress (I’m a psychologist and I know that doesn’t make me immune) but his argument was if I don’t take anxiety medication to see if my symptoms alleviate then how will I know for sure. Im unhappy at the notion of the need to medicate to rule out as a means of working through the list of possible causes. My question is I’m I being too resistant or is the GP being sensible? When I brought up microvascular angina (as I present as normal bp, low bmi, clear large arteries etc) he just said there are medications but they make you dizzy?? And wasn’t really interested in my thoughts on it. My heart rate has jumped up again as well as being on ‘pill in my pocket’ so that is a worry in itself! Thanks for your time
Advice on ruling out anxiety - British Heart Fou...
Advice on ruling out anxiety
I would want doctor to rule out any issues with my heart before he pinned your symptoms on anxiety. If you've had only an Echo and 24 ECG I would wasnt an imaging test that would identify any perfusion abnormalities. Anxiety can cause our heart to behave erratically, but with the SOB and chest pain I would want further testing, especially if I was older as many on this forum are.
Thank you for your reply, I had a look at the test you mentioned thanks. I feel like I’m not a big concern medically as my main arteries are clear and although I’ve had abnormal ecg I have a high heart rate so that ticks that box so ‘move on’ but I never went to see a doctor originally about my heart rate but actually heart spasms and discomfort. My ecg queried ischemia (st wave depressions etc) on at least 2 ecgs which does still worry me.
I decided to try and ignore everything but that’s only lasted 3 days as symptoms are still present.
I honestly feel like I have to solider on and wait to get worse before I’ll be considered for any more tests which surely is bad medicine....
Please do consider non obstructive coronary disease.
It is poorly understood and recognised. Many Cardiologist have a very limited awareness that you can have myocardial ischaemia and clear coronary arteries. I do!
Be prepared to be persistent doctors are human and cannot know everything.
Ask for a second opinion from a Cardiologist who is more open to discussing MVA or willing to learn more about the condition.
There's lots of information on the BHF website about non obstructive coronary artery disease commonly called Microvascular and vasospastic angina ( coronary artery spasms).
Hi Qasim_Raza
I can not say whether your Cardiologist is right or wrong.
However it is possible to have a type of angina with clear coronary arteries.
Microvascular angina effects the smallest blood vessels which are difficult to see all the conventional tests look for problems in the large coronary arteries.
It is a poorly recognised and understood condition and your Cardiologist may have no knowledge of the condition.
It is important that this condition is excluded.
Will your Cardiologist acknowledge information from the BHF website?
Perhaps printout the BHF information leaflet about MVA and take it to an appointment and ask to discuss this with your Cardiologist.
bhf.org.uk/informationsuppo...
bhf.org.uk/informationsuppo...
heart.bmj.com/content/104/4...
Good luck
I would want to know exactly what abnormality the ECG showed & would want to see the cardiologist again. Do you have copies of these ECG’s to take with you? Always ask for copies in future. I was given mine as a matter of routine (i.e. I didn’t have to ask) at A& E when diagnosed with AF & told to keep them & take to any future appointments.
I would be as concerned as you are at the route your GP is going down. Is there someone else you can see at the practice?
Take care
Pat x
Thanks for replies, yes I made got change doctor if I continue to have symptoms, will have the lung function test and see how stopping meds for ‘pill in your pocket works’ first.
My ecg that I saw recorded ‘ possible lateral ischemia’ and ‘possible inferior ischemia’ my GP at the time said it suggests left side reduced oxygen in the heart. He said the same as my last one 2 weeks earlier but no one told me. This was a couple of months ago now but still having same symptoms and now only taking bisprolol when I have a bad symptoms....so not very satisfactory or reassuring.
I think relaxation techniques good for all with pace of modern life, anxiety is different from most stress and I am confident I don’t have anxiety problems.
Have you thought about a one off private cardiology appointment? It would cost £150-£250 depending on who you see. You can ask for all results from tests you have had & take them with you. Peace of mind at least? Don’t have any tests privately though- exorbitantly expensive!
Pat x
It might be something I’d consider but from what the experts on here share suggests to me that the more specific tests that other conditions consider are probably too Expensive for me.
But I suppose a second opinion and reassurance might be worth an initial consultation, thank you.
Perhaps ask them if they have any knowledge of Microvascular or vasospastic angina.
Whatever the cause of your pain learning to manage anxiety is really important. Have you considered finding someone to help you manage your anxiety?
Some people find approaching how they respond to their feelings helpful -Cognitive behavioural therapy this is a technique used by psychologists when helping people to live with long term pain and anxiety.
Other strategies are meditation, tai Chi, Yoga, exercise and using breathing, visualisation and relaxation techniques.
If necessary some medication can be prescribed too.
I hope you feel more at ease soon.
I,personally, think that most GP's are too quick to hang the anxiety label on everyone. I felt unwell for a year but with no specific symptoms.However, I knew there was something wrong with me so I persisted. I had never been ill in my life. Finally, I presented with some symptoms, a family history of heart disease & very quickly referred to Cardiology. I now have 3 stents since February & absolutely no follow up.My GP mentioned anxiety at one point but I soon shot her down in flames. Told her if she put me in a room with 10 friends & asked who was the most laid back, they would all point to me! The problem is most Doctors don't actually have time to listen to you. Please continue to be persistent.
I agree with Catwumman about GPs reaching too quickly for the anxiety label. Although I do accept from personal experience that if you are anxious it can create havoc with your symptoms.
I thought that bisoprolol is supposed to calm everything down anxiety-wise. You've already tried that and it doesn't help.
That’s a really interesting point! When I looked up anxiety medication it was there so it did cross my mind why is that not helping if my issue also anxiety based. The doctor knows I don’t agree with him but it seems to be the fall back position... I wouldn’t never make a fuss either hate going to the doctor, really don’t want heart issues on medical records for all the obvious reasons, I just want to feel like I did and move on or understand why I’m feeling these things and be reassured I’m being correctly medicated etc. Thanks for reply
Beta blockers can make vasospasms worse in particular coronary artery spasms.
Do you feel the beta blocker you have been prescribed maybe making your chest pain worse?
I ended up in CCU because I was prescribed beta blockers by a well meaning Cardiologist.
It is for this reason that I suggest you seek a second opinion to exclude microvascular or vasospastic angina.
You may need to travel as there are precious few Cardiologists who are experts in these conditions.
I was originally diagnosed by a very astute and clever Cardiologist who listened well to my symptoms.
It doesn't necessarily mean lots more tests it requires an open minded Cardiologist who can look beyond the usual causes of chest pain.
Dunestar has such a Cardiologist as I do.
I also have a copy of all my ECGs too.
The last time I was in hospital the nurses did several ECGs one after another and were able to pick up the ischaemic changes that took place when I had a episode of chest pain.
I hope you find the answers soon. The uncertainty of not knowing why you have your symptoms along with those responsible for your care also appearing not to listen to you is well frustrating to say the least!
Hi, yes my symptoms of chest tightness and bouts of pain seemed more frequent on beta blocker but not had any meds since last Thursday but I’ve started now with tightness that’s stopping me from working (desk work) and I’ve had to lie down so just taken one as pain starting...see if it helps....this can’t be normal! And I’m not stressed .....
heart disease and anxiety, why no anxiety at all until about 9 months after the heart event? 
bisoprolol 
Bisoprolol versus pill in pocket!!!
Myocardial Bridge 
bisoprolol and anxiety 
