Is it possible to have a normal stress echo and still have arterial plaque sufficient to cause chest discomfort?
I have had persistent heaviness in central chest area since my GP withdrew propanalol which I had been on for one month (10mg), tapered to 5mg for a week then stopped (end of February).
I then experienced awful persistent palpitations and high BP 165/90 for about a fortnight even though I restarted the Propanalol at 5mg. I had a normal stress echo a month later and normal blood tests. I saw a cardiologist privately and told him of the chest discomfort but he said my heart was fine as stress echo was fine and blood tests were normal. He thought it may be rheumatism. He switched propanalol to bisoprolol 1.25. I'm 49 and exercise frequently. The discomfort is a dull heaviness and persistent. It's not worse with exercise but i haven't been able to exercise myself as much as I used to. The discomforting seemed to come on after the beta blocker was stopped. Has anyone had anything similar? I have heard that stopping beta blockers can cause angina.
I am seeing cardiologist again under the NHS in a weeks time. I don't want unnecessary tests but I am concerned he is not taking my chest issues seriously. I saw a GP 3 weeks ago who said 'well what do you think you have?' Whilst telling me everything was fine (BP/sats). Sorry if I am repeating myself, I would like to be well prepared for my NHS appointment. Thank you.
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Caitlyn6
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Snap! I have a similar sensation most of the time. It is affected by the car etc accelerating and fast lifts. These make it feel stronger. As yet I have been given no answers. The mystery continues......
Chronic angina with unobstructed arteries may be caused by microvascular angina and/or vasospastic angina. These disorders are hugely under-recognised by cardiologists - it took me 10 years to get diagnosed.
Beta blockers might provide symptomatic relief by reducing the oxygen requirement of the heart. I have experienced palpitations and high BP, and I have found the response to exertion to be highly variable, though a delayed increase in angina after exercise seems common in MVA.
You have not mentioned a pattern of symptoms that I would regard as highly characteristic of MVA, a fact arguably pointing away from the disease, but still it remains a possibility, I believe.
I will add a more detailed comment later and the wonderful Milkfairy may do so as well.
I had similar experience, I was convinced I had angina so in spite of passing every test I persisted when I experienced real chest pain. An angiogram revealed 3 blocked arteries resulting in a bypass. Hope this is not the case with you but I shared your frustration in not knowing what it was! It was almost a relief to receive the correct diagnosis.
I think that the answer to your question is to see a cardiologist expert in MVA. Unfortunately, that is easier said than done. There is information on MVA on the BHF website:
bhf.org.uk/informationsuppo...
bhf.org.uk/informationsuppo...
bhf.org.uk/informationsuppo...
I am sure that Milkfairy on here will be in touch with you as she is a great expert on MVA. There are very few cardiologists expert in the disease, but two are mentioned on the BHF information, namely Prof Colin Berry (Glasgow) and Prof Juan-Carlos Kaski (London). Unfortunately, Prof Kaski is in the process of retiring and, whilst I believe he still has a private practice, he has retired from the NHS.
Jonathan has sent you some useful information about his life with MVA.
His links do not seem to have worked for me so just in case it's the same for you I have resent you Prof Colin Berry's Heart Matters article and the BHF information leaflet in which Prof Berry and an expert patient with a lived experience of MVA acted as advisors.
There are several different theories about the causes. In some cases it is thought to be due to the lack of the ability of the blood vessels to relax or dilate in response to exercise.
Beta blockers are helpful in this group of patients.
There are larger heart units in the UK such as Glasgow, Liverpool, Oxford, Cambridge, Bristol, Royal Brompton Hospital and St Thomas's hospital London that have Cardiac MRI scanners that can diagnose this type of MVA.
In others it is due to spasms in the small vessels.
I live with coronary vasospastic angina, my microvessels and coronary arteries go into spasm causing angina. Beta blockers can make vasospasms worse.
My VSA was diagnosed by a very specialised angiogram only performed in a few places in the UK.
Most people have either MVA or Vasospastic angina/ coronary artery spasms some like me unfortunately have both.
Perhaps printout the BHF information leaflet and discuss this with your Cardiologist. Unfortunately MVA is poorly understood however it is important to find out why you have your pain.
I hope you are able to find the cause of your pain soon.
It can be frustrating and a cause of anxiety not knowing why you have chest pain without explanation.
Thank you. I will certainly look up the details. I am confused as to why this came on after beta blocker withdrawal but cardiologist did not relate the two events at all.
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