Pre Angiogram Symptoms: Hi everyone... - British Heart Fou...

British Heart Foundation
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Pre Angiogram Symptoms

Hi everyone. After having two perfusion scans last month I've had a letter from the hospital today to say I need to have an angiogram as there is a possible problem with the blood supply to my heart.

I've had various symptoms since January, mainly palpitations, pain between my shoulder blades, chest discomfort as if someone is pressing on my chest, throat discomfort like something stuck, also a feeling of my windpipe being squeezed, especially when I lie on my back or left hand side so I'm not sleeping very well at all. I had an endoscopy a few weeks back to check for throat and stomach problems but it came back clear.

I can't say I actually have chest pain, just discomfort. I always imagined if there was a heart problem then the pain would be quite bad. Even the cardiologists said it doesn't sound like angina. I do get crampy like feelings on the left side of my chest and back, similar to if you've been standing or lying in one position for too long. My heart feels like it's racing most of the time, worse after eating or exercise.

Are these the sort of symptoms that other people have had when referred for an angiogram or is it usually bad chest pain? After going backwards and forwards to the Dr and hospital these last six months I was beginning to get the impression that perhaps it was stress causing my symptoms, the cardiologists I saw definitely weren't concerned. Now it seems perhaps there is something more serious going on. Trying to sleep is the worst, feeling like your throat is closing up is really scary. Does anyone else get this or is it just me?

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Those sound exactly like my symptoms! No specific chest pain, weight on my chest, throat closing up. I too had an Endoscopy which was clear. Exercise ECG clear. Eventually had Angiogram which showed blockage in two arteries. I now have 3 stents in situ.

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Hello,

I am sorry that you are going through the mill like this.

I think it possible that you have microvascular angina (MVA), where the blood supply to your heart is reduced by the small blood vessels not functioning properly. I suffer from this condition and experience pretty much continual chest discomfort that often peaks at night, often accompanied by feeling short of breath. It is characteristic of MVA that the angina arises or worsens after exercise (rather than during exercise). I experience palpitations and, until I had some treatment, I had a lot of other unpleasant things going on, including gastrointestinal problems for which I had a gastroscopy and an endoscopy. I haven't experienced all the pain that you have, especially not the throat problems, but we all experience heart problems differently.

MVA affects small blood vessels that are not visible via an angiogram, but there are tests for it. That said, you do surely need the angiogram to check the condition of your arteries. Unfortunately, it seems that some cardiologists don't even think that MVA exists and you may need to see one of the very few specialists in the disorder.

MVA should at least sometimes cause subtle changes to your ECG indicating ischemia (reduced blood flow resulting in an inadequate oxygen supply). Unfortunately, it can be difficult to catch the ECG changes, since they are intermittent, and my experience is that hospital staff far too often ignore or overlook the changes - presumably because they are too small and not the sort of things they are normally looking for. I highly recommend that you keep copies of all your ECG in case there comes a time when an MVA expert can look at them.

It took me 10 years to obtain a diagnosis and, needless to say, along the way I was told more than once that I was suffering from anxiety or, at least once, from a panic attack. I have a suspicion that almost every other MVA patient has been accused of suffering from stress or anxiety and, indeed, stress is likely to worsen the condition. Things like stress and anxiety are diagnoses that doctors reach for when they can't find anything else wrong.

Well, I don't know that you have MVA and your angiogram might reveal an arterial obstruction. However, if the angiogram reveals no obstruction and your symptoms continue, it is in my view a possibility worth investigating. There is information on the BHF website:

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

If you have MVA, it is likely that a calcium channel blocker such as diltiazem will help: it might even be worth asking your GP to try prescribing it. When I have a few minutes, I will hunt down a link to one or two publications mentioning calcium channel blockers and send them to you. GTN provides some MVA patients with relief but I find that it in fact increases chest pain and have been told that this is typical for one group of MVA patients.

Do please come back to this site if you find yourself in need of more help and support.

Best wishes

Jonathan

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Jonathan

You don't need an expert in MVA to look at your ECGs to diagnose MVA.

My world expert Prof never looked at one of my ECGs in all the years he was my Cardiologist. He agreed with my local Cardiologist's diagnosis by my symptoms alone. I had an angiogram with acetylcholine which confirmed my coronary vasospastic angina.

An ECG is just a single moment in time a snap shot of what's happening. By its self it cannot be used to make a diagnosis. It requires a skilled and knowledgeable Cardiologist to interpret an ECG properly. Many experienced nurses working in CCU can be better than the medical staff in this task.

During my last stay in hospital the Cardiologist on call decided to overlook my ECG changes. The nursing staff thought otherwise.

The nurses took consecutive ECGs when I had a vasospasm this showed an ECG shift my T waves flattened, inverted and then ST depressions developed.

We called the Cardiologist back to look at these ECGs and he then acknowledged the ischaemia.

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Thank you as always for your wisdom. As you will have inferred, events took a slightly different course for me.

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Hi Jonathan

There is going to be an article posted in bmj heart soon about the recognition, description and diagnosis of Microvascular dysfunction.

The authors are hoping this article will help their fellow Cardiologists to gain the knowledge they need to spot us 'unicorns' in fairyland

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That is good - thank you for letting me know. You have excellent connections.

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I am sorry you are living with the uncertainty of not knowing what's going on and the lack of communication from the hospital is not helping.

It is very understandable for you to feel anxious.

Angina can affect people in different ways.

Someone recently said the only symptoms they experienced was pain at the back of their tongue and jaw.

Perhaps make an appointment to see your GP as they should have received the results from the hospital.

It is for the healthcare professionals responsible for your care to diagnose your condition and advise you about any treatment you may need. However sometimes as a patient you do need to be persistent to get the answers.

I hope you get your answers soon.

Good luck.

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Many thanks for your replies, very interesting to hear your experiences. Thank you so much for the links re MVA Jonathan, I shall look at those as soon as I get home. Just been to the Dr's, the hospital letter suggested I start taking aspirin, atorvastatin and bisoprolol while I wait for my angiogram so I went to get a prescription first thing. Dr doesn't seem concerned and said there's a slight chance of blocked artery so they need to investigate but it may come back clear. I got the impression he thought taking the statins and beta blockers was overkill lol. Maybe it is but the way I feel most of the time I'm glad to be taking something that might help.

I wonder what happens if the Angiogram is clear? Do I just have to accept I've got these horrible symptoms for the rest of my life. Ew. 😞

I really appreciate your replies guys, ty xx

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If you continue to have your symptoms and your angiogram shows no major blockages then it will be time to look beyond the blockages and consider non obstructive coronary artery disease such as microvascular or vasospastic angina.

Perhaps cross that bridge when you come to it though.

Here's a more upto date link from the BHF website

bhf.org.uk/informationsuppo...

I hope you feel more at ease soon.

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Ty Milkfairy 😘

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As others have said angina can manifest in many different ways. I have a diagnosis of microvascular angina and I give thanks that I never have chest pain or discomfort at all. Just breathlessness on exertion. Yet my stress echo showed "fairly global ischaemia".

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Hi dunestar

Can I have your flavour of angina please?

I am off to have a another perfusion MRI soon, last one was 5 years ago. I am not looking forward to the adenosine hit😖

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Well, yes, sometimes I feel a bit of a fraud when I read on this forum what others, including yourself, go through. Very best of luck with the MRI. Hope it's not too awful.

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Just wanted to say thanks again Jonathan and Milkfairy for those links. Very interesting. I wouldn't have known about MVA if you hadn't told me. I'm quite surprised that I've seen three different cardiologists at hospital and not one of them has mentioned it. As you say, if the angiogram is clear at least I know that MVA may be a possibility and I can bring it up afterwards with my doctor if need be.

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I had a weird feeling in my throat and a tightness in my chest etc . I felt dizzy at times too . In hospital a few cardiologists said to me that it did not sound like I had a heart condition . My ECG was normal too . But my blood tests were conflicting to what they thought. I had an angiogram . They discovered that I had an LAD which was severely blocked . I had a stent.

I was also told that I'd had a heart attack! I had no idea ! I don't even know when I had it !

So one just doesn't know when it comes to the matters of the heart! Keep an eye on yourself. If you feel very ill call your GP or 111.

I hope everything is sorted out and your angiogram goes well .

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My mom knew someone many years ago who had a heart attack and didn't know a thing about it until he was in the hospital for something else and they told him....he said no i haven't lol. Thank you for your good wishes and sharing your experience, I hope you are feeling much better since having your stent.

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So there's more people like me ! Lol! What you wrote about your mum's friend not believing he'd had a heart attack made me laugh as I had the same reaction ! I kept insissting that I hadn't had a H.A !

Thank you also for your kind wishes and responding to my message. I was expecting to feel wonderful after my stent but it hasn't happened yet ! I'm still hopeful :)

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Yes it's amazing isn't it. You'd think you'd definitely know if you're having a heart attack. Learning a lot from this forum, unfortunately some stuff is quite worrying re misdiagnosis, not being diagnosed at all etc. Glad I know now though, forewarned is forearmed.

Sorry to hear your stent has not helped yet, hope they get you sorted soon.

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Yes you're 100% right ! It's amazing and weird ! So maybe I won't know if I have another heart attack, which is a bit scary !

Misdiagnosis , not being diagnosed is worrying. The Cardiologists in hospital wanted to give me an angiogram as an outpatient , just in case I did have a heart problem. If they'd done that I could have dropped down dead anytime with a major heart attack ( because of severe LAD blockage ) . So after the 1st angiogram the docs kept saying how lucky I was to be alive. But I didn't feel lucky ! Lol!

What you're doing is the best thing ie by finding out as much as you can about angiograms , heart conditions etc .

Thank you so much ! Maybe in some people it takes time for the stent to settle? Dunno! Finding it impossible to get onto the Cardio Rehab too!

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Hi,

We all expect from previous adverts that a heart attack will make you clutch your chest and drop to the floor etc. Women can have a more subtle set of symptoms. However, I think we often downplay what's happening or don't believe it. It ridiculously did not occur to me I could be having a heart attack at 42 I could only think I wasn't having a stroke. The pressure pain down my left arm, elephant on my chest, nausea, breathlessness, cold clammy and sense of doom. Stupidly I didn't even Google my symptoms so I delayed seeking help for about 8 hours. I finally called the out of hours GP. I was lucky my outcome isn't worse as I didn't take it seriously enough at the time. We need to make more people aware of heart disease and how it affects people. It could save lives.

Hopefully they find the reason why you are having your symptoms but at least you are building up your knowledge. What the others have written is great you can consider if it applies to you if not search more. You can then ask more pertinent questions to the Cardiologist. Ask them could it be MVA or Vasospasm when they do it? My first angiogram he ignored it!!! Even though it kept getting stuck I could tell him where it was...very traumatic and alot of pain that he ignored. Second time I asked for the happy juice and it was fine and he diagnosed me properly.

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Hi Nicky 3

You are so right.

During my first angio 7 years ago I kept telling them I was having chest pain.

Nobody believed me they kept telling me it wasn't possible as my coronary arteries were clear!

They ignored the ECG changes too because again my arteries were clear so not possible.....

Women have different symptoms and almost 50% have their heart attacks initially misdiagnosed. We are anxious having panic attacks etc

Yes, lots of toad kissing required to find a the right Prince of a Cardiologist we are still so special😉

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What does an angiogram feel like? I read that once the tube was in that you couldn't feel anything but after reading your accounts it sounds horrible. My mom has had a couple and said it was fine but tbh nothing fazes her anyway, whilst I'm a complete wimp! They always have problems finding a vein big enough when I have to have a catheter in my arm....I usually come out looking like a pincushion. Is it true you can have a sedative? Feeling a bit anxious about it now.

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Having had umpteen angiograms over the last 20 years or so I was nervous with the first one - the Doctor at that time suggested I watch it on the big screen and being fascinated by thing like this readily agreed. It took my mind off the procedure and the 20/30 minutes passed very quickly. Recent ones I just take in my stride, the staff constantly monitor you and ask if you are OK.

Sedation would just relax you a little rather than send you to sleep. It is a very common procedure these days, it being like a factory production line.

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Hi GMyog,

They didn't give me any sedative or pain relief but lots of GTN for the first time whilst having the first angiogram. I was having spasms but I didn't know what was going on. It kept getting stuck because of the spasms and I had a very unfeeling Dr. However, I now know about why (spasms) and I know about sedation which I didn't before. So my lovely Cardiologist promised me on my second one he would give me the happy stuff. I did spasm alot during the second one but I had wonderful Midazolam (I think it's called). I don't like Morphine etc or take drugs other than prescription but I have to say that stuff is amazing. He could have told me he was going to chop my arm off and I would have agreed. I didn't feel out of control just happy drunk like best night out! God knows I hope I didn't embarass myself?! Don't worry forewarned is forearmed you know to ask. I have met many others without pain relief say it was not painful at all. It is just that it sets off spasms in my arteries which isn't the case for alot of people. Just special ones Unicorns and all that!!! So the first Dr was an unbeliever! Good luck don't worry and tell them if you are nervous they can't mind read.

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Yr the second person I know who’s said that. That they spasmed during a routine angie. So it makes the job easier for the cardiologist to diagnose you with CAS or VA, because they can see it on the screen. Because if not it’s like searching for a needle in a haystack 🧐

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Had letter from hospital today to say my angiogram is on 2nd July. Got my pre op tomorrow morning. Quick question....what do they do at the pre op? Is it just questions, height, weight blood pressure etc or do they take blood and urine too? And if they do take blood, what are they looking for exactly? Do heart problems show up in blood tests? Sorry for all the questions and ty in advance x

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That's great news! Sorry know nothing about outpatient pre angiogram prep! I know that normally other ops, pre-op they take blood and urine tests.

Yes they can tell if you have heart problems through your blood test. They are looking for troponin levels in your blood. High troponin levels are not good. They can tell if you've had a heart attack through troponin levels. You can google troponin levels ! Hope that helps a bit !

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Ah OK, I didn't know that I will do some research thank you.

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You're welcome !

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Just an update on my angiogram which I had on Tuesday. My arteries are clear, apparently some very minor atheroma in the proximal right coronary but consultant said it was hardly worth mentioning, everything looked great. She said to carry on with the beta blockers and aspirin as secondary prevention.

So that's me back to square one. The consultant said I should be happy that my arteries look so good at my age, I asked her why I am getting my symptoms and she said sometimes people do and they never find out why. She also mentioned not being able to see the smaller blood vessels on an angiogram which can cause problems sometimes but she didn't seem the slightest bit worried or suggest any further investigation. I can't understand how my perfusion scan showed the possibility of a problem but now I've had an angiogram showing no problem and basically been discharged.

In the meantime, since taking Bisoprolol, I no longer seem so aware of my heart beating as I was before so that's an improvement. But I still have the pain in my throat and indigestion like pains in the middle of my chest, pain across my shoulders and sleeping is a nightmare. All night long I seem to be waking up every few minutes, sometimes with a snort, sometimes with a sharp intake of breath, sometimes I just wake and don't know why. My lungs feel like they're being squashed most of the time and it's so difficult to get comfy.

I know I should be grateful that my arteries are good and I am, it's just getting me down not knowing what's causing my symptoms. I don't know if it's worth going back to the doctor, I've had extensive tests over the last 6 months and I'm still none the wiser.

Is it worth pushing for a CT angiogram? Can that show the small blood vessels as well as the main arteries? I read up on microvascular angina but I'm not sure how they actually diagnose it. I'm worried the doctor is going to think I'm a hypochondriac. Maybe I have sleep apnea, I don't know if that causes throat and indigestion like pain but my constant waking feeling like I've stopped breathing fits the bill. I have told several doctors about it, one even said it sounds like sleep apnea but didn't suggest further investigation.

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Hi

It can take time to find a Cardiologist who understands and recognises Microvascular and vasospastic angina. I am sorry that you are having a problem accessing the care you need.

It reflects the lack of knowledge about the condition by Cardiologist about MVA and Vasospastic angina. Many Cardiologists manage the challenge of not knowing by pretending a problem doesn't exist.

As others have said it is like asking them to believe in unicorns in fairyland.

I suggest you ask for a second opinion from a Cardiologist who has some understanding of MVA or is willing to learn about the condition.

My Cardiologist and I have learned and worked together over the last 7 years to find the best treatment for me.

I also see a Cardiology Professor who is a specialist in London who acts as an advisor.

I suggest you printout the BHF information from the website and this article by Prof Colin Berry's team in Glasgow he is a BHF funded researcher and is actively researching into MVA and vasospastic angina. Take them to your GP or to your next Cardiology appointment. This condition is complex and not something most GPs can manage on their own.

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

You know your body best and yes it is absolutely okay for you to ask for the care you both need and deserve.

Living with pain and the symptoms you are experiencing do need to be investigated properly. This is having an impact on the quality of your life.

If you need anymore research articles I have plenty more.

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Thank you Milkfairy, I don't have another cardio appointment but I'm sure I will be going back to my doctor soon so I will have a chat with him and see where we go from here.

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