Not sure what’s wrong

[Madparent007]

Hi all, I’m 42 female, normally healthy and fit. I had what seemed like a heart attack 4 weeks ago, I was not long awake been in shower and the chest pain hit and radiating up to my jaw, I went into a&e by ambulance they did ecg’s and bloods and chest x Ray all normal so they discharged me. Then 2 nights later I woke up from sleep clammy, sweaty palms and chest pain radiating up to my jaw again. This time they said it looked like ‘unstable angina ‘ my troponin level had raised to 2 which is nothing but still more than before, I was admitted to coronary care unit where I had regular ecg’s, echocardiogram which showed slight mitral valve and tricuspid valve regurgitation and sinus bradycardia. They weren’t worried about that. Gave me a CT angiogram which came back normal. I tried walking around the ward I was breathless and ended up getting chest pains again the only thing that takes the pain away is the GTN spray. One of the cardiologists mentioned it could be Microvascular? Eventually after 6 days they discharged me with no diagnosis - possible gastric spasms and I’m now left in limbo. I’ve since had a dull ache and chest pain nearly every day now. I’ve been back to my GP who has sent in an urgent referral back to cardiology but it’s not for another 8 weeks!! I’m at my wits end and worried that they’ll just discharge me again with no answers. After reading about Microvascular angina it sounds like I have it but if it’s difficult to diagnose or cardiologists refuse to acknowledge it, where do I go from here?? Any advice would be grateful

[shopman]

The difficulty is that we are not medical people so best we can come up with may just be a guess that could be right or wrong. Having said that I think I may be asking for a Cardiac MRI scan.

[Madparent007 in reply to shopman]

True. Thank you

[Milkfairy Heart Star]

Hi Madparent007

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

Have seen the information on the BHF website about MVA?

Printout the articles and go back to your GP and ask to be referred back to a Cardiologist who has some understanding of MVA or vasospastic angina or they are willing to learn.

You do need to be under the care of a Cardiologist as MVA and vasospastic angina are not harmless.

Your pain should also be treated appropriately whatever the cause.

It can be and does need treating. It takes a skilled astute and engaged Cardiologist to work with you to find the best treatment possible.

This article from Prof Colin Berry's team is a good one. See Table 2 for possible treatments. Definitely print this one out for your GP and they may prescribe some more medication to help.

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

There are quite a few of us around we are all affected differently and have different treatment. I am sure others will be along to share their experiences too.

It can take sometime to get the diagnosis and treatment that you need. However you know your body best and may need to be persistent and travel to see a Cardiologist who has more expertise.

While you are waiting there are somethings that you can do to help yourself.

The cold, mental and emotional stress can trigger an episode of angina.

Keep warm

Try yoga, mindfulness meditation, relaxation, breathing and visualisations techniques.

Keeping calm can help to turn the 'volume' down on your pain.

Good luck.

[Madparent007 in reply to Milkfairy]

Thank you yes I’ve seen the information on BHF and it’s definitely what I’ve been experiencing. Thank you for your advice.

[dunestar]

Hello Madparent007. I do feel for you, left in limbo. It's a pretty poor show when a cardiologist mentions MVA and then doesn't follow through.

My own route to an MVA diagnosis was much more straightforward and for that I give thanks I live just down the road from Harefield hospital. It seems it's the luck of the draw whether there's a switched on cardiologist in your area. Even so I decided to consult a specialist in MVA privately as the diagnosis from Harefield was "probable MVA". I couldn't get a GP appointment to discuss things further so I took matters into my own hands. Luckily for me again there is a specialist in MVA at the Royal Brompton which is in the same Trust as Harefield, so he was able to access my records directly. Otherwise you might have to ask for your medical records yourself if you go private. I found the consultations are not too expensive, but costs do mount up if you need tests etc.

[Madparent007 in reply to dunestar]

Thank y

[dunestar]

Sorry, just to add a bit more about going private. You can jump back and forth between NHS and private. It's not without it's risks too though. I fell out with my GP because he didn't like me seeking a private consultation, so I now go to another doctor in the practice.

[Madparent007 in reply to dunestar]

Yes I cannot afford for the tests to be done unfortunately.

[Madparent007]

My GP actually asked me if I’d considered private because he needed to refer me back to cardiology but he said they might ‘bounce’ the letter back as they had ruled out cardiac. There were other tests they could have done but decided not to.

[Milkfairy Heart Star in reply to Madparent007]

Madparent007

Where in the UK are you?

Has your GP asked for you to be assessed for Microvascular or Vasospastic angina?

Make contact with PALS and send in the BHF information and ask for your chest pain to be properly assessed.

[CharlesL in reply to Milkfairy]

Dear Milkfairy

Forgive me I did not mean to cause any offence.

C

[Milkfairy Heart Star in reply to CharlesL]

Thank you CharlesL

[CharlesL]

Hi Madparent

Try to forget about it and just get on with your life. Don't get sucked into the system

Take care

[Milkfairy Heart Star in reply to CharlesL]

Hi CharlesL

I feel your comment is unhelpful.

It underestimates the devastating debilitating pain and symptoms of microvascular and vasospastic angina.

I invite you to live with either MVA or Vasospastic angina and reassess if your comment is one of compassion and understanding.

Untreated vasospastic angina can lead to heart attacks, arrhythmias and cardiac arrest.

Heart function problems can develop if Microvascular angina is not treated.

Chronic and acute pain has long term effects on an individuals wellbeing.

Everyone has the right to have their pain acknowledged and treated apprioriately and in a timely manner.

[Madparent007]

It’s taking over my life. The chest pain is definitely debilitating and therefore worrying as I’ve had no formal diagnosis. I’m in Doncaster and PALS have said I need to wait until I’ve seen the cardiologist in August. Unfortunately I feel I cannot wait that long as I’m in ‘limbo’ so I’ve arranged for a private consultation to move things on a bit. As this peeves me that I have to pay - when I could have had more tests whilst in hospital for a week, I feel better that I’m doing something. So I’ll let you know the outcome. The consultant I have chosen has diagnosed other people with MVA, so my GP stated, so fingers crossed. Not that I want anything wrong with me I must add, I just want answers. Thank you for your advice.

[Milkfairy Heart Star in reply to Madparent007]

Hi

I am sorry, I understand the bewilderment that this condition can bring.

It took me a while to get my diagnosis accepted.

I had a very specialised angiogram and I see a Professor of Cardiologist in London who researches into microvascular dysfunction.

Hopefully the referral by your GP is truly to someone with some knowledge of MVA.

If you need some advice who else to see there is the Bradford Refractory angina service.

Ask your GP to try at least some more medication to relieve your chest pain.

Also Leeds also has some very good Cardiologists.

Did they do an angiogram to confirm that your coronary arteries are clear?

I was fortunate that as I live in London that I have been able to access the experts into MVA and VSA. It really isn't fair that you have to go privately.

If you have more chest pain especially if it is at rest go back to A&E. Go armed with copies of the BHF MVA information