First gp appointment about possible angina

[Snowboarder66]

Hi everyone first post here ! Always been a fit and well 53 year old or so I thought ! Run for years, spin cycling couple of times a week, long dog walks likewise and a very active job, also never smoked. I do however have a family history of cardiovascular disease and recently found out i was hypertensive after a bit of a health scare back end of last year. Ended up having an echo and treadmill test due to some t wave depression in one lead of my ecg. Both tests were essentially normal and the t wave changes were put down to just a normal varience in me ! I was started on ramipril for the blood pressure and initially all was good. Bp controlled and I started running again very cautiously. After 8 weeks or so, running felt better than ever but on my last run I developed central chest pain which went as soon as i stopped. Haven't run since to be honest but have noticed a mild dull ache / tightness in my central chest on exertion or when stressed out, not always but enough to notice. No other symptons apart from occasional sickliness if overexerting myself and the pain goes in seconds. To be honest i haven't felt myself since I started on ramipriI, asthma seems worse controlled, dry cough and definitely more anxious. Just visted my Gp today to see if this could be angina or maybe related to ramipril side effects of which chest pain is one ! So he's stopped the ramipril for 2-3 weeks as i never had an ambulatory bp measurement done - they just went off my recordings in A/E, he's given me a gtn spray and to see him in 2-3 weeks for a bp check , review my use of gtn and maybe start me on amlodipine if i've still got high bp and chest pain. He also wants me to consider HRT as the anxiety could be caused by that ! Does this seem an adequate response by the gp ? It just seems odd to be stopping the medication or not replacing it..... Thanks in advance

[Milkfairy Heart Star]

Hi Snowboarder66

Welcome.

The BHF website has some really good information about angina.

youtu.be/k5VjGgk7Wqc(Not working as expected?)

While angina is usually caused by fatty deposits in your coronary arteries there is a less common type which is more common in women around the time of the menopause.

You mind find this BHF information useful

bhf.org.uk/informationsuppo...

[Snowboarder66 in reply to Milkfairy]

thanks milkfairy Will take a look

[jerry12953 in reply to Milkfairy]

From the paper you referred me to, Milkfairy, the proportion of people with angina-like symptoms who have no fatty deposits in the arteries is close to one third!

[Milkfairy Heart Star in reply to jerry12953]

These people are not just experiencing angina 'like' symptoms they may actually have Microvascular and or vasospastic angina / coronary artery spasms which are conditions which can increase the chances of having a heart attack, stroke or developing heart failure.

These are under recognised possible causes of angina. They are difficult to diagnose and difficult to treat.

Nearly 10% of heart attacks occur in people with unobstructed coronary arteries known as Myocardial infarction non obstructive coronary artery ( MINOCA) some thought to be caused by Microvascular and vasospastic angina,

Some Cardiologists have great difficulty accepting this type of angina is possible and will say to the person quite often a woman that they are having a panic attack or have musculoskeletal problems.

Many on the forum and including myself struggled to have our microvacular and vasospastic angina recogised and treated appropriately.

[jerry12953 in reply to Milkfairy]

Sorry if I misled by adding the "-like" to my post. I saw a cardiologist yesterday who diagnosed me with microvascular angina, presumably by a process of elimination. While at the hospital I picked up a booklet produced by the BHF which has a section about MVA, so it does seem to be recognised as a condition more widely. I was prescribed amlodipine (?), so I'll just have to see if it helps.

[Milkfairy Heart Star in reply to jerry12953]

Hi I know am a bit of pedant about the use of the word ' like' it can lead to Cardiologists considering that microvascular angina is not worthy of recognition or treatment.

The BHF have been very responsive to patients asking for more information about MVA and vasospastic angina. This is leading to a greater awareness of the condition which is great.

I would not want anybody to have my journey to diagnosis. It was very different story 7 years ago!

This information sheet was written with advice from Prof Colin Berry and an expert patient.

bhf.org.uk/informationsuppo...

I hope the Amlodipine helps you.

Perhaps discuss with your Cardiologist the advice that people with MVA being prescribed statins and anti platelets eg aspirin?

[jerry12953 in reply to Milkfairy]

Unfortunately (?fortunately) I got a very short notice cancellation appointment with the cardiologist so I'm unlikely to see her again for some time. But that is a question i would like to have asked. Am I taking aspirin unnecessarily now in view of my main arteries being clear? Although I gather aspirin is a bit of a wonder drug that can protect against other things too. I think my cholesterol was borderline before I started on it so I guess i should keep on taking it.......

My mother began getting angina at the age of about 62 and was on medication for the rest of her long life (she died at 95). I doubt if she had any of the scans which seem almost routine these days, but she may also have had MVA.

When I bought travel insurance earlier this year MVA didn't attract anywhere near the extra premium that "ordinary" angina did. So maybe i should think myself lucky!

[Hidden in reply to Milkfairy]

I go off-topic but am still surprised to see the same BHF's article on Raynaud's online as it not entirely correct. One medical adviser's "opinion" is an opinion, just that.

The BHF should not print one doctor's opinion as "universally recognised" truth.

As much as I love BHF and what they do, they would need to be careful how they word things, and which opinions they medically rely on to disseminate to the public. The medical facts are not set in stone. These can be quickly outdated.

Medical research is constantly evolving and changing. Patients nowadays are far more informed, different from, let's say, 10 years ago when we simply read a brief article on a disease and convinced ourselves that we "knew" it all. That's no longer the case these days. . . It's best not to rely on one doctor, explaining a "disease" which is a HUGE subject itself, especially, something like Raynaud's, which is now recognised as a syndrome of the hidden vascular disease.

I have seen the research documents that concluded recently that Raynauds patients may have a hidden, undiagnosed vascular disease. Maybe, there's something to do with the female hormonal changes interacting with endothelial membrane in a complex chain reaction that I do not know. The photo with a senior lady, who has severe osteoarthritis in her hands is very apt in my opinion, however.

I'm reverting back to the OT microvascular Cardiac disease, emerging during the pre-post menopause. I heard enough about what it is and how to diagnose it fast. I would like to know more about the disease mechanism(s) if underlying causes are not the same/if there are any upcoming studies on the novel treatment(s) to halt the disease progression rather than medications to control the symptoms only.

Someone commented on the hidden "metabolic" syndrome, which could be responsible. It could be. I would like more research into this, too.

[Milkfairy Heart Star in reply to Hidden]

Hi Autumnsonnet

I agree with you about the Raynauds Phenomenon information on the BHF website. It is in desperate need to be updated.

Perhaps you would like to contact the BHF to ask them to update the information? They have a Patient Information Panel and do change information in response to patients' requests and advice.

The ' What is angina' animation I posted above is an example. I asked for Vasospastic and microvascular angina to be included which is at the beginning of the clip.

Whatever I expect so many conditions are no doubt inter linked and research is just scratching the surface on the possible underlying causes. There is loads of interesting research going on into the biome and our gut flora.

The endothelium lines every single blood vessel in our bodies and perhaps that's were the answers lie?

[Hidden in reply to Milkfairy]

Yes, definitely. . .

After all, blood vessels are all connected. Microvascular diseases are the trickiest. They affect the heart/brain/organs whilst the mainstream medicine focuses on large artery diseases easily seen on scans.

Brain and Heart connection is so close, yet it is poorly addressed on NHS.

Have you heard of vascular permiability? I'm pretty sure you have already. . .

Thank you for all your great posts!!

[Milkfairy Heart Star]

I am not sure if all heart patients can ' eat their way out' of their condition.

Eg, baby born with congenital heart disease, a pregnant woman with pre eclampsia, infection causing myocarditis, endo or percarditis. Aneurysms.

Peri partum cardiomypathy.

Inherited forms of Cardiomyopathy and heart rhythm problems.

Non obstructive coronary artery disease such as Spontaneous artery dissection, Takostubo syndrome, Microvascular and Vasospastic angina. Heart function problems.

There are more I am sure.

Is the dumping of one person's point of view about about their particular solution to obstructive coronary artery disease helpful to other posters requests for support to live well with their individual heart condition adding to the purpose of this forum?

[sos007 in reply to Milkfairy]

There's no doubt that genetics play a role, however, research indicates that 70 to 85% of chronic diseases are dietary and lifestyle in origin.

Therefore most people will benefit from a healthy diet and lifestyle, even those with genetic conditions.

What I find peculiar on this forum, unlike the Cholesterol forum, is how defensive everybody is, and how some contributors see fit to intervene in the conversation between the poster and those replying to them.

Using aggressive language like 'dumping' or 'spam' in an unsolicited response is unwarranted and unwelcome.

People post questions on this forum to get opinions. I have experience with heart disease and post my replies in hope of sharing my experience to help others. If my responses irritate you, then you are free to ignore them.

I will continue to respond with my information as I see fit.

Have a wonderful day!

[Milkfairy Heart Star in reply to sos007]

Please could I ask you to read this post from Admin?

healthunlocked.com/bhf/post...

[sos007 in reply to Milkfairy]

Helen messaged me directly and I responded to her.

[Ianc2]

Do you have a link/reference for the Reynaulds information you referred to?