MINOCA

[Debii]

Hi I am a 49 year old woman and 4 weeks ago I had a heart attack. Angiogram did not show any blockages so I am now waiting for an MRi. I feel a little in limbo as I don't know what caused it. For now I am being treated for a condition called Minoca. Has anybody else had a similar experience.

[MichaelJH Heart Star]

Hello and welcome to the forum! MINOCA is Myocardial Infarction With Nonobstructive Coronary Arteries, i.e. there are no blockages over 50% in the main arteries. There are various causes for a heart attack but others here have greater knowledge than me about this. Hopefully they will be along soon...

[Milkfairy Heart Star]

Hello Debii

As Michael has said Myocardial infarction non obstructive coronary arteries MINOCA is an uncommon cause of a heart attack thought to be about 6% of Heart attacks

It is more common in women. The usual causes are Spontaneous coronary artery dissection ( SCAD)

Vasospastic angina causing a prolonged Coronary artery spasms and rarely Microvascular angina.

I live with Vasospastic angina and 7 years ago I nearly had a Heart attack because of spasms in my coronary arteries. It was stopped by the fact I had the good fortune to meet an astute Cardiologist who guessed what was going and prescribed the correct treatment. ( he's still my Cardiologist)

Here's some information that you might find helpful.

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

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

I acknowledge how bewildering it is to come to terms with the uncertainty of not knowing what has happened. It is good to hear that your Cardiology team have recognised that you have had a MINOCA .

The underlying causes are rare and poorly understood and recognised.

I hope your MRI goes well.

Feel free to ask me any further questions if you feel I can help you further.

[Hatchjd]

Debii welcome to the board. I was one of 3 women in my cardiac rehab class of 20 men. I had no chest pain at all but angio showed 90% and 80% blockages and was I was diagnosed as NSTEMI. The other two women were admitted with classic heart attack symptoms but had clear angiograms. One diagnosed as Minoca. Her angio had one vessel with 40% blockage The Dr thought a small clot or piece of plaque had broken off and lodged in a smaller vessel and caused her heart attack. Her post op treatment and medication was exactly the same as mine. The other with takotsubo syndrome (broken heart syndrome) her heart muscle suddenly became weak, usually caused by stress or anxiety but she couldn’t relate it to any event. It does seem that woman have a higher rate of unusual heart disorders and symptoms. Hopefully they will find the cause.

[Milkfairy Heart Star in reply to Hatchjd]

Hi Hatchjd

Women as the BHF campaign highlights are subject to a bias of biology.

bhf.org.uk/what-we-do/news-...

The theory is that vasospasms can 'shake' and dislodge even minimal plaque as well as then leading to clot formation.

This can lead to a MINOCA.

Non obstructive coronary artery disease such as Microvascular and vasospastic angina are under recognised and understood. They are very difficult to diagnose.

Many Cardiologist hold onto the belief that if your coronary arteries are not blocked you cannot have a lack of blood supply to your heart myocardial ischaemia or have a heart attack.

It is important to find the underlying cause of a MINOCA as beta blockers which are routinely prescribed after a heart attack can make vasospasms in particular Coronary artery spasms worse.

I spent 5 days in Coronary Care after my well meaning Cardiologist prescribed beta blockers.....

[Hatchjd in reply to Milkfairy]

Milkfairy thank you for the link. I agree that women are treated differently. My husband was put on statins 10 years ago as he had borderline cholesterol and mildly elevated BP. I inquired 3 times over the same time period to my GP if I should be in statins as my father and brother had a series of HA’s starting in their early 30’s but was told my cholesterol ratio was within guidelines, no need. This summer I had NSTEMI d/t significant blockage, my husband had an angio 3 weeks ago which was clear. I wonder had I been male would I have been given statins earlier?

[Milkfairy Heart Star in reply to Hatchjd]

It does make you wonder......

Let's hope the BHF's campaign will lead to equality of care regardless of whether we are a man or woman.

[BARTLETT1965]

Hi

I had my heart attack and Stroke 10 years ago when was 44 .

I was having problems with chest pains and numbness in arms for about 10 -15 earlier. But asper usual all my test came back normal except for a right Aorta.

Even 3 week after H/A was admitted back to hospital.

When the professor and students came around , he said " that I didn't have a heart problem "(w this diagnosis took all of a couple of minutes, without examination or looking at my notes).

I made a complaint and was seen by Director of Cardiology, who carried out an angiogram and found I had heart spasm and diagnosed me with unstable angina.

This result lasted all off about 2 months, as my next visit I made to cardiology (because no treatment plan had been put in place ).

A Registar at same hospital looked at same aniagramme results and said that the Director of cardiology was wrong. So still in limbo and suffer the same but with no real answers.

Hope u get further with urs.

Jeff

[Milkfairy Heart Star in reply to BARTLETT1965]

Hi Jeff

It took me sometime to get my diagnosis and Admission plan in place but well worth the effort. I raised my concerns with the Director of Cardiology too and my care has improved.

I suggest you write to the Director of Cardiology and ask him/ her again to review your care again including putting plan of care in writing.

Perhaps take a printout of the latest information from the BHF about Vasospastic angina to your next appointment ?

bhf.org.uk/informationsuppo...

[BARTLETT1965 in reply to Milkfairy]

Thank u. Never though of that. Might give it ago and C were we get with it.

Hope u get ur answer u R looking for.

Jeff

[Heythrop51]

You learn something here everyday. I thought it was a post related to a holiday destination!

[CPL593H]

Hello Debii

I had a heart attack, followed by a clear angiogram, so the “heart attack” was reclassified as a cardiac event. The MRI lead to my diagnosis of severe Hypertrophic Cardiomyopathy. The MRI will give you your diagnosis.

[JoanyB]

Hi Debii! I was admitted to hospital in Jan 2016 with a suspected heart attack (I'm female, 67 at the time and a little overweight). An emergency angiogram showed my arteries as being clear. I was discharged with a possible diagnosis of Takotsubo Cardiomyopathy (Broken Heart Syndrome), rather than MINOCA.

I had an MRI 2 weeks later, and when I saw the cardiologist 4 weeks after that I was told the MRI had shown that I had had a heart attack caused by 'a tear in the lining of a coronary artery'. This is what is known as SCAD - Spontaneous Coronary Artery DIssection (as Milkfairy mentions) , that it was a 'blip' and 'shouldn't happen again'. They had missed the tear in the angiogram!

I only found out that that first event was called SCAD when I had another (lesser) event 20 months later (only around 10% of SCAD patient are unlucky enough to have a second!).

This may well not be what happened to you (as Milkfairy says, there are other causes of MINOCA). However, as you are female and (pardon me for saying!) around the age of peri-menopause/ menopause, SCAD is a possibility as this is a common age for it to happen.

Hopefully the MRI will give you a firm answer.

(Apologies for the long post - I could have rambled on for ages so count yourself lucky!)

[Milkfairy Heart Star in reply to JoanyB]

Great informative 'ramble' as ever Joany B 😊

[BluePaula]

Hi, I'm 58 and had a heart attack in June. My angio was also clear and I had to wait 4 weeks for an MRI scan which confirmed that I had had a heart attack 6 weeks later ( that's when I got my results) . The intervening time was awful as I just didn't know how bad my attack had been, I felt guilty and stupid, I had loads of questions and fortunately a good GP who helped me. The cardiac rehab team also listened to me and provided reassurance. I've never heard of MINOCA, I was told I'd had an NSTEMI attack but my prognosis is excellent if I loose a bit of weight and keep exercising. It's a troubled time dealing with something that comes out of the blue so be kind to yourself, accept help and access any groups, like this one, that you can.

Paula

[Debii]

Thank you everyone your comments they have been really helpful and encouraging, Hopefully MRi will give me some answers in the meantime I will keep taking the medication.

[Spidey1]

Hi. I also have been recently diagnosed with MINOCA. Have had MRI scan of my brain and heart and also echocardiogram since being discharged. Still awaiting results of these tests which is now becoming frustrating as my life feels as though it’s just on hold until they can get to the bottom of this. Was wondering if you’ve had any news regarding your diagnosis ? I’m finding the waiting times really frustrating now as I just want to get on with my life but am being told I can’t by my GP and that I must wait for my consultant to conclude his diagnosis.

[Debii in reply to Spidey1]

Hi I have only recently had results from mri which hasn’t really told me the cause just that I had a restriction at the back of my heart. My consultant’s appointment isn’t until December! I would recommend going to cardiac rehabilitation they have been great and really helped me to begin getting back to normal. I felt exactly the same in complete limbo until I spoke to the cardiac nurses. Good luck

[Traciee]

Hi Debii, thanks for your initial post , it came up in my google search for MINOCA. I too had a very recent heart attack , confirmed by amongst other signs, a very high amount of troponin. I was taken to a larger hospital the following day for an angiogram that basically showed a small amount of plaque disease and normal coronaries. I too was given the MINOCA diagnonis and told I'd have an MRI but not soon because of the current COVID 19 situation. I hope you're ok now and was wondering if you'd had your results ?

[Debii in reply to Traciee]

Hi Traciee yes I’m fine now thanks 😊 results from my MRI just showed that my heart is slightly damaged but did not identify the cause. Just been told that I need to take medication for life. I think the only thing for me now is psychological I was feeling well before and didn’t have high cholesterol or blood pressure and still had a heart attack! My lifestyle and diet was and is healthy so it’s not like changes I make can prevent another one and I am left worrying it is going to happen again 😕 it’s not ideal that you are effectively being put on hold because of Covid the cardio rehab were a massive help for me and guessing you cannot access that at the moment either. I am virtually back to normal now and fortunately no side effects from medication being extra careful now with Covid as you are compromised after having a heart attack. Stay safe and hope you won’t have to wait too long for your mri. Take care

[Traciee in reply to Debii]

Hi Debbi, thanks for your quick reply 😁 pleased you're feeling fine and almost back to normal 😁.

I have BP tablets that keep mine at average, have done for 12 years, I think mine is hereditary . I also am relatively fit, long walks, 25-30 ml bike rides and eat fresh 90% of time so as with you it was a shock to me. I didnt need a stent but there was visable muscle damage on the scan.

Just like you i am worried about it happening again and just hope the MRI will give some info.

The cardio support team are ringing this week ( mine only happened a week ago) so hopefully I'll have a better understanding of all.

You keep safe too 😁 and thanks again for your reply and info.

[Musicl]

Hi Debi

My case is similar to yours and I would be interested to know what your diagnosis was aftet your MRI.

[Fleur57]

Hi Debii, yes I had MINOCA 4 days ago, totally out of the blue. Waiting for MRI result. My belief is that it is stress related, as I'd been under a lot of stress. Like you in limbo...no going forward until I know.

[Rainbow1961]

Hi i had the same happen about nine months ago it has been put down to unstable angina vasospastic angina. Apparently happens more commonly for some reason to ladies around 58.

[Milkfairy Heart Star in reply to Rainbow1961]

The BHF website information about Vasospastic angina says this

'Vasospastic angina is an under-diagnosed condition that tends to affect men and women over the age of 50, but younger people can also suffer from the condition.'

I had my symptoms from my 30's

[Rainbow1961]

Thats early so how long after that did they diagnose your condition