CLEAR AS MUD - THE SAGA CONTINUES - MICRO VASCULAR ANGINA ??

[WardijaWardija]

Hi fellow Hearties.

Following my delay with a double broken shoulder and 3 fractured ribs, I today attended for my Dobuatine Stress echo test today, after a 3 week hiatus.

I was originally scheduled for this test to determine why my angina attacks are NOTcontrolled by both nitrate medication Relosorb 60mgs and the GNT spray ? and to assess for inducible ischemia.

As Consultant was querying Micro-vascular angina . . .

So, test done. Interpretation study reads:

Patient developed dyspnea at peak with chest tightness. No arrhythmias .

BASELINE - No regional wall motion abnormality

PEAK - Mid and apical lateral hypokinesia. Good global contractilites.

CONCLUSION - Evidence of inducible ischemia in lateral wall

POSITIVE STRESS ECHO

To follow-up with coronary angiography.

OK, so I'm now waiting yet another for another (4th) angio.

I'm CONFUSED, as I thought that today's test was pretty much the gold standard in accertaining the prescence of Micro-vascular Angina.

I did not get any information from the technical team carrying out the test, one way or another. Just told me an Angiogram would need to be done . . .

Obviously l am not a doctor, but from reading today's findings, and my limited medical experience, I'm assuming that I do, indeed have Micro-vascular angina.

Are there any Hearties out there who have had a similar experience or shed some light on the matter?

What bothers me is that because the nitrates and the GNT spray are not effective, what should l do in the meantime, whilst waiting for the angiogram, when I have these frequent bi-daily angina attacks?

If I was to call for emergency services, I'd literally be at the hospital's A&E at least 2 times a day 24/7

I'm confused and to be honest, scared. Help please 😕

Thank you

[Rob6868]

Hi

I'm in the same situation so please don't feel your alone.

I'm actually at work at present so difficult to explain everything. But I wanted to quickly message to say there are many on here with MVA.

Will message you at a more convenient time.

You take care.

[WardijaWardija in reply to Rob6868]

Hi Rob.

Thanks so much for getting back to me.

I will await hearing from you at your convenience ☺

[Milkfairy Heart Star]

Hi I am sorry you are no further forward in finding out why you have your ongoing chest pain.

The most accurate test for detecting microvascular angina caused by microvascular dysfunction is a perfusion MRI with adenosine.

Nitrates typically are not always effective for those with MVA due to the inability of the small blood vessels to dilate in response to stress microvascular dysfunction

Nitrates are much more effective for vasospastic angina.

Beta blockers can help those with MVA due to microvascular dysfunction however they can make vasospasms worse.

I ended up in hospital when I was prescribed beta blockers.

I have just come home from a 10 day in hospital to stabilise my latest session of unstable angina due to vasospastic angina. My perfusion MRI was normal as I don't have MVA due to microvascular dysfunction. I can exercise my blood vessels are just fickle and go into spasm.

I use a TENS machine to help with my chest pain. I have also been prescribed oxygen which helps.

2 hot water bottles one front and back.

Hopefully once your Cardiologist has more information following your angiogram they will understand better the cause of your ongoing chest pain they can start trying find the best combination of medications that will work best for you.

[WardijaWardija in reply to Milkfairy]

Hi Milkfairy. Thank you for your quick reply. I know that you have a lot of experience in this area of cardiology, so do appreciate your time and knowledge. ☺

I'm just Soo fed-up with it all, as I'm sure like many others are too.

At the outset, after the shock of learning that I had HD, I was determined not to be defined by both my heart issues, along with the other chronic conditions from which I also have, but I'm holding my hands up, I'm totally and officially overwhelmed !!

I can just see this current issue, running and running.

I have not been offered any type of MRI this time around.

Nor channel blockers.

My medication is:

Perindoprel/omeproazole/Relosorbe/Asperin/Clopydogrel/

Atorvastatin/Naproxen/Amitriptyline/Tramadol/GTN * AND

Insulin

Fortunately, I do not have any side-effects from any of the above.

* Unfortunately the GTN spray is not effective for me. Whenever, in the beginning I attempted to use it - it just used to mimic the symptoms of my angina, twice as badly!

The pain meds. are only taken as needed, not daily.

As I have painful diabetic neuropathy in feet and hands.

Now when angina strikes, all I could/can do is to sit down and let it pass. OK at home but dreadful when out and about . . Actually this happened today at the hospital shortly after the stress echo finished.

I notice that you mention oxygen. I am convinced that would help me, at least in the interim - I mentioned this today as they could see my distress, at not being to breathe properly, but the poo-poo'd this suggestion away. So as usual, I'm left hanging . . .

I'm not sure what further details they are hoping to see on the angio, as only just had one back in July . .

I'm permanently exhausted and could sleep 24 hours a day, but don't have that luxury, so battle to keep my eyes open.

I'm stressed to the max which doesn't help.

My father is in a hospice in the UK, and Im told I can't fly to be beside him. He is already on borrowd time and I can't even be there . . .this upsets me beyond belief as I know I'm not going to make it back in time 😭

So I continue to be stuck in Malta, I'm trying to move and get everything back to the UK as soon as possible, but with my heart issue and the fact that I've a shoulder that's broken in 2 places and 3 fractured ribs am finding it daunting and very slow going.

I had been holding onto the fact that by the end of today, I would finally have a diagnosis and suitable treatment would be started. It didn't, and I still don't know if I have this MVA? Feeling like I am floating in limbo . . .

Lord give me strength !!

Thanks for listening ☺ Guess I'm just feeling sorry for myself . . .

[Milkfairy Heart Star in reply to WardijaWardija]

Morning WardijaWatdija

I found reading your post really tough.

It echoed many of the feelings and emotions I have gone through on my so far 7 year journey living with Microvascular and Vasospastic angina.

I lost my mother and I could not care for her as I wanted because of my angina.

I wish I could wave a magic wand and give you the answers you need.

This condition is probably one of the most challenging heart related pain conditions for all involved. Patients and Cardiologists alike.

All I can say is somehow when you feel you are out in the bewildering limbo land of no answers that feeling will pass.

Please don't feel you are alone. There are many on the forum who have had a bumpy path to their final diagnosis.

I wish you well for the up coming angiogram

[JonathanH]

Hello,

You are going properly through the mill. I am sorry.

Your experiences seem to be similar to mine, especially with GTN increasing angina.

I have found calcium channel blockers to be helpful. Initially, a pre-existing prescription of amlodipine was doubled to 10mg a day and then 180mg diltiazem was added.

I have found that a beta-blocker (metoprolol) can reduce the intensity of angina attacks and control palpitations but is not effective in reducing chronic 24/7 angina.

Try gentle exercise: just walking round a room can sometimes reduce angina for me, but sometimes it doesn't. (By "angina" I mean both pain and shortness of breath).

Finally, I recommend a little red wine or port, especially in the night.

Whether such measures will help you, I cannot say, but they help me.

And, if you have medical insurance, I never stop recommending that you try external counterpulsation. It has been fantastic for me.

Kind regards

Jonathan

[Milkfairy Heart Star in reply to JonathanH]

Jonathan

Love the recommendation of red wine and port!

The ongoing problem is the lack of knowledge and understanding about the possible different causes and mechanisms of Microvascular and vasospastic angina amongst Cardiologists.

The appropriate tests to diagnose the conditions are commonly not being used. Saying that my very clever Cardiologist diagnosed my condition 7 years ago by listening carefully to my symptoms.

My angiogram with acetylcholine confirm the extent of the vasospasms in my coronary blood supply.

The treatment options are very different for each type of MVA.

Each of us have our own difference cause of MVA and/ or Vasospastic angina causing MVA and Coronary artery spasms. Medication and other treatment options may work for one person but not work for another.

There is no one size fits all

A proper diagnosis is a very important starting point.

Did you see the latest research from St Thomas' hospital ?

[dunestar]

I too found it tough to read your account. Sounds like you are caught in a nightmare scenario.

A stress echo is great at detecting ischaemia but it's not designed to come to a conclusion about what's causing it. The standard thinking will be that there's some kind of blockage in the main coronary arteries. That's what happened to me. I had a stress echo which was strongly positive. But the angio showed only mild atheroma in one artery. The conclusion therefore was that the ischaemia was probably being caused by lack of dilation in the microvessels.

But it's only a deduction. The resolution of the angio is not sufficient for the medics to actually see what's happening at the micro level.

I then saw an MVA consultant privately who hummed and hawed a bit but eventually concluded it was MVA.

It's a question of trying various drugs to see if any help. I take isosorbide mononitrate, ramipril and atorvastatin. That combination seems to work for me. But I'm a bit of an outlier within the MVA community as I don't get chest pain. Within the MVA umbrella there's a spectrum of different presentation of symptoms and what medication works.

As Milkfairy says the gold standard for MVA is perfusion MRI.

I do hope you can find a way forward out of your present situation.

[Prada47]

Could you not catch a ferry from Malta to Italy and then have someone drive you through Italy and then on to the UK ! Or even train it to the UK ? Just options Can't help with medical questions as I don't have any experience of it . This is how

seat61.com/Malta.htm

Regards

[WardijaWardija in reply to Prada47]

Thanks for your message.

Unfortunately I am not up for a 5 day minimum, trek across mainland Europe, either physically or mentally right now.

I've done this route twice before, being both younger and without medical conditions and its pretty arduous.

But thanks anyway.