Long story short coming up for 2year post angioplasty anniversary (jan). I get bouts of what I suspect is angina during the day and at night which is mostly lhs chest into armpit location fairly low level but can distract me from sleep. I don’t often use Gtn except when heavy and some relief may be gained for a reasonable time hour or so . I was attending local cardio consultant on a yearly basis and have had the odd trip to a&e when following gtn not relieving symptoms protocol. Cardiologist has discharged me to gp care as I’m fitter than he is and have better heart endurance (his words) and that I only need to attend A&e if having an mi likely symptoms quoted as being sweating/vomiting. It feels to me they have lifted the investigation/treatment criteria to emergency cases only :/ with no plans for ongoing investigation into symptoms presented if they aren’t severe enough. Other info they have prescribed isosorbide 80mg per day which may or may not be alleviating symptoms and when I’ve had trop tests on a&e vists they vary in the 17 to 30 though once scored a “normal” range 10. Note there is a suspicion I may have MVA but no plan to formally investigate as quote “ there’s only so much medical sciences can do” . My concern is my angina pain is a similar low level to that I had when 1st diagnosed with a number of obstructed arteries (95,75ish% and 3rd below stenting levels) so a bit miffed at the not getting further checks . Back to the gp I go to raise these concerns and see what they think the options are.
Apologies for the non constructive rant.
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BillyMct
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A perfusion MRI will detect some types microvascular dysfunction causing microvascular angina but not MVA due to vasospasms.
I suggest you ask your GP to refer you to a Cardiologist who has some interest or understanding of MVA and vasospastic angina.
It takes trial and error to find the best combination of medication that will work best for you.
The recent European society of Cardiology's guidelines into the diagnosis and management of chronic coronary syndromes includes Microvascular and vasospastic angina see section 6
Very few Cardiologists know much about MVA and they tend to discharge patients inappropriately as a result.
Snap! I will take that as a very useful quote.
"Long story short coming up for 2year post angioplasty anniversary (jan)"
So, am I right to say, you had Coronary angioplasty AKA percutaneous transluminal coronary angioplasty (PTCA) in Jan. Did you also have stenting? Some patients have both, termed as percutaneous coronary intervention (PCI).
If the "costs" come first, then that's the worry. There might have been more narrowing, but could it be the case of "too costly" to do more? A scary situ but this happens as a matter of fact to cope with restricted resources.
"How bad was your narrowing?" Were you "high-risk" for MI?
Wasn't there BBC news on stenting on low-risk patients, lately?
Private maybe the only option, there maybe another NHS trust GP can refer me to as we have 3 nearby .
Appreciate the reply Milkfairy its frustrating when there is an inconsistent approach taken by cardiology departments across the UK and especially when the current approach is not a proactive one and reactive only.
My stenting treatment ended up being done as an emergency admission post the original diagnosis of blockages , suspected as a crescendo angina or mild MI (depends on who from the cardio team I was talking as to after the event as to what was reported, though my odd Trop levels since lead me suspect mild MI happened at some point, also suggested by a junior cardiologist at a recent A&E visit, who wanted to arrange a perfusion MRI? scan but seems to have been overruled by senior team members.
At the original treatment I had 3 stents fitted though 2 are in the same artery (main one into the heart) as a branch intersected the area, this artery was ~95% blocked though flowing okish as I was told it was a large artery, and the other artery stented was ~70+% blocked but not flowing consistently . The third was below NHS stenting guidelines? which seemed to be not to stent under 70% blockages at the time.
Cheers for replies I think I just needed to vent frustration that have come to a head with the recent discharge letter.
You need to find the right Cardiologist who knows about MVA and vasospastic angina.
There are some about and they are increasing still too few. The younger doctors many in training are becoming much more aware of the latest developments and are being taught about MVA and vasospastic angina.
My specialist Cardiology Professor is at St Thomas's hospital where they are doing alot of research into microvascular dysfunction.
My local Cardiologist tried to discharge me once.....I wrote and complained. He apologised and we now have a very good relationship. He now understands how much pain I live with and how it was affecting my psychological wellbeing.
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Good morning, hope all are as well as can be. Following on from cramps in legs to a trip to A&E. 
