Thank you Sunny2day for your assistance. Goodness where to start ! Please all be patient with me as my 1st post will be long and maybe boring to some. I have lived with some form of arrhythmia since teen years and Atrial Fibrillation for nearly 40 years - at first paroxismal progressing through the 3 stages to permanent AFIB a few years ago with a HR of consistently 128 even though taking 200mg Amiodarone and 150mg Pradaxa daily. At my age, did not want to live with such a high (sometimes 138 HR) so opted for a Cardiac Ablation. My long term Cardiologist was a leading expert in AFIB/Ablations and all heart rhythm disorders at the Heart Centre in Singapore. The first ablation was thought to have been successful but after a month relapsed into a slower and more stronger and steady AFIB which left me very disappointed. After 6 months I had another Ablation and this worked so much better leaving me with only very occasional Paroxismal attacks. I have learned that it is very common to need more than 1 ablation. I am staying on Amiodarone and Pradaxa for the time being. For those of you that do have Afib it does show that one can eradicate it with the right treatment and I guess a big handful of luck. My mother is 100 in July and has Afib and does manage quite well but of course it is more prevalent in someone of that grand age. Does anyone reading this know of anyone with such problems for nearly 40 years. Now to my main reason for posting. I note that many of you exchange very interesting and helpful information and I am sure some of you have made good online friends with each other which is fabulous. Once I was clear of Afib, over the last 6 months I have found it hard to walk up inclines or long steps even though I have played sports and walked 3 times a day with my dog. Things got worse and worse until 1 day I suddenly had pulling sensations / some pain in my chest and sweated profusely whilst climbing a rather steep hill. It was extremely frightening and I became very disorientated until an ambulance took me to A&E. ECG, Trop test, BP and HR were normal which was rather confusing. I was admitted and had a bunch of tests including an Angiogram. Angiogram showed 48pct and 50 pct lesion / blockage in two main arteries to which the cardiologist decided was not flow restricting and the heart was performing well. At that time it was suggested I had Coronary Artery Vasospasms which I had never heard of but I was given medicine. Over the next month I had similar attacks usually on exertion which may indicate Angina hence I returned to the Cardiologist actually asking to be stented. Very reluctantly he did another Angiogram and again the lesions in the two arteries showed to be "minor" and not at stenting severity which is usually around 70 pct blockage and mine was less than 50pct. Also the flow through those arteries (F F R) was 87 and 93 which was in a very acceptable range. SO WHY was I getting Angina type symptoms unless it really was Cardiac Vasospasms which are almost impossible to diagnose with any definitive results. I then had a Nuclear Profusion Test, Various other Heart Scans and a type of MRI which all showed nothing to worry about except some very minor discussion points that were normal for someone of 76. I am a pretty intelligent and level headed person but now I find myself enormously worried if I am confronted by steps or a hill ( most of which I will manage with very tired legs ) but many with a pulling pain in the chest and of course natural fear which increases adrenaline flow and anxiety. I wonder if I am one of those patients whose ailment is so difficult to completely diagnose of which there must be some. I am now due to return to the Cardiologist once the Covid pandemic allows. The cardiologist that did the Angiogram and ordered all the other tests is The Head of Cardiac Intervention and an Ass. Professor - this makes it difficult to question him further as it appears he has gone well beyond his remit to examine me. He must know what he is talking about although he did say that if it is Coronary Vasospasms it is very hard to diagnose and if my symptoms only last less than a minute (which they do) I should not be overly concerned. He gave me some comfort reiterating his findings and that mortality rates of Coronary Vasospasms where apx 1 pct per year and could be adequately controlled. My dear friends - just to close let me advise my current medicines which need a calculator to prescribe... hahahaha.
Would anyone have any comment on my health status incl Afib for 38 years and the medicine listed above.
May I thank you so very much and hope I have not bored the pants of everyone.
I would be interested to hear from anyone who has any form of Angina and if it is the case with me, is it manageable or extremely life threatening. My confusion is naturally with no extensive blockage to obviously cause the "angina" what on earth could be the cause.
Thank you all so very much and stay safe. SmileyIan
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Hi Milkfairy, as you have been confirmed with Vasospasm Angina, may I take your personal view and advice. I get very leggy and breathless on a hill or with emotion however my actual pain only lasts a matter of 5 to 15 seconds which is not long. However I seem to recover any other (non pain symptom) very quickly. The pain symptom of just seconds seems only on exertion and not whilst sitting or during the night. All tests including Angio show only only minor blockage in main arteries and bp 128/70ish and HR 49 after 2 ablations. Hence "assumption" is that it is likely I have Spasms which I understand is generally a female ailment. May I enquire if the pain from your Vasospasms is severe and lasts more than a few seconds or not so. Any other views would be most appreciated. I may also have hypothyroidism which may account for my extreme exhaustion and lethargy. I look forward to hearing from you at the earliest opportunity.
Microvascular angina which effects the small vessels tends to be more common in women.
There are thought to be several causes. One the inability of the blood vessels to dilate in response to exercise or a tendency for the small blood vessels to constrict when they should dilate, Microvascular dysfunction .
People with MVA often get pain when exercising
Vasospastic angina is due to the large coronary arteries going into spasm men and women are equally affected.
The pain tends to occur at rest often in the night in response to exercise and stressors
We all are unique. I am greatly affected so not typical. I tend to have clusters of angina pain at rest lasting upto an hour however that's me. I can exercise.
If you are having some pain no matter how brief when you walk up hill you need to discuss this with your Cardiologist.
Interestingly the incidence of vasospastic angina is more common in Japan and the far east so there is much more knowledge about MVA & vasospastic angina than here in the UK
Thank you. Now I know there are 2 separate issues. Spasm and Spastic. Good explanation. I visit a Senior Cardiologist next week so will discuss further professionally. I had not heard of these Spasm issues until relatively recently hence if this is my diagnosis, I hope I can accept and live with for a few more years as owise okay. I do hope you are managing your symptoms and lead a comfortable life. Tks Ian
I have since talked to Sunnie who was marvellous and advised me that you were the "go to" person for my current presumed condition and indeed so much more. In your assistance to the medical authorities, I wonder if you have come across Prof John Camm who was the cardiologist whom I first consulted when I worked in London 40 years ago. He became a "gold standard" globally on all matters relating to all arrhythmias. He gave a lecture recently in Singapore which I sadly missed.
Hiya from NE Scotland, and here's another welcome to the forum. Great introductory post!
I don't have vasospastic angina, I have other heart conditions (mild-ish if I take my medication and follow the rules). Too many to list here, the quick list is angina with normal coronaries (confirmed Nov 2019 by angiogram and right heart study), Rheumatic Heart Syndrome, and recurrent pericarditis.
I've had the RHS since a childhood bout with rheumatic fever in the early 1960s - I've had a wonderful active life for the most part but have never tolerated more than the slightest inclines. Can't do stairs, hills and/or mountains. I had a wicked acute flare with the recurrent pericarditis (from March 2019 through April 2020, longest flare I've ever had) and it's left scars - I've come to realise it simply isn't going to improve from where it is now, ever, and as long as I stay on the flat and level I'm fine. 'Fine with it', well, I'm getting there It may be you'll need to come to terms with giving up inclines, stairs, hills, and mountains. Honestly, there are worse things than never climbing another long flight of stairs.
Milkfairy is your go-to for vasospastic angina support. She's too modest to admit this but we're certain she knows more about the condition (and microvascular angina as well) than most cardiologists.
Thank you so much for this and your other responses.
I am wondering if your cardiac output is diminished which becomes more symptomatic with exertion. Do you know what your last left ventricular ejection fraction ( LVEF) was? Would have been measured with an echocardiogram. If that is low, it points to some level of heart failure. Your symptom of disorientation puzzles me, suggests decreased oxygen level to your brain when this is happening. Chest pain might be from diminished oxygen levels too, not always caused by blockages , sometimes poor output.
Thank you so much Hoski. Let me look into that suggestion but had echo very recently and no inadequate ejection rate was mentioned but will try to find that info in my paperwork. I will also raise at next consultancy in a few weeks. I thought I heard consultant say good ejection rate but will follow up. I think my disorientation was extreme anxiety and fear of something I had not experienced before. My pain lasts between 5 and 15 seconds each episode and I am struggling to get accustomed to it. I am most grateful for your comments.
I have spent an hour going through my results which are generally very satisfactory. My lesions in LAD and LAX are less than 50pct which in theory should not cause symptoms of Angina hence I am still work in progress. I had nearly 40 years with various Arrhythmia with longstanding AF which is now under control after 2 ablations - I had wondered if something went a little out of normal during those procedures causing this new condition. Btw - my report says Satisfactory Perfusion of Left Ventricle and the general Myocardial Perfusion test Gated Spect showed Normal LV size and function. Negative for Ischemia and LVEF of 57 percent. I am pleased to hear from you and hope you are generally well and enjoying life albeit with restricted activity due to Covid19. If I respond to an individual on this Chat Group, does the reply just go to the individual or do all the Members get to read it. I am new and learning - but enjoying the contact. Thank you once again.
we have a real mixture of heart issues here on the forum, I have had OHS to replace aortic valve and had a bypass at the same time. Now 31/2 years down the mended heart road things are good, but it’s good to know if I have problem there are people here who will listen and give me sound advice. It’s also good to be able to give advice too, when someone is waiting for open heart surgery and they feel scared and anxious it’s good to offer an insight into what they are facing and that it’s not such a scary place they are heading into.
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It may be you'll need to come to terms with giving up inclines, stairs, hills, and mountains. Honestly, there are worse things than never climbing another long flight of stairs.
Angina at rest
No pain 
Cardiologist report to gp
Vasospastic angina (Coronary artery spasms)
Mvd & cardiologists, 
