No further forward

[45sue]

I posted recently about a telephone assessment of my husband carried out by the rapid access chest pain clinic which concluded that his symptoms were not cardiac related since they are not brought on by exertion. He agreed with his GP to watch & wait but this was before he got a copy of the assessment report which contained omissions and inaccuracies. He sent a letter to the cardiologist pointing these out. He has now received a reply - after contacting PALS. It says the records will be amended with the info he sent but affirmed the conclusion of the Sister who carried out the assessment, saying she is very experienced and had taken all relevant factors into account. It did not answer his query re unstable angina which does not depend on exertion. The current situation is that he is still getting symptoms of pressure in his chest on early morning waking. They are not daily or severe enough to merit going to A & E. His resting pulse is low at 50 . He has no idea what his blood pressure is & was last tested for cholesterol some 8 years ago. How can he get a proper assessment now that a cardiac referral appears to be blocked?

[Sunnie2day]

Can you go private? It is expensive but it does help to push things forward, answer questions, and sometimes establish a treatment plan.

I'm shocked the telephone RACP assessment has now been 'certified' - angina without exertion is serious and should be investigated and it isn't an assessment that can be done over the phone.

If you can't go private, go back to the GP with print-outs of BHF publications about unstable angina pain:

bhf.org.uk/informationsuppo...

Hopefully once the GP sees the importance of investigating unstable angina (from reading the BHF publications) he/she will push until your husband is seen in-person by the RACP unit. Some GPs aren't familiar with unstable angina so the print-outs help.

Thank-you for the update and I hope you'll continue updating.

[84green in reply to Sunnie2day]

Hi Sue

To follow on from Sunnie.

My GP (and cardiologist) both think it unlikely with my level of artery narrowings that I have angina. I raised it because I was feeling near constant rib/ shoulder pain. I was told it was musculoskeletal. I think this may be the case as I am now seeing a physio and the pain is a lot better with treatment. So I think it probably is muscular and made worse by anxiety.

When I raised the subject with my GP their view was that if it didn’t occur on exertion and GTN spray didn’t help it won’t be angina. Other forms of angina were just written off as “very rare.” In your husband’s case, I would expect a nurse from a rapid access chest pain clinic to at least be aware of the possibility or explain how/why they can rule it out.

I went private initially. I found a cardiologist who provided an echocardiogram, ECG and consultation for around £350. They did the tests themselves and so I got the results instantaneously. The ECG indicated ischemia and cardiologist recommended a CT Angiogram to confirm and determine the severity of any blockages. Fortunately, in my case, the narrowings were mild. These tests took four days.

It may be worth considering for your peace of mind.

Best wishes

[petef1]

Very similar situation to me. The RCAP clinic nurse concluded that my chest/shoulder pain (with breathlessness) probably wasn't cardiac related as it's weakly correlated with exertion and on most of the time. But everything else about it points to angina, verging on unstable. Stress really sets it off. Gtn usually relieves it too. Been unable to do much since I awoke with it one day in late Feb. They have reluctantly agreed to a ct angiogram (pending) after bit of pleading, so will see what happens. The echocardiogram that my gp set up had "no significant abnormalities".

I went into a+e in march twice with bad chest pain but ecg and troponin was fine. Have also been to a+e late may with swollen leg and d-dimer at 15000+ (but a doppler scan showed no dvt). They put this down to dehydration, which was odd as i was drinking loads. Wonder if it could be bisoprolol 5mg that gp put me on to see if they would help chest.

I also get the early morning pain. When i wake theres not much, then within a few minutes it builds to chest/back pain.

Has husband been referred for anything else such as ct angio or angiography, while they watch and wait?

Hope you get some answers and results.

[Milkfairy Heart Star]

Has anybody considered non obstructive coronary artery disease?

This is a less common and unusual often over looked cause of angina.

If you look at the BHF info that Sunnie2day sent you you will see a video clip. It shows Microvascular angina and vasospastic angina which are types of non obstructive coronary artery disease.

I live with coronary vasospastic angina I have temporary narrowing of my coronary blood vessels microvascular and coronary artery spasms. It is a form of unstable angina or acute coronary syndrome.

My vasospastic angina was diagnosed by a special type of angiogram. All my other tests were normal. Though I do have ECG changes and slight Troponin level rises when I have alot of symptoms.

I get my chest pain and breathlessness at rest.

The BHF Angina information also has some links to some information about microvascular and vasospastic angina.

I suggest you read through them and as Sunnie2day says print them out and talk to your GP.

You cannot assess for a lack of blood supply to the heart by a telephone consultation.

The nurse maybe experienced in obstructive coronary artery disease however have little knowledge of Microvascular or vasospastic angina.

Good luck!

It took me a while to get my diagnosis so sometimes you need to be persistent and if necessary help some healthcare professionals to update their knowledge.

[petef1 in reply to Milkfairy]

Good idea Milkfairy. I have thought this could be a possible cause. If they don't see anything blockage-wise on ct angiography, I will talk about non-obstructive with the gp.

Did yours come on very quickly? I went to bed ok one night, then woke up with chest/shoulder pain the next morning, and strangely a good amount of congealed blood in crusty nasal mucus (sorry about details)?

[Milkfairy Heart Star in reply to petef1]

Hi petef1

Mine sort of crept up on me.

I then had sudden pain and a trip to hospital with query heart attack or unstable angina.

The rest is history as they say.

I hope you get some answers soon.The uncertainty of not knowing why you have your symptoms is stressful.

[petef1 in reply to Milkfairy]

Thanks Milkfairy. Hope you are keeping well and sane with the Corona lockdown.

[Hidden]

Hi 45 sue had a similar experience rapid chest pain clinic had a phone assessment and she said they are not going to do any thing else as it sounds not cardiac I said do you wish to double check they said no the same afternoon I rang the same hosp and asked if I pay can I be checked they said yes same day cardiologist rang arranged a ct scan within 3 days done and this was after 5 a and e vists with chest pain this rcpc seems to only act if absolutely life threatening anx then you have to wait for ever to be seen so I would suggest if you have the funds pay for it I was totally disgusted as I have been a tax payer for 40 years and the only time I asked for help they turned ms away oh and by the way I have pericarditus with a touch of pleurisy and a lung nodule which wouldn't have been found maybe too late later on

[petef1 in reply to Hidden]

Hopefully you feeling bit better now Biketrip and your health issues are being addressed.

[petef1]

TRST. It is worrying isn't it. I think that about cells being damaged, but don't know as my echo came back with no significant abnormalities.

Such a shame you have to even consider self-medicating too. Did you ever get a definitive diagnosis?

I was quite amazed how slow cardiology investigations seem to take at present. I am also under hepatology and they are so much faster. I had a flare of a condition in April and it was addressed, treated quickly with steroids and now I'm in remission again and reducing steroids. My chest pain started in January and i only just had echocardiogram that was booked in January and still not had any appointment date for ct angiogram, despite rapid chest pain clinic referral in march. They must be significantly more busy with cardiology. I expect the corona requires cardiologists too.

Are you still under investigation for your condition?

[petef1]

You going through the mill. So sorry to hear. And especially that you having to effectively be your own doctor. I do so hope things get better for you. Especially when the virus dwindles a little.

Are you in UK?

Do so hope things improve for you.

[petef1]

Yes uk here. 43 years old. Nottingham.

Yes be nice to have had that echo you mentioned. Might help inform your gp and your decisions wrt your tablets.

All the best and hope you get some progress in your treatment.