Artery Spasms / Variant

[Smileyian]

Anyone please answer but maybe one for Milkfairy. I am somewhat confused by my diagnosis of Artery Spasms vs Vaso vs Variant vs other names. When I had a 2nd Angiogram 6 months ago, the cardiologist said he saw my LAD and another Artery go into spasm during the angiogram procedure but said both the arteries with stenosis were at or apx 50pct with FFRs of .93 and .87 thus should not be causing Angina pain. My pain is initiated by stress, emotion and walking up hills and would normally last less than a minute. I thought that Variant and the other forms of Angina which Milkfairy has or is an expert on where attributed to the smaller arterioles and not main arteries. I am now a little confused as to whether I have variant angina, vasospasms or spasms of the main arteries as witnessed during the angiogram. I live in Singapore and just by chance raised the matter with my younger sister who is 74. She totally surprised me by telling me she was diagnosed with variant angina in her mid 50's which was 20 years ago. She regularly gets 10 min attacks which are usually at night or when distressed. She was told by a London based cardiologist 20 years ago "not to worry" the prognosis is good - keep your GTN to hand. All that time she has never mentioned it. Gosh when I read this back, I can see it is so rambling and wish I never started it hahaha.....any comments most welcome.

[gilreid1]

War and peace must be your favourite novel

[Smileyian in reply to gilreid1]

War and Peace ???

[gilreid1]

The length of your posts. Scottish humour no offence intended 😂 hope you are not charged by the hour in Singapore 🇸🇬.

[Smileyian in reply to gilreid1]

As someone who regularly walked the fields of Camster Burn, Caithness over 70 years ago, I havn't a clue what you mean ! You just need faster eyes !

[Janma123 in reply to Smileyian]

Was up at Camster yesterday!

[Smileyian in reply to Janma123]

Wow ! I have not been there for 35 years 🤣 prob not changed much.

[Smileyian in reply to Janma123]

Oops I was there in 1993.

[Janma123 in reply to Smileyian]

It was beautiful yesterday - warm sun and no wind. Clear and could see for miles!

[Smileyian in reply to Janma123]

I wish I could have joined you as it would be such a treat for me. Singapore is clean, crime free and everything works. However I miss the tranquillity of nature and open spaces. Must not grumble as cannot have everything and the healthcare is sublime. As a Senior Citizen, I can see the top cardiologist within 3 weeks and importantly the same one ongoing. Take care and breathe in that lovely highland air. 😀

[Milkfairy Heart Star]

Hello Ian

Vasospastic angina effects the large coronary arteries

aka Prinzmetal/ variant angina also Coronary artery spasms.

Microvascular angina effects the small coronary blood vessels caused by Microvascular dysfunction due to the inability of the blood vessels to dilate in response to exercise or stress. Meaning usually pain on exertion.

Or vasospasms in the small vessels these usually means angina pain at rest.

I live with coronary vasospastic angina. I have coronary vasospasms in my coronary arteries and smaller blood vessels.

I can exercise I get all my pain at rest or in response to emotional and mental stress and the cold🥶

The knowledge about both Microvascular and vasospastic has advanced including prognosis in the last 20 years.

Gilreid is this of sufficient brevity 😉

[Smileyian in reply to Milkfairy]

Exactly and I mean exactly the explanation I needed. It is understandably confusing for some of us who do not fully understand the complexities of the "various forms" of angina. Would my sisters 20 year diagnosis of variant be unusual as it seems an excessive amount of time ? I hope you are doing well and modern medicine and treatment keeps you comfortable. No reference of coronary spasms in War and Peace hahaha😂

[gilreid1 in reply to Milkfairy]

Sorry for late reply golfing and enjoying life. Would not dare question the hierarchy

[Smileyian in reply to gilreid1]

Wonderful. I hope you shot par or under. If you are passing this way, consider a round at Sentosa Golf Club.

[gilreid1 in reply to Smileyian]

Have played many times. Over priced. But luckily for me was always on a corporate deal 😊

[Milkfairy Heart Star]

There has been awareness that a variant type of angina existed for a long time. Hence the name variant angina

A cardiologist in the 1950's suggested it was caused by a transient vasospasm in the coronary arteries. His name Dr Myron Prinzmetal.

Hence the term Prinzmetal angina and Coronary artery spasms.

There has been a refinement of the definition of what tends to be referred to as Vasospastic angina.

Transient changes to a person's ECG , chest pain at rest, exercise tolerant.

The episodes come in clusters becoming worse and worse 'crescendo' angina.

If acetylcholine is injected into the coronary arteries during an angiogram and vasospasms occur this confirms the diagnosis.

Vasospastic angina usually responds quickly to short acting GTN

[Squash1961 in reply to Milkfairy]

Hi Milkfairy

Some good advice and information as usual! Thanks.

I'll be seeing my Cardiologist in a few weeks to try and work out whether my chest aches are due to INOCA (either microvascular or vasospastic angina) or maybe just the drug side effects. My symptoms are a little different, in that I don't get acute, short lived pain (typical angina) but just a gradual ache across the chest that gets progressively worse, usually in the evening. I haven't taken the GTN spray supplied as yet, but I jump on the spin bike instead and the aches go away (I guess exercise works the same as GTN in that you get vasodilation). So possible VA since my symptoms are when I am at rest.

I still can't find any research that links a heart attack due to a coronary artery occlusion (STEMI or NSTEMI) with subsequent development of MV or Vasospactic angina or anyone on here who has had both. So they appear to be independent heart dysfunctions. Which means that I have either been very unlucky since I had a HA and a stent in the RCA and how have developed MVA/VA or it is due to drug side effects. Ill keep you informed.

Regards

Squash

[Smileyian in reply to Squash1961]

I would also be very interested in your results Squash1961

[Squash1961 in reply to Smileyian]

Hi Smileyian and Milkfairy.

So I saw my Cardiologist (Dr Daryl Ooi) about my ongoing chest and stomach aches and whether it could be due to CVA or Vasospastic Angina. He is in fact one of the leading experts in the field of Vasospastic Angina along with Prof John Beltrame, here in Adelaide and they have written many joint papers together. Based on the fact that I do not have any pain on exertion, and that it is worse when I twist (therefore muscular) and my ECG results are always good, he believes that it is unlikely and that is probably due to drug interactions. Since I am 9 months on from my HA and 2 stents in my RCA, he will start looking at down titrating some of the drugs (Statin(Crestor) - since LDL is now 1.0, and Total C is 3.0) and maybe swap out the Ticagrelor with Clopidogrel (but with the same dosage for at least another 3 months). After a year, I will likely drop off one of the DAPT drugs, the PPI and maybe Ramipril (although this ACEI also helps to reduce inflammation and oxygen free radical production) - Having read the HOPE study, I might stay on it if it is not the cause of my aches.

As an aside, I was also getting fairly regular ectopics prior to seeing him (maybe one every hour or so during the day. I was going to wear a Holter monitor for a day, but in between waiting the 4 weeks one was available, I started taking Magnesium Chelate and they went completely within a day !

Regards

Squash

[Smileyian in reply to Squash1961]

Thanks for the interesting post Squash1961. A fair bit of info in your comprehensive explanation. I am glad your Mag worked on your ectopics and you are now free of those annoying beats. I used to get up to 80 an hour at my worst point. Much better after 2 ablations and continued medicine for Afib. You take care and fully recover.

[Milkfairy Heart Star in reply to Squash1961]

Hi Squash

It might be a chicken and egg story.

A person can have both obstructive heart disease and Microvascular and vasospastic angina.

The blockages are treated with stents when the underlying problem may have beenMicrovascular dysfunction or vasospastic angina .

There are several forum members who have had stents inserted or surgery who have ongoing angina due to Microvascular dysfunction and or vasospastic angina.

acc.org/latest-in-cardiolog...

bhf.org.uk/informationsuppo...

[Squash1961 in reply to Milkfairy]

Thanks Milkfairy for the links, I’ll have a read

[Milkfairy Heart Star]

Microvascular and vasospastic angina are not well understood though there are now tests that can detect the conditions.

You can also have chest pain at rest with some types of Microvascular angina.

I am surprised that a Cardiologist recommended you took ibuprofen as heart patients are usually advised not to take non steroidal anti inflammatory drugs.

It depends how you feel whether you want to know why you experience your pain once a year or so.

[Smileyian in reply to Milkfairy]

I am not only surprised but aghast !

[Milkfairy Heart Star]

health.harvard.edu/blog/fda...