Telephone consultation Coronary Spasm and MVA which drug diltazem or nicorandil?

[Sunshinebrew]

Feeling a bit upset been feeling a lot worse lately and had a bad night due to chest pain off and on from 4 this morning which has now settled.

Just had a planned telephone consultation with a doctor not my consultant on his behalf. I told him I was feeling worse and was having more pain.

He suggested increasing my current meds but I'm on the highest dose already.

Then suggested amlodipine which I had to stop because of swelling.

I asked one question which was is my diagnosis MVA or coronary spasm. I asked this because both have been mentioned previously and I'm a bit unsure.

He just said that both are treated with medication so it didn't matter anyway, and the only way to be sure is to have more invasive tests.

So he suggested trying either diltazem or nicorandil ?

Does anyone have experience of either of these drugs

I get what he was saying especially in the current situation, but he couldn't get me off the phone quick enough, clearly had not read my notes and his attitude did not reassure me or fill me with confidence.

Feeling a bit sorry for myself now 😢

[MichaelJH Heart Star]

Diltiazem is a CCI (calcium channel inhibitor) and is one of the first choice drugs for all types of angina. I found it quite effective for stable angina caused by narrowing of four coronary arteries. Nicorandil is usually prescribed where CCIs are ineffective or not tolerated. I would suggest you start with the Diltiazem.

Note: Please bear in mind I am not a medical professional.

[Sunshinebrew in reply to MichaelJH]

Thank you that’s helpful I’ll be speaking to my GP about it and discussing it first. I like to be as knowledgeable as possible

[Milkfairy Heart Star]

Hello Sunshinebrew

I am sorry to hear you didn't have a positive experience.

As all of us know living with Microvascular and or vasospastic angina that unfortunately the knowledge about these heart conditions is not good amongst some Cardiologists.

I have been prescribed very high doses Diltiazem to try and prevent my coronary artery vasospasms.

Also a small dose of Amlodipine as well as top doses of Nicorandil.

However I do have a confirmed diagnosis after invasive testing.

The treatment for Microvascular angina due to microvascular dysfunction is different to Vasospastic angina. So yes it does matter whether you have Microvascular or vasospastic angina!

I suggest you contact your usual Cardiologist for further advice.

[Sunshinebrew in reply to Milkfairy]

Many thanks this is helpful and reassuring unfortunately I don’t have any way of contacting the cardiologist I’m under and in fact have only seen him once. I’m just one of many patients on his list and have been assigned to other doctors from his team.

I could make a fuss but I’m not sure it will get me any benefit not sure my consultants an expert either and would say any different and I wouldn’t want any further tests done especially now with COVID

I will speak to my GP and try the new tablets after discussing with him, I’m a bit more informed now with yours and Michaels replies

So glad I’ve got this site to get support and advice

Thank you both

[Grandma63]

Hi I was diagnosed with MVA a few years ago which on my last visit to see my cardiologist, he said was due to vasospasm. I have been taking Dilzem for a while now and it has helped. I struggled with Nicorandil as it gave me bad headaches. I hope you get your medication sorted, it’s so important to get the right one to suit you.

[Sunshinebrew in reply to Grandma63]

Thank you for your reply it is helpful to hear from others with the same and similar conditions

[dunestar]

Honestly Sunshinebrew no wonder you are feeling down in the dumps with such a disappointing consultation. As Milkfairy has said MVA and vasospastic angina are two separate conditions. Some people have one or the other and some have both. There may possibly be some commonality in treatments but equally there are some contraindications. I hope his vagueness was because he hadn't read your notes rather than he genuinely didn't know. But that is bad enough. You can't go prescribing if you are not sure what the condition is.

[Sunshinebrew in reply to dunestar]

Thanks for understanding makes me feel much better

[Fluffybee]

Sunshinebrew

So sorry you’re feeling so unwell, I know like a lot of us I think, that Dr’s don’t always have a bedside manner, but being reassuring and understanding should be basic nature.

I haven’t had experience with either of those meds so I’m sorry I cannot help there.

Do you think it’s worth ringing the nurses to get advice?

Was the pain you had during the early hours the same pain you usually get ?

Don’t feel sad, we’re all here for you 🤗

[Sunshinebrew in reply to Fluffybee]

Yes same pain but hasn’t been so bad for ages

I’m fine today just tired and breathless and I’m over my grump feel better talking to others

Could be worse 🤗

[Fluffybee in reply to Sunshinebrew]

It does really help talking on here doesn’t it, take things easy, big hugs 🤗🤗🤗

[Sunshinebrew in reply to Fluffybee]

Definitely helps a lot

[Bradshaw278]

Hi Sunshine brew

I had big doses of Diltiazem plus Nicarandil after a stent. I started exercising and then they removed the nicorandil and the doses of Diltiazem went down and down and after twelve months I got off it. I also have low blood pressure and heart rate due to years of exercise. My exercise went stronger and stronger and with it the docs reduced the medication.

This year I had Coronary Artery Spasm and was put on Amlodopine rather than returning to Diltiazem. To start with I had side effects but those have passed. Am on 5 mg. I am on it to open arteries, not to reduce blood pressure but it does that as well. However I had not realised that due to three years of heart and cancer treatment I was displaying symptoms of anxiety. Now I have understood that I am getting that under control and my heart spasms are very much under control too. My spasms may also been provoked by stress and it is a dimension to bear in mind. My prostate cancer is very much defeated now. An endoscopy revealed no problems either and the relief has allowed me to recover. I am insisting on a medication review at my next appointment in November.

If you get poor treatment then go private and see a consultant from a heart specialist hospital. There is a great difference between the expertise of the Consultants at say Liverpool Heart and Chest and the Cardiologist at your local hospital. I now only attend appointments at Liverpool.

[Sunshinebrew in reply to Bradshaw278]

Thanks for replying I also have 3 stents in my LAD I’m hoping now that once I start the new meds I will be able to increase my activity at the moment I’m struggling to walk everyday without becoming breathless and having chest pain.

I do find also that getting stressed brings on symptoms but it’s hard to stay stress free especially at the moment

But your reply is encouraging and I’m feeling more positive now, good to hear you’re doing well

[Twalsh244]

Hello can I ask what symptoms you have? I too am under investigation for Coronary spasm and just wanted to compare

[Sunshinebrew in reply to Twalsh244]

Hello TwalshYes, my symptoms are chest pain which usually happens early morning and feels like a tight pressure around chest and upper back. It isn't a sharp pain but it stops me doing anything and can last a while sometimes up to an hour. I sometimes take the spray which eases it a bit but I always have to rest until it goes completely and it leaves me feeling so tired I have to rest for a day of so. In between I'm fine and can go for walks etc. Since changing meds from nebivolol to adizem I have much more energy and much less breathlessness. The symptoms come about once a week. I'm still working with my GP and cardiologist to get the best outcome hoping to reduce the number of times I get symptoms. They are still not sure whether it's MVA or coronary spasms, I may need a further test but at the moment just trying to live with it.

Hope this helps you

All the best

[Milkfairy Heart Star in reply to Twalsh244]

Hello Twalsh244,

The symptoms of microvascular and vasospastic angina can be very similar.

I live with vasospastic angina and mine was confirmed by an angiogram using acetylcholine to induce my vasospasms.

Coronary vasospasms tend to occur at rest in particular between 12 midnight and 6am.

I can exercise and get my pain at night which often wakes me about 4am.

The BHF has this information about microvascular and vasospastic angina.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

There is also this website established by 4 patients living with microvascular and vasospastic angina. They have over 25 Cardiologists supporting their initiative.

internationalheartspasmsall...

[Sunshinebrew in reply to Milkfairy]

Hello Milk fairyI have just clicked on the last link and looked at the information and watched the video

This is fantastic so good to read and watch loved it and gives Hope for better diagnosis and treatments for the future.

Hope your feeling ok

[Milkfairy Heart Star in reply to Sunshinebrew]

Hi Sunshinebrew,

I am glad you found the website helpful. It was written for patients by patients with a hopeful positive outlook.

I am doing okay thank you. I had a trip into hospital just before Easter came home and broke my ribs....ouch!

However I am on the mend now and my puppy is now a year old and keeps me occupied in the best of ways.

I hope you manage to get your symptoms under better control and you can enjoy life even more.

[Sunshinebrew in reply to Milkfairy]

O no very painful Glad your feeling better now

Good weather on the way too enjoy the summer!

[beemiles]

Hi, I’ve experienced this kind of apathy for over 3 years now, and still don’t have a diagnosis. I’ve even suggested MVA and vasospasms myself as 5 visits to A&E over that period, with severe chest pain, have yielded nothing more than a suggestion of gastric issues. I’m now waiting on a CT angio.I’ve even been told by a cardiac nurse that if it was MVA/vasospasms, ‘there is no treatment anyway’!

I personally think the cardiac profession need a kick up the backside with regard to diagnosis protocols and support for chest pain, and this has nothing to do with Covid.

Hope something materialises for you

[Sunshinebrew in reply to beemiles]

Sorry to hear this and it doesn’t surprise meHave a look at the links from milkfairy in the previous answer offers some hope for the future and keep pushing for yourself

Wishing you well