Various incl Variant Angina

[Smileyian]

As posted before, nearly 40 years with a myriad of different arrhythmia incl Afib (much better after 3 Ablations). However now the unknown world of likely Variant Angina which came totally unexpected. Of course at 77, I am concerned as I always thought "Angina" was the beginning of the end. However after reading many of your posts, esp Milkfairy's, I realise this may not be the case and someone my age and indeed those younger, may have many years ahead, even decades. With all my heart arrhythmia/palpitation history, I never had a single pain until 18 months ago and am still trying to understand Why now and where does one go from here. Please do comment as I have Elephant Ears for you all. 😀

[Sunnie2day]

My cardiologist has me listed as having 'angina with normal coronaries - presumed microvascular angina' and looking back it appears I've had it for decades, at least since the mid-late 1990s. I'm still here and apart from being in the middle of another acute flare of my recurrent pericarditis, apparently microvascular dysfunction, if managed carefully, isn't a game-ender. Usually.

In my case, a low-dose beta blocker (Bisoprolol 1.25mg once a day) seems to have it 97-99% controlled (heat and humidity bring it on but it only lasts a few seconds, so quick I rarely have time to get the GTN out of my pocket). I have a few other heart conditions but the beta blocker seems to be helping those as well. But it is a constant worry, at the back of my mind is the thought if I become complacent I'll dismiss signals of something dangerous.

The thing about 'variant angina' is it can be microvascular dysfunction presenting as different types, microvascular angina (MVA) like mine is beta blocker helped BUT vasospastic angina (VA) is made worse with beta blockers, and then there is the combination of MVA and VA and getting medications right for that is very difficult.

All we can do is make every effort to learn, learn, and learn more.

[Smileyian in reply to Sunnie2day]

An excellent post. Very educational with some similarities to myself. We all learn a lot from each other on here. Thank you

[Milkfairy Heart Star in reply to Smileyian]

I would like to make a clarification.

Variant angina also known as Prinzmetal angina/ coronary artery spasms now more commonly known as Vasospastic angina effects the large coronary blood vessels the coronary arteries.

This type of angina occurs at rest usually in the night between midnight and 6am.

It is a distinct condition from Microvascular dysfunction,

which effects the small or microvessels only. Patients with MVD tend to experience their chest pain in response to exercise.

Microvascular dysfunction is when the small blood vessels fail to dilate or stay dilated in response to extra demands such as exercise.

It is diagnosed when a person's coronary flow reserve (CFR) is below 2.

Also with an increased index Microvascular resistance (IMR)

Vasospastic angina is not a type of Microvascular dysfunction as it is due to temporary transient constrictions of the coronary arteries though some people have vasospasms in their small blood vessels. The CFR and IMR is normal in this group of people.

Just to make life confusing Microvascular dysfunction and microvessel vasospasms are often both referred to as Microvascular angina.

The disease process is thought to be different for Microvascular dysfunction and vasospastic angina and hence the treatment options.

This article has some good tables illustrating the differences between the conditions.

See table 2 and figure 4.

eurointervention.pcronline....

Wishing everyone a lovely peaceful and restful Christmas and healthy New Year.

[Sunnie2day in reply to Milkfairy]

Milkfairy, those of us with any of these conditions continual ask ourselves what we would do without your knowledge. Thank-you for clarifying, I did think all these were part of a 'microvascular dysfunction' group but I know better now having read your post here, thank-you!

[Smileyian in reply to Sunnie2day]

Sunny, I have struggled to find someone like yourself who have possible Angina for "a few seconds". I have a pain or discomfort at times which may only last 5 or 6 seconds and immediately dissipates. I may get this once a week but actually am questioning if this IS part of my Spasm problem. All advice seems to suggest that such a short pain is unlikely to be any type of Angina but more likely Gerd or Hiatal Hernia. I still believe my few second pain is cardiac related and wondered apx how many seconds yours would be...... like you, I have no time to respond with GTN. Any suggestion would be most appreciated. Tks.

[Sunnie2day in reply to Smileyian]

I don't think I'll ever forget overhearing my cardiologist telling off the nurse when she said she thought I was imagining the very quick flash of stabbing chest pain. She thought I couldn't have heard the ensuing dressing down she got and when she came back into the exam room I pretended I hadn't.

Long story short, the pain showed as a very brief very high spike on the exercise ecg she insisted couldn't be indicative of any sort of real angina and he came right back at her so strongly I was glad they were out in the corridor and not in the room with me. That was the first time I heard the cardiologist suggest it might well be a condition called microvascular angina and she should be doing some further reading on the topic rather than dismissing patients as frauds. He then insisted she review all her similar reporting patients to see if she'd missed anyone out. (The only reason he saw that spike on the print-out was owing to one of the other nurses taking it to him the second I was off the treadmill and trying to recover on the exam table she helped me onto).

The only thing I can suggest is what I think you already do - a prophylactic hit of the GTN before heading into anything strenuous physically or mentally.

I'd laugh (in fact I'm smiling at the memory) about the mental part - whilst dressing the Christmas tree this year my husband became increasingly tetchy, so much so I could feel my patience possibly being diminished...I put my hand up, reached for the GTN canister and said 'Hold on, I need a shot of GTN before the row gets into full swing!'

By the time I got to the sofa and took the spray he and I were both laughing but it really wasn't funny, not really.

But the prophylactic spray does work and the effect seems to be of sufficient duration to get me through the row or the supermarket 🤣 Of course that's only if it has time to be prophylactic - sometimes we have to move fast without advance notice. When that happens I tell myself it will pass quickly, and hope I'm right. Usually I am.

[Sunnie2day in reply to Smileyian]

Btw, I've been checked for non-cardiac related reasons for that flash of pain and all have been ruled out.

I do have nerve damage from a motor wreck (happened in spring 1973 and left me with the nerve damage and a few other 'treats' like essential tremor) and it's progressed to a condition called thoracic outlet syndrome (TOS). The pain that brings on is so similar to angina and also an acute flare of pericarditis that my orthopaedist thought my reports of chest pain were down to the TOS back in the late 1990s - and as a consequence what was actually pericarditis was not considered until I collapsed on the evening exercise walk and had to be blue-lighted, ended up having to watch and feel (no time for the pain meds to take effect) a tube inserted to drain off the cardiac tamponade (extreme pericardial effusion).

That orthopaedist never stopped apologising for missing the pericarditis - but he was spot-on the pain is so similar it is almost impossible to differentiate from angina. I'm now at a point where if the pain persists past the 5-10 seconds I know it's really (usually) the TOS and not the presumed (not been definitively diagnosed owing to the pandemic delays for the test) MVA. I say usually because pericarditis pain doesn't go away either when an acute pericarditis flare is coming on.

Ah, the quite dubious joys of having multiple conditions - so so so dubious, those 'joys'!

[Smileyian in reply to Sunnie2day]

Hi Sunnie, I have read your various long messages over and over and cannot be more grateful for what I have learnt from you. You sound as though you have a fantastic sense of humour which can be "off beat" at times, just like mine. I did not have a Christmas tree this year hence no chance of arguing with my wife which ball should go on which branch hahaha. Tks also for your private msg - my wife sends her thanks and best wishes to you. Talk again.