Angina and ECG: I have just come home... - British Heart Fou...

British Heart Foundation

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Angina and ECG

Mazmum
Mazmum

I have just come home after 2 days in hospital following an episode of prolonged chest pain which I treated with GTN spray, but which kept coming back over several hours. Doctor in A&E diagnosed heart pain and I was admitted. Kept having episodes and was put on a GTN infusion, which helped the pain but made me feel terrible. They had to keep stopping the infusion because it made my blood pressure drop too low. I saw a locum cardiologist today who said that as my ECG was normal it couldn’t be heart related, even though the pain felt like someone standing on my chest and radiated to my back. I have been sent home on loads of heart meds, so I’m feeling really confused. Any ideas?

48 Replies

Sorry to hear what u had to go through, and hope u are feeling better.

I too would be interested to hear from anyone knowledgeable on this subject.

Is a locum cardio the same as a cardio based in the hospital? Can one make a chest pain diagnosis based simply on an ECG? Plus it's a fact that ECGs only catch whatever's going on, only when something's happening.

I had an internal medicine doctor tell me that as my ECG was normal, the chest sensations I had experienced was not a heart attack. And so refused me a troponin test. The cardio I subsequently saw, said the internal medicine doc was incorrect re the ECG.

Best wishes.

Mazmum
Mazmum in reply to ling

Thanks for the reply. My confusion sent helped by being sent home with heart meds prescribed by the same consultant. I now have Diltiazem, Nicorandil, Isosorbide, clopidogrel, Aspirin and a GTN spray for chest pain that he says is not angina!

ling
ling in reply to Mazmum

😂

Chief_68
Chief_68 in reply to Mazmum

😜 Sounds like you have angina or a hypertension thing going on at least.. Good luck.

Mazmum
Mazmum in reply to Chief_68

Thanks. Definitely not hypertension, but surely it must be angina?

Smileyian
Smileyian in reply to Mazmum

Goodness, I would not be happy with this situation. Please don't be fobbed off with "its not heart pain" unless proven. Sounds to me very much like an angina attack but do follow up as they have given you the usual medicines for Angina. An ECG is not the best tool for diagnosis, especially if hours after the attack. Really don't know what to add.

Shoshov
Shoshov in reply to ling

hi when i was having my heart attack my ecg was normal. only when troponoin came back at 805 did they pay attention

ling
ling in reply to Shoshov

Thank you!

What were your symptoms during the heart attack?

Shoshov
Shoshov in reply to ling

i thought i had indigestion for 2 days which i don’t really suffer from normally. on second day i started to feel really ill. sweating dizzy. saw doc and he gave me indigestion tablets. about an hour later thought i was gonna pass out. really ill feeling and then pins and needles down left arm which i knew was heart attack as dad died of that. by the time i got to hospital i was fine. even told the doc i fealty like a fraud. good luck in your journey. don’t be fobbed off. i have found you have to be firm and be your own advocate. let us know how you get on ❤️

ling
ling in reply to Shoshov

Thank you very much for taking the time to share your experience.

Shoshov
Shoshov in reply to ling

your welcome. hope it helped in some small way

I had Angina symptoms last year. My ECG etc was fine but a narrowing of my LAD artery only showed up on a CT of my heart...have you had a CT scan yet?

ling
ling in reply to Lad0820

Which CT scan is this?

What treatment are you receiving after the scan?

Thank you

Lad0820
Lad0820 in reply to ling

I had a CT scan of my heart that identified the narrowing. This was followed by an Angiogram that resulted in a stent being fitted. I have to take Clopidogrel (75mg) daily for 6 months whilst the stent settles in and then am on a statin and dispersible aspirin daily for life...

Mazmum
Mazmum in reply to Lad0820

I'm glad that something is being done about your problems, and hopefully all will be plain sailing from now on.

ling
ling in reply to Lad0820

Is the CT scan the calcium scoring scan?

Did u have any symptoms or high cholesterol results prior to the CT scan?

Mazmum
Mazmum in reply to ling

I haven’t had the CT yet, and haven’t heard of calcium scoring. I obviously have so much to learn!

ling
ling in reply to Mazmum

I saw in one of your replies you are waiting for your angiogram. That test would be the gold standard for checking blockage in heart arteries. If there's blockage and its not 100%, stenting can be done to keep blood flow going.

My mum had an angiogram as well, and no serious blockage found. I suspect that's one of the reasons why she's not had any chest pains or angina to date, though she still carries her GTN around just in case.

Lad0820
Lad0820 in reply to ling

CT scan is Computerised Tomography also known as a CAT scan. I had high bad cholesterol but also high good so was under no treatment for it. Also blood tests showed no high calcium levels...

ling
ling in reply to Lad0820

So it's a little invasive as in dye was injected?

The calcium scoring test is different as in totally non invasive, more like x ray.

Sorry, I missed your question earlier. No CT scan for me yet, just the calcium scoring scan. My LAD is not in good shape. But I haven't yet checked out how calcium scoring results translate to an angiogram as in how blocked up my LAD actually is. My cardio has prescribed astorvastatin 20mg.

Thank you very much for your replies. Taking your cue, I think my next heart step should possibly be angiogram and stenting if the blockage is bad.

Lad0820
Lad0820 in reply to ling

Yes the CT scan uses contrast die to highlight any narrowing. Good luck on your journey...

ling
ling in reply to Lad0820

Thank you very much. The same to you.

And thank you very much for sharing your experiences with me. I really appreciate it : )

I hope they get to the bottom of this please keep perusing this I'm waiting to have a CT scan for similar symptoms my ecg and ultrasound were clear apart from a bit of regurgitation. I think l have angina my pain happens a lot mainly when I'm cold. Please keep us posted

Mazmum
Mazmum in reply to kingsnorth

I am on the waiting list for an “urgent” CT coronary angiogram since I first saw a different cardiologist at another hospital in November. Apparently the two cardiologists cannot communicate because the hospitals are in different trusts!

kingsnorth
kingsnorth in reply to Mazmum

Hopefully you don’t have to wait too long. My gp told me they arnt doing angiograms because of covid and that l may have an MRI I’m waiting to have a 24 hour monitor. I have a telephone consultation booked for March. I don’t get breathless thankfully

For the last 3 horrid years my GTN spray has been my best friend!

I won't go into my lengthy turgid experiences of utter professional ineptitude that even my GP has been enraged about.

But I am on the receiving end of guessology medication prescriptions from the specialists at Papworth and Peterborough City Hospital where I honestly don't believe they know what is wrong with me!

Up until all my problems began I was an exceptionally fit an active man riding my bikes on extensive high speed cross country rides as well as walking my dogs across the fields for 4 miles each time twice daily, but then my life changed. Now I can only look at my bikes and my field walks are a fraction of what they used to be and more often than not, my chest pains being very restrictive and at times causing me to double up in pain!

Some of my walks will see me taking as many as 6 double doses of GTN in a 90 min. period, yet on other slightly warmer drier days I don't need my GTN at all.

My heart rate can be very irregular at times where it can do 3 or 4 normal beats followed by it missing 3 or 4! My bloody oxygen can go right down as can my blood pressure as well before them then both returning to a very healthy and strong state.

My condition has perplexed the consultants at Papworth and yet I have been discharged as it would appear after an enormous number of tests that they don't know what is wrong with me, however both my Coronary and Respiratory consultants have instructed me to contact them directly on an SOS basis, short circuiting out my GP!

Some believe my problems have been stress related, with this in mind we have recently moved house to get away from a vile, foul mouthed neighbour and I have to admit that for a very limited amount of time my condition did improve, but now it is very much as it was before.

I know that changes in diet doesn't improve matters and neither does cutting out any alcoholic drinks. All I do know is that I can only dream of my former life.

I’m sorry to read about all you are going through. It was a consultant at Peterborough who said he was sure I had some form of CAD, but he was also a locum, so who knows if I’ll ever see him again. The doctor yesterday flatly said that he didn’t believe it! I think I just have to plough through my carrier bagful of meds and see what happens.

ling
ling in reply to Mazmum

Has your cholesterol levels been checked? Any high BP?

Mazmum
Mazmum in reply to ling

Cholesterol 7, BP within normal range.

ling
ling in reply to Mazmum

Any cholesterol meds?

Mazmum
Mazmum in reply to ling

No, just a diet sheet. I’m normal weight and vegetarian, so can’t see much I can change.

ling
ling in reply to Mazmum

Cholesterol 7, that's total cholesterol? Do u know the range?

LDL and triglycerides ok?

Re weight. I'm normal weight as well. My cardio was pretty sure my arteries were ok prior to testing. She didn't, as per most doctors nowadays, check with me for my health history. Otherwise, she would have different expectations of my test. I could have told her so if she had asked : )

My point is weight is not a good predictor of how blocked up one's arteries can be.

Vegetarian. Have u been vegetarian most of your life?

How's your diet been most of your life? Specifically refined carbs, saturated fats, sugar?

My lifelong dietary habits have caused my LAD artery to be in the state its in : (

Mazmum
Mazmum in reply to ling

I’ve been veggie since the 80s. I’ve made an appointment to speak to GP tomorrow to try to understand all this.

ling
ling in reply to Mazmum

Good for you!

Sunnie2day
Sunnie2day in reply to Mazmum

Making clear I am not medically trained, the meds you describe earlier on this discussion are the ones most people with microvascular dysfunction of one sort or the other (microvascular angina and/or vasospastic angina, beta blockers work nicely for microvascular angina but badly for vasospastic) are given - did the prescribing medic say anything about the possibility you have one or both conditions?

Please keep us updated. It takes a while for heart meds to really make a difference and often part of that process involves repeated attempts by the medics to get the dosage and type right for each patient.

Mazmum
Mazmum in reply to Sunnie2day

That’s a very helpful response, thank you. The confusion is because he sad he didn’t think it was my heart at all!

Sunnie2day
Sunnie2day in reply to Mazmum

Er, yes, that's sometimes what 'they' say when ecg and troponin results don't scream heart attack.

Hopefully your GP will now refer you on to the Rapid Access Chest Pain unit where your symptoms will be investigated, you'll be told it's not your heart owing to the ecg and troponin results of their initial tests, but then you'll be sent on to the cardiologist who will fully investigate (echocardiogram, then CT or MRI or the gold standard angiogram with or without provocation) and a diagnosis based on the deeper investigations made.

If it doesn't happen that way (the RACP unit and cardiology referrals), be a nuisance. Trust me.

Mazmum
Mazmum in reply to Sunnie2day

Thanks, will do.

Fluffybee
Fluffybee in reply to Mazmum

Hi

I had a similar experience, I’ve had all the tests, few things not 100% but diagnosed with micro vascular dysfunction, my local hospital doesn’t have a cardiologist who specialises in this so now waiting for a referral to another hospital to get more specialised care.

Definitely something worth asking about like Sunnie2day says

Fluffybee
Fluffybee in reply to Sunnie2day

Hi Sunnie2day

Took the words out of my mouth, 🤗 x

I've had similar experiences as yours and I went to A&E. First, an ECG was done and then a blood test to see the troponin level. On one occasion, the troponin level was high and rising and I was hospitalised. for 4 nights After having gone through all the regular tests (CT Scan , etc), I have been finally diagnosed with Microvascular Angina. The pain you had sounds very much like angina.

Mazmum
Mazmum in reply to monotone

Thanks, that is reassuring. My troponin levels were not raised, but I’m not sure how significant this is.

The troponin level will indicate whether you've had a heart attack. It is one of the tests that is used according to my GP. There will be a record of your normal troponin level and if the blood test shows a substantially higher level than normal, then they suspect that you may have experienced a heart attack. I am on a load of medication, too, and I am hoping they will help with the angina pains. I was advised recently to use the GTN spray as soon as I have the slightest pain to stop it. If one waits until the pain gets worse, and use the spray then, it won't help. I'm just learning how to manage my angina and you will, too.

Thanks. I was given the GTN spray with no recommendation as to when and how often to use it, so was waiting until the pain was really bad, since I hate the taste! Plus it gives me a headache and I almost fainted after taking it. I read in someone else’s post that it is better yo sit down when taking it, and I can see why now!

ling
ling in reply to Mazmum

Yes, please do sit down before using the GTN. The pharmacist so advised my mom when dispensing the med to her.

My heart attack presented as pressure. My ECG was normal but my Troponin levels were raised which meant I'd had a heart attack. Keep pushing on this. good luck.

I would definitely seek a second opinion from a regular cardiologist at ur local hospital even ur gp will have a discharge summary so can tell u exactly why u have been given all these medications,It’s could all be as a preventative measure for example have other health issues, high blood pressure, cholesterol issues, age, weight and family history

I had a similar experience, Christmas Eve. My ECG was normal. But my Troponin via blood tests was 18/19. A&E thought heart attack and treated me for one with injections etc. Then in MAU not heart attack but posdible Angina. Then one doctor on MAU suggested it was Gastric and sent me home with Omeprazole. I was back in on 27th December with chest pain again, not with the same wave of nausea / faintness (Troponin was 10) and A&E saying Angina. I was sent home with GTN.

I'm waiting for an Angiogram. My GP downloaded the hospital notes. Was surprised over treatment on Christmas Eve. I'm now on a cocktail of beta blockers, statins, aspirin and the Isorsorbide Mononotrite.

There is one other condition that can mimic heart pain apparently and that esophageal spasms, but they don't effect Troponin. I'd never heard of them. But from what I gather nitro meds can alleviate them as well. The only real way to differentiate if they aren't sure is via the Angiogram.

I've read so much over the last couple of weeks as I was left very confused and a little mistrusting because of my experience Christmas Eve. To go from the shock of being told I've had a heart attack to being sent home with Omeprazole was just disconcerting.

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