Update: So the Coronary Angiogram... - British Heart Fou...

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Update

SloopyLJ profile image

So the Coronary Angiogram complete. It was ok, the staff were lovely and cardiologist answered all my questions. I didn't really feel anything other than an ache when they were feeding the tube through. I told them I was very nervous and asked if they could give me something to help relax me and they did. Worked a treat! I'm already at home and had the procedure this morning. I have an achy wrist/arm but that's it.

Results - well my arteries look fine, no signs of CAD and definately no signs of having had a heart attack. I did ask about Microvascular / Coronary Artery Spasms. But they said they don't do the test for Coronary Artery Spasms anymore. They work on the basis of ruling things out. So they are keeping me on my current medications as they are controlling the chest pain but are referring me to Gastro to rule out issues with my Esophagus. Makes sense as I understand that Coronary Artery Spasms and Microvascular Angina are controlled by the meds I'm already on and that chest pain can also be caused by problems with the esophagus so they have to rule that in/out, whichever way it goes.

So I'm extremely relieved I did not have a heart attack at Christmas and that I haven't got CAD and haven't had to have a stent. I feel I'm finally getting answers. It makes a huge difference to my mental health.

I know I've been posting everything that's happened to me. I'm hoping it may help anyone else going through similar experience. I've found this forum so helpful along with the information on the BHF site. So will keep posting until full diagnoses is finally made.

18 Replies

Hi SloppyLJ,

I have had many esophageal spasms and was told to always go to A&E and have them checked out as the pains are very similar to having a heart attack. After a few spasms I found a trick that stopped the pain, In August 2019 I had another spasm I tried my usual trick and rested for a while the pain eased a little bit but didn't go away, the following day the pain got worse, I took myself to A&E and after the tests etc, I was told I had had a heart attack. After I had a stent fitted I have been fine.

SloopyLJ profile image
SloopyLJ in reply to TuckBox2

Blimey it sounds like you had Angina leading up to the hear attack. Out of interest did they ever refer you to Cardiology for a CT scan?

My GP referred me to Cardiology first. I've had a few conversations with a number of doctors and today with the Cardiologist. It sounds like it's so difficult to differentiate between the two without Angiograms and if required an Endoscopy.

From what I gather the pain signals go through the same nerve and angina can't be ruled out if a CT scan or Coronary Angiogram is clear as you have the additional complication of Microvascular and Prinzmetals which are difficult to diagnose.

I'm glad they managed to help you and you're feeling better. Whatever this chest pain is of mine it was really causing me problems, stopping me in my tracks so to speak and causing a problem overnight. But it is being controlled by Isorobide Mononitrate. But I'll be glad when I have the final verdict so to speak.

TuckBox2 profile image
TuckBox2 in reply to SloopyLJ

My spasms started a while after I had a fundoplication 2009 for acid reflux and I used to have them every 3 to 4 months. I did have some CT scans, echocardiograms, endoscopy etc but nothing showed up. I had 2 bad boughts of diverticulitis April 2019 and they found a benign tumour on one of my adrenal glands and I had my heart attack after having some follow up tests. This put further tests etc on hold, then I had an AVS last March to determine which gland was faulty, I was put forward for surgery after but we were then all put on lockdown so this has been put on hold again. I have had some troubles which I was started on Isosorbide Mononitrate in January and things are settling down again now.

Sounds as if your angio went better than mine. Think I had a learner driver on the first attempts. The consultant finally did it through the femoral artery, which went fine, but is a bit of a wotsit for the aftercare. But I suppose new docs have to learn. I would never refuse a learning opportunity for trainees without very good reason.

SloopyLJ profile image
SloopyLJ in reply to RufusScamp

Yeah I don't think my post would have been as positive if my experience had been like that! I was really nervous. The angio went fine. I'm just questioning whether I need an aspirin a day and Briscopol now. Whatever pain I have the Isorobide manages. If it's a gastro problem aspirin would antagonise that. If it's coronary artery spasms my understanding is that calcium channel blockers are better than beta blockers. Will wait for the GP to contact me to discuss.

Wilddatepom profile image
Wilddatepom in reply to SloopyLJ

Yes from my understanding beta blockers can make spasms worse. But that is just from my research I’m not at all medically trained!!

SloopyLJ profile image
SloopyLJ in reply to Wilddatepom

Me neither. I was asked by the cardiologist if I was yesterday. I said no I'd just had time to research. They mentioned Google quite flippantly. I wish I'd corrected them and said no the BHF site but at the time I was taking in what he was saying and didn't want to sound like I'd taken offence. I hadn't.

Milkfairy profile image
MilkfairyHeart Star in reply to Wilddatepom

Beta blockers are contraindicated by the NICE angina guidelines for patients with vasospastic angina.

I ended up in CCU for 5 days after I was prescribed beta blockers before my diagnosis of vasospastic angina was confirmed by an angiogram with acetylcholine.

It's written all over my medical records NO BETA BLOCKERS!

SloopyLJ profile image
SloopyLJ in reply to Milkfairy

Thank you Milkfairy, I will be discussing it with my GP now they've ruled out CAD. I'd rather come off them and stick with the Isorobide Mononitrate. Whatever they diagnose now that definately has helped.

In vasospastic angina, yes, beta blockers worsen.

But in microvascular angina, beta blockers are amazing, absolute game-changers. I'm on Bisoprolol 1.25mg+300mg aspirin once a day for nearly two years now and honestly have never felt this good - even through two acute flares of my recurrent pericarditis. I cannot imagine trying to get through a day without that wee white tab every morning.

Glad it went well for you. I now laugh at the fact that at my angiogram as they were taking everything off me, I was thinking that’s great I didn’t even need a stent. Then once I was off the table they hit me with “you need a quadruple heart bypass”. I didn’t laugh at the time- but nearly 2 years later I can now laugh!!

SloopyLJ profile image
SloopyLJ in reply to Gail1967

Yikes - I'd have needed more of the happy drug if they'd have told me that. I felt extremely lucky yesterday I have to admit. Further tests and final verdict required. But I haven't got CAD so one down.

That’s really helpful SloopyLJ, I have variant / Microvascular on my radar as potentially what happened to me (although the cardiologist has ruled it out without any tests for it) so good to hear what you’ve said and what you’ve said below. Encourages me to seek another opinion. Glad the test wasn’t too bad.

Milkfairy profile image
MilkfairyHeart Star

Your Cardiologists response about testing for Microvascular dysfunction and vasospastic angina is not quite right. Their response reflects their lack of knowledge of the conditions.

Testing for Microvascular dysfunction and vasospastic angina is most certainly taking place. It needs to be carried out at a larger heart centre by an experienced Interventional Cardiologist.

Often patients with vasospastic angina experience spontaneous coronary vasospasms during a rountine angiogram.

Lots of chest pain and ECG changes such as ST elevations and depressions are seen, not something that should be overlooked by any Cardiologist during an angiogram.

A Cardiac MRI can detect some types of Microvascular angina due to Microvascular dysfunction.

Why is diagnosis important, because the treatment for Microvascular angina is different to Vasospastic angina.

academic.oup.com/eurheartj/...

Milkfairy profile image
MilkfairyHeart Star

This is from the European Association of Percutaneous interventions consensus document

How Microvascular and vasospastic angina are diagnosed during an angiogram
SloopyLJ profile image
SloopyLJ in reply to Milkfairy

Thank you! That's really useful. I'm guessing our hospital just doesn't do the procedure. Im in limbo again now as they've referred me to Gastro for an endoscopy, to rule out issues with my Esophagus. I understand as they need to rule it out. But getting diagnosis is just such a long winded process thanks to Covid. I've got to wait for that procedure and results before I can push back really.

However they said to stick to my meds. The Isorobide Mononitrate definately works, it's a harsh drug side effect wise to start with but it's taken the chest pain away and is the most recent prescription, as I was using GTN frequently. But I'm going to ask about swapping the Beta Blockers out. I've never been convinced they were helping.

Milkfairy profile image
MilkfairyHeart Star in reply to SloopyLJ

You may need to travel.

Where are you in the UK?

Here are the recommended treatment options for MVA and vasospastic angina

Glad everything went ok .

Take care .

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