A&E visit question

[Buffy6956]

I’d been having fleeting left arm pain for the past six days which could come on at any time at rest or walking around so I figured this couldn’t be angina as that is usually excertional . I then thought the other scenario was “unstable angina” which can happen at rest but that usually gets worse not just stop. Anyway today I had shoulder pain similar to trapped air and a little jaw pain also an uncomfortable feeling in chest but up high so I decided to go get checked out at a&e.

Two ecg’s normal

Two troponin T completely normal

Other blood tests normal

So consultant said she has referred me to rapid chest clinic so they can check what it was or could be as she’s not a cardiologist so felt she would be foolish to brush it off as non cardiac although in her opinion all tests were very reassuring and angina usually happens with excertion and mine was happening at rest but she would of thought that if it was unstable it would get worse and not be fleeting.

Should I be reassured by these results?

Everything I’ve read about unstable angina says that ecg changes would show ST depression usually

Help please

[Highnoon]

Hi buffyhad heart attack yr ago ok now walk 3 or 4 miles every day no chest pain but at night in bed get shooting pains in my chest doc said not angina try not till worry but u do rite till get all checked out

[jwd52]

I also had a normal ecg and blood tests but was referred to the rapid chest pain clinic. Had an angiogram and straight away told I needed a bypass. It was August 2020 when I had a double bypass and I'm now feeling great.Better to be safe than sorry.

[Milkfairy Heart Star]

Hi Buffy6956,

Unstable angina which is classed as acute coronary sydrome can include

Vasospastic angina when the blood vessels in the heart go into temporary spasms temporarily constricting the blood flow to the heart.

Some people have both obstructive coronary artery disease and vasospastic angina at the same time.

Unfortunately vasospastic angina is often overlooked however if you are experiencing chest pain at rest especially between midnight and 6 am it something that should perhaps be considered.

I was admitted to hospital recently with unstable vasospastic angina with T wave inversions in 4 leads, my Troponin levels only slightly raised. I wanted to go home but the A&E Consultant thought otherwise.

I had all my pain at rest.

Hopefully the Rapid Chest Pain will be able to help determine what is going on for you.

[Buffy6956 in reply to Milkfairy]

Tks milkfairy Yes I’ve researched unstable angina and like you say it’s also called acute coronary syndrome.... usually caused by a small part of plaque breaking off and partially blocking artery... it’s an acute situation not a chronic one so I do get confused when people are saying they’ve had unstable angina for months? My pain is fleeting lasting no more than around 30 seconds each time I get it... but I’m also well aware you can have normal trop and normal ecg even if you have unstable angina although usually your ecg would show ST depression. I’m a logical kind of girl when helping others yet that seems to go out the window when it’s myself getting pain. Everything about my symptoms doesn’t sound like unstable angina because it’s fleeting and doesn’t get worse and it doesn’t sound like angina as it happens at rest as well as excercise? But the areas I’m getting pain are areas associated with the symptoms you can get with heart problems... it’s all very confusing. Hopefully they will do a nuclear stress test at rapid access clinic to see if they can produce and Inducable iscaemia on excercise as that test only shows blockages over 70% and my blockage was deemed around 40/60% do that test could determine if my blockage has increased in size. I hate all this not knowing and worrying. I try my best each time I get pain or discomfort to ignore it and usually I manage that by gaining confidence after each time by saying to myself well that was nothing. Also usually if I have any discomfort I will get up and excercise to see if it makes it worse or not as I figure that surely it would get worse in excercise if I had blockage right? But this time I just wanted to get it checked out... arrggggghh this stinks I hate it

[Tyronefitsimmons in reply to Milkfairy]

Hi Milk fairy, Just what is your opinion on just why after stents implants that quite a lot of people have very bad shoulder pains, and often after pain relief causes many other problems, , This is a question I get quite a lot , and so many different views,

[Milkfairy Heart Star in reply to Tyronefitsimmons]

There is growing evidence that while the obstructive cause of angina is ' fixed' by stents or surgery, a person may also have a functional vasomotion problem with their coronary blood vessels.Microvascular dysfunction and or vasospastic angina.

There is some research being carried out by the Coronary Vasomotor Disorders International Study Group COVADIS into this problem.

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

covadis.online/?gclid=CjwKC...

[Milkfairy Heart Star]

There is another cause of angina and myocardial ischaemia, non obstructive coronary artery disease ( NOCAD)

This includes Microvascular dysfunction and vasospastic angina. These conditions are more common in women.

I have unobstructed coronary arteries but still have myocardial ischaemia. It can be like walking on a tight rope living with vasospastic angina. However I have had the tests to tell me why I have my chest pain.

Not knowing the cause of your chest pain can I agree be very unsettling.

Do you have a GTN spray?

[Buffy6956 in reply to Milkfairy]

Yes I know about that condition however I do have iscaemic heart disease. My LAD and left main including all the small arteries off them are free from disease. My RCA had an 80% plaque now stented and I have mild atheroma in the proximal portion of the RCA (but probably almost all people my age would have the same amount tbh) and lastly I have a plaque around 40/60% in my Lcx deemed non significant after a wire study as it’s not obstructing blood flow

[Milkfairy Heart Star]

NOCAD is a type of ischaemic heart disease too.

escardio.org/Guidelines/Cli...

You can have both CAD and NOCAD at the same time, especially if you are a woman.

Have you seen Prof Angela Maas's book 'A Woman's Heart' ? it discusses how women are effected differently by heart disease.

[Buffy6956 in reply to Milkfairy]

No but I will look... ty .... what confuses me the most is I can be doing housework etc no pain then I can sit and rest... pain.... it just doesn’t add up... I have to go to work now this morning cleaning a clients house and I’m scared but I feel I need to do it to see if I get any pain

[XmasEve24 in reply to Buffy6956]

Yes that was me. Put up with ever increasing pain for years -pain is always in my back at rest. Then had an excruciating episode involving arm and jaw. Went to A&E where they found no sign of heart attack and discharged me. 3 months later had angiogram at Papworth Hospital next day had an emergency double bypass on widow maker -with 100% and 70% blockages on arteries. I was 61. Never experienced any pain through exertion only at rest. Don't ignore it and read Angela Maas book.

[Milkfairy Heart Star in reply to Buffy6956]

I can exercise and get pain at rest in response later at rest.

I hope your wait to be seen at the Rapid Chest Pain clinic is not too long.

Take care

[Buffy6956 in reply to Milkfairy]

Well I’ve just done a house deep clean that I’d scheduled for today.., proper hard work but did it didn’t get any pain anywhere... felt a bit dizzy two times right after each other but I was hot and bothered and was bending down cleaning img windows and hungry so think it may of been that... just took my blood pressure and it’s 128/74 pulse 77 so that’s ok as well.... I just think that surely if I had a blockage big enough to cause unstable or normal angina then surely it would react to hard work and stress wouldn’t it?

[Alessa69 in reply to Buffy6956]

Just reading your comment about being dizzy (above) make sure that you aren’t getting de- hydrated when you are working etc ? I know from personal experience that it can severely impact my HR & AF if I don’t pay attention to hydration .

[Tyronefitsimmons]

Please take notice of what you have been told, . pains in the shoulder after stents are normal , , get pain relief and get physiotherapy check with your GP, or A.E,

[Milkfairy Heart Star in reply to Tyronefitsimmons]

Not necessarily so. Your advice above is potentially harmful.

There are many forum members who have on going angina after stents and even surgery the cause either microvascular dysfunction or vasospastic angina.

All angina like pain needs to be properly evaluated by a registered healthcare professional.

You might be interested in this BHF Heart Matters article about a person who had chest pain following open heart surgery the cause a disorder of the small blood vessels in the heart, microvascular angina.

bhf.org.uk/informationsuppo...

[Milkfairy Heart Star]

Tyronefitsimmons,

Can I ask why you feel it necessary to be so offensive, rude and judgemental when you are challenged?

( I note your original offensive, rude and judgmental comment has now been removed by the moderators of the forum)