Recurring intermittent chest pains after NSTEMI heart attack

[Ericasuncle]

Hi. I am looking for some advice. I had an NSTEMI in December last year followed by 2 stents in my right coronary artery and a third blockage in the left was treated with an angioplasty. I am now on a selection of drugs including antiplatlet, blood pressure, statins, beta blockers, and angina drugs. Over the last few months I have had half a dozen chest pain episodes on my left side that appear for several days. I have followed the guidelines and taken GTN which has had no effect so I have gone to A&E. The blood tests and ECG always come back negative and I am sent home. I have had an echocardiogram which came back fine and I am waiting for another angiogram (delayed several times). The pains are not always strong, sometimes a dull ache which lasts for a few days and sometimes accompanied by a fluttering feeling. The angina meds don’t seem to have changed anything and I didn’t get these pains before the heart attack, so I don’t think they are muscular. Can somebody help me with the questions and avenues I should be asking my GP and the cardiology nurse? I haven’t been able to speak to an actual cardiologist since I left hospital in December and I am struggling to move forward with the rehab until this is sorted.

[Hidden]

I've had a similar problem for year now since a stent was fitted. I haven't got to the bottom of it yet. It could be costochondritis (but that typically doesn't last for a year), could be hypo-thyroidism (although my blood tests say otherwise), or it could be something called mast cell activiation syndrome (that I am edging towards due to other symptoms).

For now I'm tolerating it and trying not to worry as I've had it confirmed it is not my heart. Hope that helps a little.

[Ericasuncle]

Thanks for the reply. It’s strangely reassuring to know somebody else has similar issues.I’m currently working on the assumption that it’s heart related, as it began following the heart attack and associates treatment. So far my interactions have largely been with A&E who quite rightly check for a recurrence of a heart attack and send me home when that’s all clear. Due to lockdown my contact time with my GP and a cardiologist has been very limited so I’m stuck in this cycle. I assume other people on this forum have similar issues following heart attack and stents, so just trying to see what anecdotes and experiences others have had is helpful.

[Lee180]

I had this while at rehab and was told not to worry as it didn’t effect what I was doing in anyway and I’ve had these pains ever since then. I have just left it now as no one else seems too worried about them.

[Gizzimos]

HiI had similar story to yours, to cut long story short I’ve been diagnosed with Microvascular Disease (MVD) where the small vessels around heart spasm, and separately Prinzmetals Angina.

Giz

[Ericasuncle in reply to Gizzimos]

Thanks for the reply. I do wonder whether I have some sort of micro vascular problem or variant angina. Maybe the angiogram will give some indication. I’m just trying to understand if this is a common set of circumstances after a heart attack.

[Milkfairy Heart Star in reply to Ericasuncle]

Hi

I live with vasospastic angina which is the term now more commonly used to describe Prinzmetal/ variant angina or Coronary Artery Spasms.

During an angiogram the microvessels function can be assessed using adenosine and a guide wire.

Acetylcholine is used to assess for vasospasms.

Very few centres offer this type of testing at the moment.

I suggest you ask to be seen by a Cardiologist who has some understanding of Microvascular dysfunction and vasospastic angina.

The BHF has this information about Microvascular and vasospastic angina.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

This is a link to a group recently established by 4 patients who live with the conditions supported by 25 world leading Cardiologists.

internationalheartspasmsall...

[Tom2019]

Following the first stents (7) I had fitted I had chest pains too. I also had all the blood tests and ECGs come back normal. After discussing these with the rehab nurse I had various medications changed. It took a while but eventually I found a combination of meds that resolved the problem. 10 years later I had another stent fitted with no pains afterwards. My pain was always at its worst when lying down or squatting so one of them was affecting me with some sort of reflux type pain. This might be another route for you to explore? Hope you can get to rehab group soon as contact with others that have gone through the same will help as will exercise in a safe environment. You will worry we all do. You will be concerned about twinges and stabbing pains you would have not given a second thought too before. When I came home the first time I was scared to walk to my garden gate because of the pains that still occurred. Now I swim, play golf and can walk all day and I recovered after the recent stent in three weeks. Things will be a bit better tomorrow. The medics may fix the plumbing but its group like this that will get you though the recovery.

[Ericasuncle in reply to Tom2019]

Thanks for the reply. I will follow these up with the cardiologist, although I’ve just realised that I’ve fallen between the cracks. It seems because I’m having problems, I’ve been taken off the list for a follow up appointment with the consultant even though I’m due to have a second angiogram next week I still haven’t spoken with a cardiologist since my original hospital admission.

[Squash1961 in reply to Tom2019]

Hi Tom2019

Which drug (s) did you find were the culprits for the chest pain. I am in the same boat and trying to work through my medications to see which one (or combination) is causing my chest and stomach aches

Thanks

Squash

[Tom2019 in reply to Squash1961]

After changing most and being put on Omprazole and drinking gallons of Gaviscon to help the reflux it appears I can not tolerate a high dose statin. I am now on a low dose Atorvastatin (20 mg) and Ezetimibe (10mg) to lower my high cholesterol (famile) Lansoprazole 30mg ( reducing over next 3 months) Candesartan 4 mg Bisoprolol 2.5 mg and Aspirin 75 mg. I now have no chest pains and no reflux and no Gaviscon. Cardio nurse had to write to my GP to get me on Ezetimibe because of cost over statins.

[Squash1961 in reply to Tom2019]

Thanks Tom. My statin is next on the list to drop for 2 weeks to see if the chest and stomach aches improve. I’m only on 10mg of Rousuvastatin but it could be the problem

[Marcathon]

Hi there. I'm in a similar position, NSTEMI and stents in December. I have occasional twinges / spasms etc and some times worry that I'm having a heart attack again - have been back to A&E 3 times, each time it hasn't been heart related. So I am living with it and just being careful. Of course the danger then is... what if it is actually a HA and I've not gone in to A&E? Waiting to see cardiologist specialist mid-May so hoping to get some answers then.

[Ericasuncle]

Looks like there’s a few of others in the same boat. I had an angiogram last week and all came back ok. No further disease or narrowing around the stents. Obviously, that’s good news and I can be slightly less conservative about going to A&E with chest pains. It still unclear as to what’s been causing them and I assume they will reoccur at some point. Cardiologist wasn’t really interested in pursuing the micro vascular route. Hopefully the pains will disappear.