Asking a cardiologist to re-evaluate an angiogram? Possibility of something being overlooked?

[Robbie1964]

I'm posting this to ask if anyone has had to have a second angiogram because the first may have overlooked something or something needs to be clarified? Hopefully the following will make what I mean clear. Apologies for the lengthy post though.

In March this year I had a heart attack and after an angiogram had a stent implanted as there was a 95% to 99% narrowing in my left anterior descending (LAD) artery. The discharge letter I was given showed that all other artieries had 0% narrowing as such:

Left Main: 0%

LAD Prox: 0% (95%-99% pre-PCI)

LAD Other: 0%

LCX: 0%

RCA: 0%

Other than the LAD Prox all are showing as 0% both pre- and post- PCI.

However I have had a feeling of slight tightness around my chest ever since I left hospital. Tightness, soreness, a slight feeling of breathlessness at times and excessive tiredness. I would best describe this as being "very mild angina" if such a thing exists. There's no pain other than the above discomfort. I mentioned this to the cardiac nurse at my post-hospital follow up appointment and she tried to reassure me that it was most likely not cardiac related given the above post-PCI report. I do suffer from anxiety and she suggested that it could possibly be due to that.

I did have a heart attack back in 2010 and still have the discharge letter from back then. The pre- and post-PCI report paints a picture of another heart altogether.

Left Main: 0%

LAD Prox: mild atheroma (both pre- and post-PCI)

LAD Other: 50% to 74% (again both pre- and post-PCI)*

LCX: mild atheroma (again both pre-and post-PCI) in the LCX Prox

RCA: 95%-99% pre-PCI, 0% post-PCI (this is the artery that was stented back in 2010, hence why it went to 0% after the procedure).

* the cardiologist at the time explained - and it is on the discharge letter - that there was very distal 70% stenosis in the artery that would be difficult to stent due to where it was. He did explain more than that, but over time I've forgotten most of it.

As can be seen there is a massive difference between the two discharge letters. As atheroma can't vanish I'm left worried by what has happened here. I had a phone appointment with my GP yesterday and mentioned this. He was able to see both letters and was taken aback. He said he will write to the Lead Clinician (a Professor) listed on the letter, asking that they review my records and will also ask the Professor (in practice, one of the cariac nurses I would imagine) to contact me. My GP also said he will enclose a copy of both my 2021 and 2010 discharge summary letters.

I do feel like I have some mild angina (though it doesn't get any worse if I walk, exercise, do housework ect) and on top of that am worried by what I am seeing here. Has anyone encountered something similar? If so, what was the outcome? I do hope one of the cardiologists from the hospital that performed the angioplasty does contact me but what if they don't? The problem here is that my initial hospitalisation and subsequent outpatient follow ups are with another hospital. Only one hospital in the region performs stenting and I was sent to that hospital from the other hospital purely for the angiogram / angioplasty before I went home. My "home" hospital won't have the details of the actual procedure, they appear to only have the same information as myself and my GP has.

Any advice that anyone can give me is appreciated.

[Kristin1812 Heart Star]

That does sound strange, and your GP says so, too. He’s done just the right thing writing so clearly to the Consultant. But, apart from this real confusion, and if I read this right, your problem now is mild angina? I transferred my care to the bigger Heart centre, away from my local hospital because of very similar communication problems.

It had made my care much more streamlined and access to tests and procedures and sub-specialists much easier. You do have a choice to do that.

[Robbie1964 in reply to Kristin1812]

Thanks for the reply. I'm not realy sure if it is angina but it's a feeling like it might be angina. There's a feeling that there's something there. If my arteries really are clear then it may just be anxiety. But there's this nagging doubt in my mind that there is some narrowing.

I'll see how it goes from here. I didn't know I could transfer my care to the main heart hospital. It would have made it much easier for me to have queried the differences in the discharge letters as I would have been speaking to the cardiac nurses at the hospital where my angiogram and stent insertion was done.

[Kristin1812 Heart Star in reply to Robbie1964]

Mention ‘Patient Choice’. Transferring has worked well for me, thought the only snag is if you are planning an emergency admission via ambulance, they take you to your nearest local hospital, and the link-up seems poor. I just carry my latest hospital letter and my latest ECG with me,

[Milkfairy Heart Star in reply to Robbie1964]

Hi Robbie1964

'If my arteries really are clear then it may just be anxiety'

It is possible to have angina without permanent blockage of your coronary arteries.

Microvascular and vasospastic angina.

There is a lack of awareness of these types of angina within the Cardiology profession.

I suggest you ask your GP to refer you to a Cardiologist who has knowledge of non obstructive coronary artery disease.

The BHF has this information about the conditions.

"Vasospastic angina - Causes, Symptoms & Treatments" bhf.org.uk/informationsuppo...

"What is microvascular angina? | BHF" bhf.org.uk/informationsuppo...

[richard_jw]

Your current symptoms sound like mine. I had a heart attack last august. RCA was completely blocked, and some heart muscle died. They could not stent for tech reasons. However, the symptoms I now get are slight chest pain, breathlessness, and extreme tiredness.

I have ben reassessed several times, (ECG, chest xray, stress echo, myocardial perfusion scan), and they tell me there is no angina.

The last diagnosis was that the pain might be digestive (GERD). I am not ruling this out.

The tiredness is after any form of exercise. I attribute it to low blood pressure (postural hypotension). Typically by BP is 90/65 at worst and 110/80 at best.

The fact that your chest pain does not get worse, makes me wonder if there is some other cause.

As far as the angiograms are concerned, surely it is possible for a cardiologist to look at the actual pictures etc that were produced both times. That should at least determine if the 2 are from the same heart/

I would talk to the secretary of the relevant cardiologist. Nobody wants this sort of mistake.

[Robbie1964 in reply to richard_jw]

Thanks Richard. I'll give it a couple of weeks to see if my GPs letter triggers any phone calls. If not I'll phone up the secretary.

[WilliamMurray]

Hi Robbie1964 ,

I suffered a heart attack last September and had 3 stents over two arteries put in, they were classed as severely diseased.

There was a 3rd artery which was classed as borderline and they chose not to stent that one.

Not long after discharge I developed chest pains which initially my GP thought was digestive related, (more meds for that), but then eventually I pushed to see the cardiologist again to get another Angiogram done.

Because of referral times this took several months, by which time it was confirmed the 3rd artery had cleared itself with the medication and no further stents were required.

That tied in with the angina stopping on Christmas Eve, completely and I didn't need to take the GTN spray anymore.

I would however encourage you to continue with the pros and get assessed again, I went private to get a 3rd opinion as well just to be safe.

[Robbie1964]

Hello again. I've got a follow up question to my first post, above. I've not heard anything back from the cardiologist and I've checked with my GP practice in case a reply was sent to my GP rather than me and they haven't had a reply either. What should I do next? Phone the secretary? It's over three weeks since my GP wrote to the cardiologist / consultant.

I have considered consulting a private cardiologist for a second opinion / to get a clear direction on what to do next but I'm not rich. I would have enough to pay for the initial consultation and perhaps one follow up appointment but not for anything more than that. The only problem with that is that all the private cardiologists in my area work at the hospital where I had my angiogram / PCI, including the cardiologist / Professor. I feel like I would be paying money to get them to check their own records.