Hi I have just recently been diagnosed with mild stenosis. I have constant chest pains,is this normal

[theclark]

Narrowing of the artery

[MichaelJH Heart Star]

Hello and welcome to the forum!

Unfortunately you provide so little detail it is difficult to comment.

How we're you diagnosed? Visit to GP, visit to Urgent Chest Pain Clinic, an angiogram, etc? I was diagnosed with four severely blocked arteries after an angiogram.

What medications are you on? I would anticipate Aspirin, a statin and perhaps an ACE Inhibitor depending on your BP. There can be additional medication such as an anti-anginal like Isosorbide Mononitrate or Diltazem, a PPI stomach protector like Omeprazole and other drugs as felt appropriate by your GP or cardiologist.

[theclark in reply to MichaelJH]

Hi. I went to casualty with chest pains and they sent me to the chest pain clinic. Chest pain clinic recommend that I get a ct scan which showed up I have mild stenosis in the proximal and mid lad which confers moderate cardiovascular risk. I am already on diabetes,high blood pressure,statin,omeprozole tablets and they have arranged for me to have a stress echocardiogram test. That is all I know atm. I still get constant chest pains and I’m at a loss why. Is this normal for mild stenosis. I’m sorry to hear of your predicament Micheal and hope you get sorted soon. Ty for your reply

[Smileyian in reply to theclark]

It is not necessarily normal as folk with between 35 pct and around 65pct usually do not have impaired blood flow and little or no pain. (Usually). Is it in any way possible you may have Prinzmetal Angina - especially if you have pain at rest ?

[Milkfairy Heart Star in reply to Smileyian]

Vasospastic angina the term now used to describe Prinzmetal/variant angina / Coronary artery spasms is rare.

Microvascular dysfunction another cause of angina much more common.

Both are very difficult to diagnose from a person's symptoms alone.

Both microvascular and vasospastic angina are often overlooked and under recognised types of angina.

You might be interested in this website created by 4 patients with a over 50 years combined experience of living with these conditions. They are supported by nearly 30 worldwide expert Cardiologists.

internationalheartspasmsall...

[Smileyian in reply to Milkfairy]

Thanks Very Much for your usual guidance Milkfairy. Invaluable. I am in a number of websites totalling thousands of folk mostly in the U.S. suffering with Vasospastic Angina and the does seem to be a growing opinion that "rare" maybe too strong an opinion amongst those sufferers. It seems there are many who are misdiagnosed with something else, with some being medicated for years for Anxiety, Gerd and Muscular Skeletal ailments It does seem from my collegues on the various Facebook Prinzmetal MVD help groups that, Vasospastic Angina is more common than perceived, with misdiagnosis and undiagnosed cases in the many thousands. It is quite a minefield for the suffer to work through to gain a diagnosis or presumptive diagnosis. My sister has what you correctly classify as Vasospastic Angina for 23 years but was originally diagnosed otherwise. I have now started taking beet root and grape smoothies daily and 2 or 3 sticks of celery to add to the normal medication. At 77 and afternearly 40 years with varying arrhythmia, I am very disappointed to have CAS and poss MVD. I hear there has been some nice weather in UK - Big thunderstorm here in Singapore this morning. Always good to hear from you.

[Milkfairy Heart Star in reply to Smileyian]

I am very much part of the Facebook groups you participate in.

I am also very well aware of the difficulties people face obtaining a correct confirmed diagnosis.

Many patients are incorrectly presumed to have vasospastic angina without proper testing when they actually have microvascular dysfunction and viscera versa.

This article from Prof Colin Berry's team gives the distribution of the different types of non obstructive coronary artery disease.

ahajournals.org/doi/10.1161...

The Coronary vasomotion disorders study group COVADIS has lots of useful information.

Not having a correct diagnosis is not helpful as the treatment options are different.

The International Heart Spasms Alliance website was created by two long established groups,. The authors are expert patients by experience. 2 from the US, one from Australia and the UK. The combined membership of the FB groups is about 3,000. About a third of the members are from the UK.

The IHSA website is very useful source of research based evidence about Coronary vasospasms and microvascular angina.

Vasospastic is classified as a rare disease as so few patients have a confirmed diagnosis through testing with acetylcholine during an angiogram.

Microvascular dysfunction causing microvascular angina is much more common, so probably better to say under recognised rather than rare.

The IHSA was recently included on National Organisation of Rare Diseases,NORD register. The bar is set high to be able to be included on this register.

rarediseases.org/organizati...

Berry et al

[Smileyian in reply to Milkfairy]

Thanks. All noted. My last angiogram showed 2 arteries in spasm and afterwards I was shown the video of the spasms in progress and given a great explanation of what was happening - interesting. I am grateful that the 3 Cardiac Rehab physiotherapists at the Singapore Heart Foundations (SHF) are all well briefed on Vasospasms and in my opinion have far greater knowledge than most GP's. Maybe CAS is more widespread in my part of the world. Luckily we have a number of Consultant cardiologists at the National Heart Centre who have extensive experience. Do look after yourself. I am off for my Beetroot smoothie 🤗

[Milkfairy Heart Star in reply to Smileyian]

I am amazed you could watch your vasospasms during your angiogram.

I was in so much pain that I given morphine during my angiogram with acetylcholine.

I also had ST elevations and depressions with my chest pain.

I well and truly ticked the diagnostic boxes.

[Smileyian in reply to Milkfairy]

Wow I am sorry to hear that. My pain was only around a 3. However the cardiologist told me that I had 2 arteries in spasm and gave me medicine to stop the spasm during the Angiogram - I conversed with him during the procedure as was expected a stent. However I could hear his discussion with his Fellow saying Mr Roberton does not need stenting / angioplasty as the stenosis is much less than 50 pct. In the follow up consultation, he played me the video clip in normal and slow motion to explain the spasm shown on his screen. It was very interesting although disconcerting.

[Milkfairy Heart Star in reply to Smileyian]

You are fortunate that your vasospasms are not too severe and long may they continue that way.

My Cardiologist and I both agree that I am not going anywhere near a cath lab again anytime soon.

My blood vessels are so fickle that my Cardiac MRI landed me in A&E as it provoked my vasospasms.

[Smileyian in reply to Milkfairy]

Yes, you are correct I am lucky in that respect. My level 5/6 pain would be in my jaw, teeth and armpit but bearable most of the time if not welcome. I know you have experienced many rough years hence hope you continue to get adequate relief. I will read that very long link you sent me and wonder if I could print out for my Cardiologist.

[Smileyian in reply to Milkfairy]

Due to the length and complexity of Dr Berry's report and the information therein, it will likely take me a day to read and digest. Many thanks.

[theclark in reply to Milkfairy]

Sorry for late reply. I went again to casualty due to chest pain. Ended up in coronary care for the night and rest of the day. Cardiologist says I shouldn’t be getting chest pains as the narrowing is very mild but did mention micro vascular so he put me on isosorbide mononitrate. Unfortunately this has not worked and I am still getting the pains in my chest,arm,neck and jaw. I am at my wits end now as it’s been 10-12 weeks and no let up. I feel as if I’ve got no where to turn any advice would be appreciated

[Milkfairy Heart Star in reply to theclark]

I am so sorry to hear that you are only a alittle further forward.

It is good that microvascular angina has been considered.

However it sounds as though you need a review of your medication.

Interestingly there is some research that suggests that isosorbide mononitrate doesn't always help patients with MVA

There is a research study into a possible new treatment for microvascular angina, Tge PRIZE trial.

clinicaltrials.gov/ct2/show...

Perhaps ask your Cardiologist to get in contact with the Principal Investigator, Prof Colin Berry for advice.

Here is another article written about the possible treatment stratergies for microvascular and vasospastic angina.

They are different for each type.

It took awhile to get my diagnosis of vasospastic angina confirmed and I too was demented by my symptoms which I kept being told were not heart related

It is a tough rocky path at times.

I find breathing and relaxation techniques helpful.

Hot water bottles

A warm bath

Rest and pacing.

I also found Mindfulness meditation and self hypnosis helped me to manage my symptoms

Your pain is real and not in your head. It can take time to find a Cardiologist who will be able and willing to patiently work with you to find the best combination of medication that will work best for you.

There are quite a few of us on the forum living with microvascular and/ or vasospastic angina.

Please don't feel you are alone , give a shout and someone will be along to share their experiences with you too.

internationalheartspasmsall...

[Milkfairy Heart Star in reply to Milkfairy]

Here's a link to the PRIZE trial that will work!

clinicaltrials.gov/ct2/show...

[theclark in reply to Milkfairy]

Ah ty so much for your reply. Nothing seems to work. I have gtn spray and pain killers to no avail. I will give the hot water bottle and your other recommendations a try. Your so helpful it feels at times that I’m just making it up. Let me ask you was your pain constant before you got your treatment? Can this disease cause heart attacks? Are you able to work with it ?

[Milkfairy Heart Star in reply to theclark]

Like every illness it can be learning to manage your condition.

Some people with the right combination of medications are able to find a way to adapt how they live and their angina doesn't effect them as much.

Not knowing the cause of my symptoms or not feeling I was believed at first did make it more difficult.

I now have a very good and supportive Cardiologist whom I can contact when my angina is becoming unstable and I need to go into hospital.

Some people are able to continue to work, others work part time, others have to retire

Microvascular dysfunction and vasospastic angina are serious heart conditions and need to be treated well to prevent any further problems.

If you are still having problems perhaps go back to your GP, or contact your Cardiologist's medical secretary and ask for an earlier appointment.

[theclark in reply to Milkfairy]

Ty so much for your quick reply. I will contact the dr tomorrow and will let you know the outcome

[Milkfairy Heart Star]

Hello,

I am sorry to hear you are in pain and you don't now as yet what is causing your chest pain.

Has your GP prescribed you a GTN spray ?

If not I suggest you discuss your chest pain with your GP.

Keeping a diary of your symptoms is useful to show the Cardiologists when you have an appointment with them.

I hope you find the cause of your chest pain soon.