Angina?

[richard_jw]

If I exert myself (eg spend 1 or 2 hours gardening) maybe 2 hours after I stop I start to get slight chest pains palpitations I feel sick and unsteady gtn helps somewhat

I had a STEMI 14 months ago. I had an angioplasty they could not fit stents because the artery was too wide. So they cleared the clot and now I take anticoagulants etc

I have seen cardiologists but they don't think it's angina.

I had an angiogram in June and the arteries are clear. I guess it's microvascular angina or similar. Should I push for a proper diagnosis or just take ranolazine. Which the cardiologist suggested .

Because My BP is lowish normal antianginals aren't suitable because they lower my BP too much.

Any suggestions gratefully appreciated

[Milkfairy Heart Star]

My thoughts are perhaps ask for a referral to a specialist who understands non obstructive coronary artery disease, NOCAD.

Perhaps a question to ask is whether any permanent narrowing was seen during your angiogram or was only the clot the cause of your heart attack?

Large or tortuous arteries can affect the way the blood flows through your blood vessels. This can lead to blood clots forming.

Approximately 10% of heart attacks occur without any blockages.

A MINOCA, Myocardial infarction non obstructive coronary arteries.

Microvascular and vasospastic angina are complex conditions. It takes an astute Cardiologist, at the top of their game, with a bucket full of compassion to care for us as patients.

I am very fortunate I have just that. It took me a while to find them in a hospital near where I live, in north London.

If you want to know why you are having your symptoms, if it is affecting the quality of your life, then yes, seek out the best help possible.

Where are you based in the UK?

[richard_jw in reply to Milkfairy]

Thanks MilkFairy. I will ask for a referral. The initial clotting was in the RCA. It was completely occluded. They could not use a stent and tried to clear the clot manually during the angioplasty they were not successful and put me on an infusion overnight. The following day, because I was showing symptoms again, they did a second angioplasty and got sluggish blood flow. This was some 15 months agoSince then I have been on Rivaroxaban, clopidogrel; low dose aspirin and atorvastatin, along with bisoprolol.

I had a second angiogram in June this year which showed no stenosis or occlusion. It's true that the artery is not even. That is some parts of the vessel are wider than others, but nobody has said this is a problem. It was described to me that wide coronary arteries results in slow blood flow, and this can cause "eddying" which can knock a plaque off the artery wall which results in a clot. That's what happened in my case and caused the STEMI 15 months ago

I think the current problem is different, given that 2 cardiologists have looked at the angiogram done 3 months ago. I suspect that the fundamental problem is not some sort of arrhythmia, given the symptoms I had only yesterday which were angina for sure. I am still having slight chest pains though (I did 2 hours of physical work yesterday.)

Trouble is that if I phone a GP or 111 they will send me to A&E who will do the necessary bloods and ECG and pronounce no heart attack just like they have done 6 times before.

Sorry for the diatribe Milk Fairy, but I appreciate your views.

I live in Surrey The hospital nearest to me is in Chertsey, and is where I was taken after the STEMI

[Milkfairy Heart Star in reply to richard_jw]

You might be interested in this article about coronary slow flow?

earlycareervoice.profession...

Prof John Beltrame in Australia has researched this, along with MINOCA and non obstructive coronary artery disease, NOCAD.

One of my triggers for an episode of vasospasms is exercise.

I did too much in the garden recently. My reward 4 hours of chest pain later.

I have to get the amount I do just right.

The A&E staff and some Cardiologists switch off when a heart attack is ruled out. Ongoing angina does not get the attention it deserves.

There is a team at St Thomas's hospital London undertaking research into microvascular dysfunction and it might be worth contacting them.

The contact details of the researchers can be found in this link.

isrctn.com/ISRCTN94728379

[Supportbuddies77]

It may be an idea to ask your GP it may not be your heart . ? BP too low perhaps review medication or 24hour tape to check BP could phone British heart foundation cardiac nurses helpline

[XmasEve24]

This is just my experience. I can no longer garden for more than 30 mins and have to rest. My grandfather stopped taking his angina meds as he said he felt better and after digging his garden walked into the house and collapsed from a fatal heart attack. I read somewhere that a lot of heart attacks happen from people clearing snow. As it’s a job people do until they’ve cleared the path and they are using their arms and upper chest a good old bashing. Try a half hour and see how you feel, then an hour to see what your limits are. Also all the good advice from previous hearties. Good luck.

[Ruby40]

Two hours of gardening and hard physical work may be too much for you.