Morning, I attended accident and emergency yesterday due to waking up in the middle of the night with bad chest pains and struggling to breathe as well as jaw and arm pain but again my blood work ect was fine and that is great but the struggle with everything is getting me down, I have coronary arterie disease and angina and some days are just terrible, I have been back to my doctor several times and had a call with my cardiologist but she is dismissive that my condition would cause the issues I am having saying it may not all be coming from my heart some days I struggle to get round the supermarket as I struggle to catch a breath my doctor and the doctors I have seen in accident and emergency always say it needs more investigation by cardiology and do a referral but how do I get them to take it more seriously, the gtn does work sometimes other times only gives short tems relief, I take aspirin, bisporol, mononitrate and a statin , my wife's constantly worries about me and it really is effecting our lives I am only 43, I intend to ring the cardiologist secretary this morning.
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What do I do next
I am sorry to hear about your problems.
I suggest you ask for a review of your medication along with an assessment, whether your coronary heart disease is getting worse.
Also perhaps ask your Cardiologist to consider microvascular dysfunction or vasospastic angina as a cause of your symptoms.
It is possible to have both obstructive coronary artery disease, CAD and non obstructive coronary artery disease, NOCAD at the sametime.
Thanks I have phoned and sent an email to cardiologist asking for a review
Please push for a review by your cardiologist, during these times with nhs under pressure if you dont push you may get sidelined so hold your ground. We shouldn't have to but can you afford to pay for a private consultation. Your health is crucial. Good luck. Get phoning and pushing please.
Tanks for the reply, I have phoned and sent an email to the cardiologist this morning.
We are all just laymen on here but once you realise you have CHD you do get a certain amount of knowledge. If I were you I would ask for a second opinion, I don't see how she can tell from blood tests how severe your arteries may be blocked and the way you have described your symptoms make her comments regarding them not being heart related seem rather odd to me. Have you had an Angiogram? As has been suggested to you before, next time it happens If I were you having been through it all myself, just ring for an ambulance, you are far more likely to be taken in and looked at properly. Maybe she is dismissive due to your age, do you have any strong markers for CHD, family history, high Cholesterol etc? There are plenty of people your age who have had a heart attack you need to get it sorted before you join them, just keep pushing.
Hi Yes I have had an angogram and it was found my rca was completely blocked but there was and a collateral arterie and my other arteries has between 35 to 50 % blockages and a severe lesion on one as well as some disease, I have a strong family history of heart attack and strokes from age 40 to 60, I also have high colestoral.
So are you waiting for a CABG?
Bypass was mentioned during the angiogram but then I got landed with this cardiologist and she doesn’t think it necessary right now
So did the cardiologist open up the RCA and put a stent in? 100% blockage usuallt means a heart attack
Morning nope no heart attack I was told lifestyle and treat medically with tablets
I have no medical qualifications, but I can understand why a cardiologist may want to pause before progressing to a bypass operation.
Open heart surgery is a serious matter, yes it's routine but it's certainly not trivial and it carries a material level of risk.
Bypass surgery is also an option that, in almost all cases, you only get once. It's not a cure for our underlying heart disease, and even with significant changes to our life styles the chances are that a bypass won't last indefinitely. Consequently a cardiologist won't want to play this "joker" card too early. At 43 you're still very young, I believe the average age for a bypass in the UK is 68.
When you say "35-50% blockage" I appreciate that this may sound serious, but actually it's quite difficult to even detect any blockage under 50%. There are plenty of people on this forum who weren't even aware of heart disease before they were diagnosed with arterial blockage of 90% or more.
For patients who are obese or smokers then a cardiologist may be concerned that a bypass may only provide a very temporary respite before symptoms re-occured.
I'm not arguing against a second opinion, just pointing out that these treatment decisions are complicated, with a lot of conflicting issues to be balanced.
Good luck and I hope your future treatment works to your satisfaction.
Thanks for your reply, I take on board and understand what you are saying
Chappy has made a very good point as usual. I was not aware until recently that a CABG is supposed to have a limited life, 15 years on average - now, I am not sure why that is, but I have a sneaking suspicion it is because of people like a guy I know. He had one due to similar problems as you, which he put down to "too much partying and late nights when working down in London" for 20 years or so (he was 45 at the time). Has he changed his ways? No, still eating all the wrong stuff and boozing like a good un because he thinks he has been fixed. Thing is yes you are young to have one, but on the reverse of the coin you sound as if you are having a pretty bad time of it at a young age so maybe it might be worth it, if you were very disciplined with yourself afterwards as regards diet and exercise? I suppose if the computer says no you don't have a choice, but maybe a chat with the cardiologist to discuss the options and your attitude to it would be worth a shot. There are many people still going strong that have had them for way longer than 15 years.
My surgeon told me that with good management (diet, exercise, etc) I would get at least 25 years without further intervention from my bypass. Admittedly, I was and continue to be fit and healthy. That was good enough for me.... I was 65 at the time! I have friends who had a bypass 40+ years ago.
Yes I hear you, a triple bypass lasts abput 10 to 15 years but I know a friend who had a second bypass 5 years ago and is doing well. I would have thought that in the interim stenting where required would increase your quality of life.
Yes and very true it is difficult and yes the cardiologist no doubt has her reasons but yes I am not having a great time at the moment as I am sure many other aren't either but I just feel this is going to lead upto something much worse it is seriously causing my wife and myself a lot of worry and I need to back to work properly at some point, hopefully I will get some sort of response to my email thanks.
Hi, I'm sorry to hear regarding your issue. I advice you ask for another anigram and take it from there maybe a stent can fix your issue.
You don't say what your weight is, if you are either slightly or grossly overweight this can result in quite a few of your problems, it can also result sometimes in certain areas of the NHS being quite dismissive ! Furthermore, do you eat a healthy low fat diet and don't consume large amounts of sugary drinks......... and also are you or have you been a heavy smoker as that too can result in a change in attitude by certain people in the nhs?
Onto your condition, do you have any breathing problems, might you be asthmatic and might your blood oxygen levels at times be low to very low..... This is my problem and it is something I have been banging my head against the proverbial brick wall with consultants at both Papworth and Peterborough (the same Trust!). Finally for me and at long last, I have now met a respiratory consultant who agrees that my lungs inability at times to provide high enough levels of Blood Oxygen is resulting in my angina problems and she is now speaking directly to the coronary consultant I am now under.
Over the 4+ years I have been experiencing my own problems, I have sadly discovered that the only way to get action in certain areas of the NHS is to rattle cages!
Buzzy, I'm so surprised to hear you have a problem with Papworth and the Peterborough trust. I have found them absolutely brilliant! I have been in touch with the rehab team on frequent occasions during the past year since my SCA and have had nothing but support and have been back for further consultations several times following referrals from either my GP or the consultant at Hinchinbrooke. The girls in the rehab team have made it their business to go back to my consultant to get answers to questions about my treatment and medication. It seems something was lost between the cardiologists and the respiratory consultant... that's not uncommon, of course. I hope things improve for you now you have an answer to that question. All the best.
What you describe there is more like prinzmetal angina or vasospastic angina, since you have coronary arterie disease. If it is the case, you have to talk to your cardiologist to change the bisoprolol because it can make those spasms much worse. they have to put you on CCB (calcium channel blocker) like Diltiazem or Amlodipine. you must stop smoking if you smoke, nicotine cause coronary artery spasms. Limit as much you can alcohol drinks and caffeine intake.
I have to agree with the comments about Bisoprolol if there’s a chance you have MVA. Mine was stopped immediately after confirmed diagnosis. Prescribed Diltiazem which was great but reacted. Try badly to it. Also on several other meds. Amlodopine as well but had to be stopped due to swollen ankle etc. Really hope you get better diagnosis and help. I recognise your symptoms and trips to A&E as do similar to mine. Luckily I’ve been treat well by staff. I did not have MVA or any symptoms at all until after my HA (STEMI) one year ago today. Good luck. Keep pushing
In the circumstances you describe, you are quite entitled to obtain a second opinion from either your own hospital or an alternative hospital. None of the replies to you have mentioned your GP's role in this situation. I have recently had a similar experience for what is a potentially very serious heart condition and discussed this option with my GP. He is quite prepared to arrange a referral with a consultant of my choice. I am now waiting for a report from the consultant with whom I have just had a telephone appointment and will then discuss this option with him.
Sorry to hear about your situation. I just wonder whether you have been given a reason for not having your 100% blocked RCA dealt with. I had my HA due to a blocked RCA which was dealt with immediately by the insertion of stents. I'm not surprised you are getting severe pains while this immediate problem is not attended to.
Just be aware that you can ask for a change of consultant. We did this for my dad who was misdiagnosed when he actually had advanced prostate cancer. He saw the new consultant the same day when we kicked up a fuss.
Sorry to hear about your situation. I have somewhat similar symptom but nowhere near as severe.I have to say it's very difficult to see or talk to a cardiologist. My NHS one is totally unresponsive. Like you I have been to A&E on several occasions. I can only guess about why the lack of responsiveness.
You appear to have a couple of options. One is to see a cardiologist privately. I have done so on 2 occasions. The last time, the guy changed my meds, and that has a v beneficial result.
I have found that even private cardiologists have their limits. I have seen this guy 2 times, and he does not actually want to own the problem, rather he directs me back to the NHS.
However, the result was good.
Another possibility might be to talk to PALS.
It's a bit of a nuclear option, i.e. it may not endear you to the NHS guy.
Both those approaches may produce some results.
When I saw the private guy, I went armed with absolutely all the reports etc. plus a CD of an angiogram done recently, plus a list of all the meds.
In fact I produced a report with all this in plus the CD and sent it to him before the appointment. The private guy I saw also works in the NHS, but did not have access to my NHS data, so I had to provide it.
It was a pain in the A** getting all this stuff, but was worth it.
Reading your post again, it occurs to me that an angiogram would be a very good idea. It's the gold standard for diagnosing this sort of stuff. I read what Milk Fairy says, and it may well be microvascular angina. But perhaps one step at a time might be a good idea. So a normal angiogram might be a good idea.
Trouble is with GP referrals, they can take weeks if not months especially with cardiology, since covid especially.
I resorted to PALS regarding a cataract operation, which was required because of a previous operation that had to be done. The initial consultants attitude was that I was not a priority as I had one good eye, and he would do it as and when he had time in between his other patients, not even a rough idea of timescales. This even though the sight in the affected aye was very poor. After getting PALS involved I got swapped to another consultant and the operation done within a few weeks.
The paramedic last week told us that in our area Covid - 19 patients are being prioritised if they present with chest pain symptoms after they have had covid therefore it is having a knock on effect to others on the waiting lists. I know our life is on hold at moment as my hubby is having much of the same symptoms you are describing and he is only 58 and has two stents from a previous heart attack. We paid private and the consultant has arranged an angiogram a week Monday hopefully. AandE are not very helpful when he goes in at all either and were not happy we paid private. Our GP got on the phone to the paramedics when they were here last week as he was in a bad way and said she wanted him to go to a hospital with a cath lab and have an immediate angiogram. She was ignored. It is so frustrating.
Hi and thanks for the reply, it is very frustrating go to accident and emergency been told twice not there issue you need a cardiologist and I won't get one in here but they will send a letter to them, I have now sent a strong email to them asking to be seen so see if that gets me anywhere
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