ANGINA: I had a heart attack 14 months... - British Heart Fou...

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ANGINA

Sootycat profile image
53 Replies

I had a heart attack 14 months ago. An MI. Gradually over the year my angina has got to the point I could have a breakdown. I don't want to sound dramatic but I'm at my wits end. The pain is so bad every day. Even upon resting.

It shoots into my armpits down my arms into my hands. Up both sides of my neck and into my ears and teeth.

I cant lift anything or walk a few feet.

I haven't seen a doctor for so long I can't remember. I saw the diabetes nurse and was told just take your gtn. I do and it never makes a difference.

This pain is only just less than my heart attack pain.

At the time in hospital a doctor said he thought I had angina and microvascular angina but didn't write it down. I sent for my notes but it just described the stents going in.

I have quite a high pain threshold but I am getting worn down with this. My husband is fairly frantic.

Does anyone else have angina the same ? Is this really how it is ? I can't walk to the car now.

Cannot get a Doctors appointment. What should I do ?

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53 Replies
Snowdrops_17 profile image
Snowdrops_17

I would let my husband drive me to A&E ! Or call your Surgery and request a call back from the Duty doctor on call that day but call early! Your symptoms don't sound right at all!

Try call 111 as well !

If all fails A & E 👍👍👍👍

Please do something darling, don't suffer like this! Remember you only live ones! And our life is precious ❤️

Sootycat profile image
Sootycat in reply to Snowdrops_17

Thank you so much for your kind reply. It felt so caring I was touched.I am so sick of my doctors I am almost getting Doctor phobia. It is so long since I saw them. I also find them abrupt and disinterested. And I was a nurse 29 years ago and my daughter is a nurse married to a doctor overseas. My lot are just not nice.

So purely by chance we have had to come away with my husbands work so I bit the bullet and rang the Doctors here.

Within 5 minutes they called me back. I had a phone appointment at 4.30 on a Friday afternoon and I have a face to face appointment on Monday at 9am.

They even changed my diabetic meds over the phone.

I am astounded.

It was the encouragement I got on here that made me ring.

So we will see what happens on Monday. Thank you xxx 🙏

Snowdrops_17 profile image
Snowdrops_17 in reply to Sootycat

Oh wow Sootycat, that is definitely progress, fantastic honestly! Now praying you get this other horrible crippling Angina pain sorted out! Keep at it darling okay! Sometimes we have to be persistent to get things sorted! If it affects our daily life to a point we feel disabled literally, something needs to be done urgently! You hang in there and good luck with your Monday appointment darling 🙏👍👌❤️

Snowdrops_17 profile image
Snowdrops_17

And I am so sorry you have such a rough time Sootycat! Big hugs for you 🤗🤗🤗❤️

Sootycat profile image
Sootycat in reply to Snowdrops_17

And back to you double x☺

Milkfairy profile image
MilkfairyHeart Star

If you have chest pain ring 111 or 999.

Then a paramedic can come and review you at home rather than you being driven to A&E which can lead to delays in your care.

I live with vasospastic angina and I experience debilitating pain at rest.

My Cardiologist's instructions are to ring for an ambulance when this happens.

Please call 111 or 999 ASAP.

Tell us how you get on.

MichaelJH profile image
MichaelJHHeart Star in reply to Milkfairy

You can wait hours to be assessed in A&E if you just rock up.

Milkfairy profile image
MilkfairyHeart Star in reply to MichaelJH

If the paramedics pick up a ST elevation on an ECG at home the protocol is to take the patient to the nearest heart attack centre, straight to the cath lab.

The national standard is 150 minutes from call to arriving on the cath lab table.

The call to balloon time.

Unnecessary delay can happen if a patient goes straight to A&E.

The NHS advice and the National Cardiac Audit Programme is to ring 111 or 999 to be triaged if you have chest pain.

Snowdrops_17 profile image
Snowdrops_17 in reply to Milkfairy

Thanks for that info Milkfairy! You are right! 999 is best! 👍

Sootycat profile image
Sootycat in reply to Milkfairy

We live near a small hospital who desperately tried to get a boat and ambulance to get me seen at a bigger hospital but made us wait until my trooping went up. When it was 6,000 the next hospital took me. They then couldn't get an ambulance for so long they ended up dialling 999 to get one.They were worried the delay would damage my heart. I finally got to the heart hospital at 11pm and went into cath lab 9am following morning. So it all took a long time.

Now I worry about this chest pain and the length of time it toom last time so unless it was after the time of the last boat I think I would get my husband to drive me to a large hospital. The CCC u heart hospital does not have an a and e you have to be sent there.

Sootycat profile image
Sootycat in reply to Sootycat

Trooping in Troponin !!

Milkfairy profile image
MilkfairyHeart Star in reply to Sootycat

Oh my goodness, that is difficult! It sounds as though you are between a rock and a hard place.

I hope you are able to access the care that you need soon.

Sootycat profile image
Sootycat in reply to Milkfairy

I had never heard of vasopastic angina and so I have been researching it. Thank you.I had My heartattack on July 1st 2020 and still have had no follow up, no rehab and have no cardiologist.

I am just cast adrift still.

Please see my reply to snowdrops.

Thank you for your care and information xx

MONIREN profile image
MONIREN

Sorry to hear that you are struggling, it isn't easy coping with an extra pain and stress that goes with being diagnosed with a heart condition. GTN spray should ease your angina. Angina at rest is typical of microvascular angina, milkfairy knows more, there is another angina that doesn't respond to GTN spray, but you do really need a special angiogram for proper diagnosis. Of course that is difficult without seeing gp and cardiologist. Have you tried different clinics? In preparation, you should keep records of angina and what you are doing. Stress can also mimic angina or make things worse. Wish there was an easy answer. Music always helps me de stress. Maybe someone here can help. Take care. Moni

Milkfairy profile image
MilkfairyHeart Star in reply to MONIREN

Chest pain at rest is more common in vasospastic angina and unstable angina

Any chest pain at rest needs an urgent review if debilitating.

Microvascular angina tends to lead to chest pain on exertion.

The pain caused by coronary vasospasms is typically very painful, mine feels as though I am in labour in my heart.

Snowdrops_17 profile image
Snowdrops_17 in reply to Milkfairy

Oh that sounds bad Milkfairy 🧐 best for Sootycat is 999! The past few weeks on and off I did feel my heart but only mildly!

It's the stress I am under due to being understaffed at work! But only work part-time, couldn't do full-time, to much!❤️

But I need to watch it and get my lunch break on time so I can rest!

Sootycat profile image
Sootycat in reply to MONIREN

Thank you Moni. My husband and I just feel alone no support our Doctors still not seeing me and I have no cardiologist.I felt like a car going to the garage after blowing up. Fix the engine send it home.

Never actually finding out what made it blow up in the first place.

Thank you for lovely message 😘

bludnut profile image
bludnut in reply to Sootycat

Good morning,

I was diagnosed with Angina pectoris last October on a cruise, since then I have been seen by one of our GPs. I am also taking part in an Angina Management group, where I am being seen by a Heart Surgeon. She has explained how the pain is generated and how it affects your heart. In simple terms, your heart suddenly realises that it is not getting a normal supply of blood, so it starts growing a number of minute blood vessels in order to get the extra blood that it needs. When the adrenilin has dissipated then the heart returns to normal. Their combined advice is as follows, if using my GTN spray doesn't take the pain away after using it twice in quick succesion to reduce the pain, then ring 999 without delay. Aparently Adrenilin is the culprit of most of the pain, so trying to keep comfortable and not doing anything too strenuose which might bring on adrenilin, is a big factor in keeping pain in check.

hope this helps,

bludnut

Hello :-)

I agree with all the other comments you have had , this does not seem right and you should not be in this much pain

I would also suggest 111 or go to A&E and you are not been dramatic but you do need some medical attention

Let us know how you get on :-) x

Sootycat profile image
Sootycat in reply to

I am away coincidentally hundreds of miles away with my husbands work and rang the doctors here who immediately replied. Arranged a phone appointment 1 hour later and I have a face to face at 3.30 on Monday.They doubled my diabetic meds as not working and I hope I will be able to get heart advice on Monday . Good luck to you 😘

in reply to Sootycat

Hello :-)

Their response was very quick which is really good

And getting you on Monday as well is good compared with some at the moment

Let us know what they say when you have been :-) x

Sunnie2day profile image
Sunnie2day

Can you go private? The cost (including scans, an initial discussion with the cardiologist and then at least another to discuss the test results) is around or slightly under £1000 and it is a very worthwhile investment in your health. Bonus, often the private cardiologist will put you on his NHS list once he/she gets a look in at your test results - mine did, marked me as 'urgent' and it fast tracked everything.

Mind, this was pre-Covid but my experience even during Covid has been reasonably quick - I telephone his secretary or email straight to him and within 24 hours I'm being seen by him or sent to the cath lab. His secretary says it's owing to him having me on his 'urgent list' - 2+years on.

If I had it all to do again, I would even if it meant taking a loan.

Sootycat profile image
Sootycat in reply to Sunnie2day

You are quite right.We paid for a private appointment last Xmas as I had no cardiologist no follow ups. He was helpful but could only do so much as he was so snowed under he couldn't get people even onto the lists by 'jumping the queue shall we say to be seen. I don't like even doing that. But he explained the situation is critical and lack of staff, lack of ambulances living remotely etc etc the staff that were available are working round the clock.

I haven't seen him since early Dec and his private list is full. Even his secretary said the situation here is pretty desperate.

I hope you are OK and improving xxx🙏

Page12 profile image
Page12

Hi, sorry to hear about your pain. I really don't think this is Angina it's more then that and it doesn't seem to good either. I suggest you speak to your GP and request him to send a letter to your cardiologist for angiogram, this only can be truly known by angiogram what is that pain and what is the course of it. Best of luck.

Sootycat profile image
Sootycat in reply to Page12

OK. So I haven't been able to speak to my GP for so long now I cannot even remember the last time. No face to face appointments and can't get them on the phone.All I get when I make a fuss is the diabetic nurse who still hasn't sorted out my diabetes which is out of control.

I have still no cardiac rehab no cardiologist or even a cardiac nurse.

There are none available and I must have phoned 200 times.

All I get is nothing in our area and all lists are full.

I feel so desperate I could scream and scream.

I have made the radical decision to seek help as we are away in a different area for my husbands work so I will now try anything.

1st of July 2020 my MI and stents and still nothing and no one and no support.

If it wasn't for this website and friendly helpful group to turn to I would have given up. Thank you for your care I appreciate it so much xxx 🙏

mathematics profile image
mathematics

Ring 999 or 111 they will triage you as Milkfairy said. My husband had stents 2007 and had problems with them 2009 when he had an angiogram and he is having problems again now. You definitely need to do something shout if you don't get heard and nag. We paid private in the end for a consultant as when they referred my husband with chest pain the waiting list in our area was 14 months to see a cardiologist. The private consultant arranged a heart scan on the nhs and a angiogram, which he is having on Monday thank goodness as things are deteriorating with him. Take care and do something even if you just go to AandE.

Sootycat profile image
Sootycat in reply to mathematics

Oh this all sounds so familiar.Please could you tell me the trouble he was having with his stents and how he knew ??

I wonder if mine have reblocked.

Hope all goes well for you both. Sending love 🙏

mathematics profile image
mathematics in reply to Sootycat

Hi hope your ok, thanks for your response. My husband was getting pains in his jaw running down his neck into his chest and down his left arm it was happening at rest as well, which was worrying. He was also getting bad teeth after an attack. Nothing would budge it he tried his GTN spray and it was just not working so we then tried 300 mg of aspirin which did kick in but not the other day when he ended up in A and E again. We bought an oximeter that goes on your finger and his oxygen levels when getting pain was all over the place. He felt as if he was having a heart attack again which is why we paid to see a consultant privately. He advised us it was probably his stents and arranged the chest scan and angiogram on the NHS. However as he is deteriorating and they wanted to keep him in last week he is getting the angiogram on Monday. He is just worried that nothing will show up again but I am sure it will. He is getting a lot of discomfort in his chest and is too scared to exert himself as he does not want to set anything off again. He is on blood thinners and angina tablets from the cardiologist he saw in A and E last week. Hope you get sorted soon as I know with this problem your life feels on hold.

Sootycat profile image
Sootycat in reply to mathematics

All that sounds just like me.I hope so much he is OK. Sounds like he is on the right path now.

I'm still in mid air but will try to push a bit harder. Keep me posted please xxxxx

Healthyhearts profile image
Healthyhearts

I’m interested in the experience of sootycat & the advice given. Your experience sounds similar to my partner. My partner had a heart attack 4 years ago & 2 stents fitted. His chest pains returned 12 months ago & he was diagnosed with angina. Over this year he has had his medication increased & a number of tablets prescribed but his pain continues daily. He even has chest pain at rest in bed, constant headaches so has to take co codomol or paracetamol every few hours. The GTN doesn’t ease the pain but gives him headaches so bad he’d rather deal with the chest pain. He’s due a review by his cardiologist on 15/11. Any advice to take to that appointment would be welcome. I do agree with everyone on here saying you need to return to your GP Sootycat. I hope you get your situation resolved soon.

Sootycat profile image
Sootycat in reply to Healthyhearts

This all sounds identical. I have no one. I can't even get my doctor. No chance.All cardiac lists are full. Only dealing with acute immediate intervention.

My gtn does nothing.

I cant even walk to the car.

I wish I could say something useful or helpful. I'm desperate.

The only plan I have now is as we are suddenly hundreds of miles away by chance with my husbands work I am going to try and do something now.

I rang a local doctors surgery yesterday who were so shocked at my blood sugar and uncontrolled diabetes they doubled my meds over the phone at 3.30 on a Fri afternoon and I am to go and see them Monday at 9am.

I guess nows my chance ?

Good Luck to you all the very best 🙏

mathematics profile image
mathematics in reply to Sootycat

It sounds as if you are having a real tough time at the moment I hope that you get the help you need soon and someone listens to you.

Treeclimber62 profile image
Treeclimber62

Sorry to hear that .I had something similar a few months ago they prescribed isosorbide mononitrate and upped my beta blocker to 5mg bisopolol .it did help but I still get pain .they did mention microvascular angina and a drug called ranolazine but so far have done nothing ,my gp is impossible to see and even a telephone consultation is difficult .a@e is a nightmare you can be there for hours on end in very uncomfortable conditions .I know I sound very negative I dong like being but it seems to me the NHS is failing big time without being abusive you have to insist on better treatment and push hard for it which if your not feeling great is hard to do .I do hope things improve for you and you get the treatment you need at the moment I despair about the way our country is going

Sootycat profile image
Sootycat in reply to Treeclimber62

This is it. Nail on the head. I agree with everything you say and I am a retired nurse and my daughter is a nurse.No one at home will see me to discuss anything or is even interested. And everyone I talk to is the same.

Even private are struggling.

It's as if since covid our doctors closed their doors and have never reopened properly.

I just seem to ring everywhere all the time moan nag push and annoy and still nothing.

I hate being like that.

Now I look like the bad guy.

I am shouting in my head I just want examined.........please.

Tracy7574 profile image
Tracy7574

I have exactly the same. I had my first heart attack in May 2011 and 3 stents. No issues whatsoever with my heart until December 2019 and started getting jaw pain (which is my trigger for an impending attack), I told my Dr and everyone who would listen that I just knew another heart attack was imminent, but nobody listened. In February 2020 I had a heart attack. No stents needed, but since then I've nothing but pain. I didn't work for 12 months, I had various tests and a nuclear stress test to which I was told I "might" have microvascular angina. I have daily pain which includes jaw pain. I've just returned from a week in Turkey and was using my gtn approx 10 times a day. Just moving caused pain. I'm sat here writing this waiting to go for yet another treadmill test at 10am. I've been put on extra medication but no change. I've had to come back out of work after only being back 6 months. I hate my life as it is. Dont get me wrong. I'm grateful to wake up every morning, but hate the fact that I feel like I'm going to die every day either. Sorry for the long reply. Take care and I hope you find answers.

Milkfairy profile image
MilkfairyHeart Star in reply to Tracy7574

Hi Tracey7574,

I am sorry you are in this situation.

I suggest you ask to be referred to a Cardiologist who understands Microvascular dysfunction and vasospastic angina.

These are also known as Ischaemia non obstructive coronary arteries INOCA or non obstructive coronary artery disease NOCAD.

They are complex conditions.

There are several centres taking part in study into a possible treatment for Microvascular angina. The PRIZE trial

clinicaltrials.gov/ct2/show...

It might be worth asking to be referred to one of these centres or ask your Cardiology team to get their advice.

academic.oup.com/eurheartj/...

Diagnostic pathway for Microvascular dysfunction and vasospastic angina
Sootycat profile image
Sootycat in reply to Milkfairy

Thank you so much for this. I am on to it.

Sootycat profile image
Sootycat in reply to Tracy7574

Poor you. You just sound like me. Desperate.Don't ''they'' understand its our lives.

We are screaming help and no one is listening.

The one private appointment I paid for as I am still waiting for my 6 weeks follow up 15 months later suggested I even pretended to go shopping near the Heart hospital collapse in the street so an ambulance was called and even though it does not have an a and e being heart symptoms they might take me there. That advice not to be repeated !!! So I deny it !

All I can send you is genuine love and the wish somehow it gets better for you ❤

Jimba4866 profile image
Jimba4866

Get yourself to A&E but unfortunately angina doesn’t show up on bloods so if your sent home then maybe a visit or two may be required to get anything done . It took me 5 years and the same amount of angios and different nitrates I was given a 60mg modified release Isasorbide Mononitrate and been pain free for two years now. I was in the same position as yourself regarding angina pain.

Sootycat profile image
Sootycat in reply to Jimba4866

Thank you Jimba. You have had a rocky road but you sound positive and after a lot of medical intervention it sounds like you are stable. I will try and push more I am just not very good at it.I am easily flummoxed. Good Luck to you 😘

Healthyhearts profile image
Healthyhearts in reply to Jimba4866

It’s good to know you’ve found a solution. My partner is on 40g of those so I’ll suggest he asks his consultant to increase the dose. Do they give you headaches?

Boxroad profile image
Boxroad

That sounds like how I was feeling for about 10 months, I had a coronary angiogram after a trip to A&E no stenting needed. I was getting a vibrating feeling in my arms legs and body, I was given GTN spray but it didn’t help me, I also suffer from IBS and diabetes, my sugars started to lower to the point I stopped my 50 units of insulin and 1500 mg of metformin and my sugars on waking were about 6. My IBS went completely out of control, I had an ultrasound in may that showed up kidney stones, I have an appointment at kidney clinic in two weeks time. The pain in my chest has just about gone away now, my sugars are settling and my IBS has calmed down. I wondered if it had anything to do with the covid jabs? When my chest was at its worst in the middle of lockdown I was so bad one night my daughter who had been helping with our shopping came to say goodbye, but I can’t remember much about that. You should pester you GP or call 111 and don’t take no for an answer.

Sootycat profile image
Sootycat in reply to Boxroad

I am so glad you feel on the mend.I'm afraid talking to a doctor at my practice is impossible.

The nurse or receptionist just ring and say go to A & E.

Not interested.

My bloods are through the roof diabetes wise. I was always 6.7 on waking. Now 12.

Tea time 14 evening 19.

They wouldn't even see me. They said come back in 4 months.

So as we are hundreds of miles away in another area I have rung here yesterday and they see me Monday. Fingers crossed.

Hope you continue to improve and all goes well 😘

Boxroad profile image
Boxroad in reply to Sootycat

Those are very high sugars, do you eat a lot of pastry or breads? I have found free from to be a lot better than gluten free as they are very low on sugars as well. If I am going through constipation then my sugars go high but if I am suffering diarrhoea my sugars drop. It’s all a juggling act with diet once you have more than one issue that’s for sure

richard_jw profile image
richard_jw

I had a STEMI 15 months ago.After a lot of subsequent tests including an angiogram which did not reveal any blockage in the main coronary arteries, a cardiologist came to the conclusion that it might be microvascular angina. My pain is nowhere near as bas as you are suffering.

The first thing is to rule out any further partial Blockage of the arteries.

Since your pain is becoming worse, that needs to be done.

A&E would be a good start.

They can check to see if you have had a further MI or partial blockage of the arteries.

They may well change your medication to ease the pain. The fact that it seems to be getting worse means that a visit to A&E is important. Yes you have to wait around, in my case 10 hours was not uncommon.

A&E treat chest pain much more seriously than most other things because it's potentially life threatening, and they never complain about wasting their time

Cocolelaissey profile image
Cocolelaissey

Hi ,I had a heart attack 14 months ago too ,they were unable to place stents ,I also have a constant pain and symptoms as you describe and have been sent to a&e 4 times over this period ,a&e and my gp have referred me back to cardio team but not been seen yet .....as I sit here writing this i have pain down my left side but I'm learning to ignore it ,I do have a high pain threshold though as I found out when heart attack was happening ,if I were you get your go to get an appointment with cardio asap and keep on at them until you see a consultant ,also do a pain log to show them .....,sending hugs and hope you get to see someone soon and if you go to a&e get them to write to your go about a cardio appointment too

Sootycat profile image
Sootycat in reply to Cocolelaissey

Thank you. If only it was all that simple. Our GPS won't see you. I rang and rang and they told me it was a waste of time referring as they were not seeing any for 14 months.I still have no cardiologist. No one.

I feel like I'm drowning and no one will help me.Hope you get good treatment and something is done for you 😘

Larkswood profile image
Larkswood

Hi sorry to read about how you are I have been told that I have micro vascular angina I get tightening in my left upper arm and tingling sensation down my arm also I have the same now in my other arm this started a few weeks ago I have had an angiogram done two months ago and waiting to see the cardiologist for the results but yesterday I got an emergency phone call from my gp to tell my my lung function is low and also my kidney function so I have to have blood taken on Monday morning I feel like you absolutely fed up I find when I bend over I get breathless and I can’t walk very far now which isn’t good as I used to see to our grandchildren taking them to school so I feel as though I’m letting my daughter down my husband finishes work early on a Friday now to do the shopping sometimes I go other times I’m so tired I stay at home so you do have to change your life style but when I see the cardiologist I will be asking a lot of questions if I was you I would contact your cardiologist secretary and ask for an appointment as you are getting worse you look after yourself and take care

Sootycat profile image
Sootycat in reply to Larkswood

I'm afraid I don't have a cardiologist. I'm still waiting 14 months on.No cardiac nurse nothing.

I'm like you tired and worn out. I cant shop now or walk outside the house. I feel ill all the time and in pain.

I hope you improve and get good care. 👍

Tricia7048 profile image
Tricia7048

I have just come out of hospital for the same thing!!!! I had foliate deficiency anaemia ..lack of folic acid...which was causing it. I had to get 2 blood transfusions and I havent had angina since. I had a heart attack as i went to hospital too but i feel so much better, its like a miracle!!! Find out if you are anaemic and hopefully you too can feel better huni xx

Smerblue profile image
Smerblue

Sorry to hear about the pain your suffering it really does have you at your wits end.... i’m Not condoning my actions are advising anyone with what I have to say but this is my experience with so called angina and chest pains. Had a HA in 2019 with 2 stents fitted then two more fitted last year. I have had HA type angina pains and heart flutters ever since. They feel like HA symptoms and I was having these every few hours leading to so many trips to A&E it was unreal. Nothing was found to be wrong on any occasion, after the stents of course. 4 weeks ago another trip into A&E with pains and palps but found nothing wrong. Still was sent out with double dose of isorsobide. A few weeks ago I went touring round the South West I knew I was going to run out of medication so tried to order some but the docs suggested I rang whilst on holiday and they could order for a boots near where I was but I was never in one place long enough. I ran out on the Thursday before I came back. Now I had been having chest pains and palps hourly whilst away and nearly called 999 at several points. Friday without tablets I had less pains flutters, Saturday had a few less and Sunday I had none. I rang the docs when I returned home and he could only offer a phone appointment a week later. That full week only taking aspirin I had no issues..... not one..... now after having a year of these pains this was amazing. Under docs instructions I am now reintroducing the tablets back one by one to see if one of them was causing an issue. There are several heart meds that can cause chest pains and heart flutters. I know how frustrating it is trying to convince hospital staff that the pains you are experiencing are real and feeling like a fraud when nothing is found. I hope you find the cause of your pain quickly and you can be pain free soon.

DiggyDoggy profile image
DiggyDoggy

Isosorbide Mononitrate - I was prescribed this as it is like a tablet of GTN that you tak (e every day, It worked for me, although my Angina was not anywhere near as 'bad' as yours. It would be worth asking your doctor.

And do ring 111 when you next have this pain. In order to get treated quickly (and more thoroughly in my opinion) you need to get to hospital via an ambulance, and that happens when you call 111. I call 111 if I worry, and pack a bag- ready to stay in a couple of nights if required.

Sootycat profile image
Sootycat in reply to DiggyDoggy

Thank you for the medical info and advice.I will look into it. All replies so gratefully received. Xxx

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