Micro vascular angina

[Blues1977]

Hi all I recently got admitted to hospital with a serious angina attack,had to stay in 3 days and have a angiogram.as I’ve had angina for 2 years that seemed in control with isosorbide mononitrate and they have now put me on statins clopidogrel bisoprolol and upped dose of mononitrate anyway I have now been diagnosed with micro vascular angina and wondered if anyone has been taking ranazolone and what it’s like as I see my doctor next week and might see if this would be a better treatment.

[Milkfairy Heart Star]

Hello Blues1977,

Welcome to the forum.

I am sorry to hear you have joined us in the non obstructive coronary artery disease NOCAD, club.

This includes those who live with Microvascular and vasospastic angina.

How was your Microvascular angina diagnosed?

Did they measure your coronary flow reserve, CFR?

It's important to get an accurate diagnosis as the symptoms of Microvascular and vasospastic angina can be very similar, however the treatment is different.

Ranolazine is a medication that is a bit like marmite.

It works for 50% of people and doesn't for the other half.

The only way to tell is to take it and see if it helps.

It didn't help me, I experienced really awful palpitations and arrthymias.

I live with coronary vasospasms, I have spasms in my small and large coronary blood vessels. Microvascular and vasospastic angina.

The BHF has this information about Microvascular and vasospastic angina.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

There are several other members of the forum who live with Microvascular and / or vasospastic angina, Hopefully they will be along, to share their experiences with you too.

[Blues1977 in reply to Milkfairy]

Thanks for the welcome and information and tbh i don’t know if they done a CFR I will ask when I see them next week.I have high blood pressure and unfortunately caught Covid and it attacked my heart,It sounds weird but at first it was like a electrical snake was inside my heart then my heart rate went from 60 bpm to 150 bpm and I couldn’t breathe properly at all I called a ambulance and when they come about 2 hrs later my heart rate had dropped to a hundred bpm so they said if I go with them to hospital I would be put on a Covid ward and there was a high chance I would catch phneumonia so I suffered indoors with it,Then about a month later I had a myocardial infarction and this time the ambulance took me to hospital gave me some aspirin and put me in resuscitation and after a couple of hours I felt a lot better so it was a minor one,I also didn’t produce no high level of troponin.So they diagnosed me with the unstable angina and it’s been a downhill ski slope since then.Overall a horrible couple of years but these new tablets seem to be working so as you say it’s like marmite I think I may stick with the ones I’m on and just use my gt spray when I have the bad pains thanks for the reply and listening.All the best 😉

[Hidden]

Hi. I'm currently in hospital having had a 2nd heart attack and am awaiting an angiogram. It's been suggested to me tat ranazolin? May be he right way forward for me. The head cardiac nurse stopped by and we had a chat as she remembered me from last time and she seems to think it's a bit of a wonder drug and has helped lots of people. So fingers crossed this will be the case.Good luck with your recovery 👍

[Blues1977 in reply to Hidden]

Oh sorry to hear that,Good luck with your recovery too All the best 😉

[Billyjean123]

Hiya I'm also a microvascular angina sufferer. I take Ranolazine 500mgs and have had some benefit from it but not enough to control my symptoms when walking up hills etc. They did start me on a lower dose and increased it to 750mgs. However I did get some minor visual disturbances with that dose so they reduced it to the 500mgs. Good luck with it all. Unfortunately MVA isn't widely known about outside the cardiology world so it helps to talk here about our concerns and worries

[jerry12953 in reply to Billyjean123]

And it's not widely known about INSIDE the cardiology world either.......

[Blues1977 in reply to jerry12953]

Yh I also think u are right they don’t seem to know too much about it either let’s hope they pull there finger out and speed up the research.

[Milkfairy Heart Star in reply to Blues1977]

There is research going on into non obstructive coronary artery disease, NOCAD.

I have, over the nearly 10 years of living with vasospastic angina, noticed that the Cardiologists I now encounter do have more knowledge.

You might find this website helpful. It was written by 4 patients with over 50 years combined experience of living with NOCAD.

They are supported by over 25 world expert Cardiologists.

internationalheartspasmsall...

[Blues1977 in reply to Milkfairy]

Ok thanks for that il have a read later once I get in 👍

[richard_jw in reply to Milkfairy]

But what's the treatment for MVA? It sounds like the treatment is likely to be ranolazine. If that's the case is it worth expensive tests to see if it really is MVA. So if you prescribe ranolazine and it fixes the problem then the patient is happy and the NHS saves money

[Milkfairy Heart Star in reply to richard_jw]

Unfortunately it's not that easy.There is no good research evidence to suggest that Ranolazine is effective in treating Microvascular angina.

Ranolazine doesn't help half of patients.

There are are no medications available that have been specifically designed to treat Microvascular angina.

Many patients are presumed to have Microvascular dysfunction when in fact they have coronary vasospasms either in the small or large coronary blood vessels.

Accurate testing is definitely needed. The symptoms of Microvascular and vasospastic can be very similar, however the treatment options are different.

Patients who live with Microvascular or vasospastic angina live with angina that has a profound negative effect on the quality of their lives.

What is required is a holistic patient centred approach. This requires a multidisciplinary approach of a Cardiologist, Cardiac rehabilitation and Pain management services.

Patients also require other secondary protection medication to prevent complications such as heart attacks, heart failure and major cardiac events.

I am fortunate, I have a knowledgeable and supportive Cardiologist with whom I co designed my Admission plan and he respects my expertise in my lived experience of my condition.

I would love to clone him if I could.

[richard_jw in reply to Milkfairy]

That's the problem. It's easier to treat MVA or vasospastic angina by trial and error. When cardiologists are thin on the ground and many are occupied treating COVID patients more escoteric cardiac conditions don't get the attention they deserve. It's also true that many cardiologists either don't recognise these sorts of angina or consider them non life threatening and prioritise other conditions

[Milkfairy Heart Star in reply to richard_jw]

Microvascular angina is actually much more common than acknowledged.

The lack of acknowledgement of these heart conditions, can also be seen as a reflection of the unconscious bias about women and heart disease.

Non obstructive coronary artery disease, NOCAD, disproportionately effects women.

Quality of life important, it's not just about the length of our lives it's how well we can live them.

A trial and error approach can lead to harm.

I was prescribed beta blockers, as I was presumed to have Microvascular dysfunction which is more common than vasospastic angina.

I ended up in CCU for 5 days with unstable angina.

I now know beta blockers are contraindicated for those living with vasospastic angina.

I don't find it helpful to say that because of Covid that any heart patient is unable to access the care they need.

[richard_jw in reply to Milkfairy]

It may not be helpful to say that because of a shortage of cardiologists and the fact that COVID is putting the NHS and cardiology under more pressure reduces the level of service available, but that's the current situation.Just look at the number of posts on this forum where people are in real trouble because they can't get any attention from cardiology for more basic heart problems

[Milkfairy Heart Star in reply to richard_jw]

bhf.org.uk/what-we-do/polic...

[Blues1977 in reply to Billyjean123]

Yh thanks for your reply and Yh that’s when I had my last bad attack mid November I started trying to exercise too much and I think I just have to accept that I can’t do what I used too,But it is frustrating as I love walking and stuff that’s why when I heard about that new drug apparently it can help with exercise so Yh anyway.All the best 😉

[Hidden]

Hi Blues1977

I’m have microvascular/coronary artery spasms. My troubles started sometime around Feb/March 2020. Gradually got worse and I ended up in hospital Christmas Eve last year with a suspected heart attack. My troponin levelled were raised but didn’t increase significantly after 6 hours. Nothing caught on ECG. So I was sent home with a suggestion it was gastric . The months that followed saw me in and out of A&E.

I’m was put on Isorobide Mononitrate. Originally 2 x 10mg (AM /PM) at the end of January 2021. However on its own it really wasn’t controlling the angina. Prior to diagnosis they also put me on Bisoprolol, but that either didn’t work or exacerbated the problem. It took a while to catch my problem on ECG, and because I had a clear angiogram they again suggested to my GP that they refer me to Gastric. That was a frustrating period of time.

But after a few more repeat trips to A&E they caught it on ECG. My iWatch had also caught the same pattern during previous attacks and I had already emailed that to my GP (who it has to be said has been brilliant and did follow up with Cardio).

Since catching it on ECG they have increased my Isorobide Mononitrate, I’m now on 2 x 20mg. They also put me on Diltiazem (120mg). I’m also on Atorstavatin (20mg). They suspect it’s Microvascular / Coronary Artery Spasms. Based on all the information I’ve read I think that too. The medication now does seem to be controlling it. I have the odd niggle, but nothing that results in a call to A&E thank goodness.

I’ve got a myocardial profusion scan coming up this Thursday (stress test) and another a week tomorrow (rest test). I’ve been waiting for a number of months for those. It’ll be interesting to see what the outcome of those are. I’m definitely no where near as fit as I used to be. I keep active, I had returned to jogging. But have now scaled that back to walking as my pulse just seemed to shoot up when jogging.

Best wishes and i hope you get sorted with the meds xx

[Blues1977 in reply to Hidden]

Xx

[Sunshinebrew]

I have presumed micro vascular angina and also have 3 stents in my LAD which were fortunately put in before having a Heart attack. I suffered for 5 years with ongoing symptoms after having the stents. It was presumed that the problem was with the micro vessels as numerous angiograms to check the stents and large arteries came back fine. I had been prescribed beta blockers just before having stents put in, and I was subsequently prescribed nitrates and ranolazine I continued with symptoms until my cardiologist replaced the beta blockers with calcium channel blockers and have been symptom free now for 8 months I am able to exercise and have a lot more energy and no breathlessness or chest pain at all. I haven’t had a specific angiogram to diagnose the problem but I am sure from my own research that I was suffering from spasms in the micro vessels and I believe that in my case the beta blockers weren’t helping me. I am still on high doses of nitrates and the ranolazine but it’s replacing the Nebivolol with Adizem that has made the difference to me. I will be reducing the doses of nitrates and ranolazine next spring on the advice of my cardiologist provided I continue to be symptom free. With regard to ranolazine I think it helps and I have no side effects with it .

[Blues1977 in reply to Sunshinebrew]

Thanks for the heads up All the best 😉

[HectorsDad]

I’ve been on Ranolazine as part of my cocktail for quite a while, 750 twice per day, and it definitely helps- I really know if I miss a dose. It is an odd drug, and my cardioligist says they don’t know how it works, but it does for some.I’ve also been taking Isosorbide as a slow release capsule, but was recently switched to Nitrate patches. It is very obvious that these work better- cardio suspects that my gluten intolerance may interfere with the slow release mechanism, which makes sense.

[Blues1977 in reply to HectorsDad]

Yh I been thinking about getting on the patches instead of the slow realease tablets as they interfere with my gut thanks for the reply All the best 😉

[Lakefield2]

Hi ranolazine was a game changer for me was having lots of hospital admissions then got prescribed ranolazine it's great x