Advice required from Milkfairy and others.

[Ghost-233]

Hi I am having an angiogram next week. I have been treated for angina for many years although an angiogram over 20 years ago when I was 50 was judged to be normal. One Cardiologist suggested I might have Pritzmetal angina but another Cardiologist later discounted this. I have found it very confusing over the years that one Doctor says one thing and another says something else.

Since then I’ve had episodes of chest pain but in the last 6 months this has become worse and I was admitted to hospital when I had a really bad episode. I was admitted overnight as my Troponin levels were raised. The two Consultants in the ward heard a heart murmur and thought I might have a leaking valve but they both stressed they were not Cardiologists. When I was seen by the Cardiologist he did not mention a murmur but said he wanted an angiogram and echo done.

I was seen in clinic by a very knowledgeable young woman Cardiologist and we discussed the fact that I might microvascular angina. I’m going to one of the large teaching hospitals for the angiogram and wondered what questions should I ask-if I get the opportunity to ask.

Would appreciate any advice thanking you in advance.

[Hidden]

Dear Ghost-233.

I am sure that Milkfairy will be along soon to answer a large part of your post.

So what can I tell you?

Mainly that I and many others feel for you having to cope with mixed messages that you have been given with regards to your health.

Personally I think that you should disregard everything prior to this upcoming test as most of it appears to be 20 years old.

She [ your new cardiologist ] seems switched on to your concerns and I’m sure with the results of the tests in front of her she will , at long last, give you some answers, or if not certainly what the next stage of your treatment will be.

You say you are going to a large teaching hospital for your tests, I did the same here in Southampton.

Now I don’t know how yours works { maybe a phone call would tell you } as sometimes I’m seen directly after by the heart team/ cardiologist and they can answer the questions raised by the tests.

Other times I have gone for scans when just the technician is there , and they are not allowed to say anything { gone are the days when they used to give you the nod one way or the other }

Good luck with it all, I shall be following your journey with interest .

[Ghost-233 in reply to Hidden]

Thank you Blue1958 for your kind reply. I’ve had some excellent advice from Milkfairy. I think probably things have moved on very much in the last 20 years and Cardiologists seem much more more approachable. I hope this finds you doing well.

[Milkfairy Heart Star]

Hello,

I agree with Blue1958's advice about disregarding your previous tests.

There have been enormous developments in the understanding of heart disease over the last 20 years.

Also as we get older the chances of developing permanent blockages in your coronary arteries increases.

I have seen in the 10 years of living with Vasospastic angina how attitudes and knowledge have improved.

When I meet a new on call Cardiologist, I ask them what their experience is of caring for patients with non obstructive coronary artery disease NOCAD.

Microvascular dysfunction and vasospastic angina.

Unfortunately the knowledge base isn't always great, but it is getting better.

Most of the doctors I meet have heard of the condition however few have actually met a patient with in particular vasospastic angina.

Many patients' microvascular and vasospastic angina in the past was overlooked because of lack of understanding and knowledge.

I would ask this question as well. During the angiogram as well as looking for blockages in your arteries will the way your blood vessels function also be assessed?

If not why not?

During an angiogram they have now developed techniques to assess the function of the small blood vessels.

They look at the way the blood flows. In this way they can diagnose microvascular dysfunction which is a cause of microvascular angina.

In a few centres they are performing a test during the angiogram to detect coronary vasospasms. This is when there are transient constrictions in the coronary arteries, vasospastic angina.

Vasospastic angina is the term more commonly used rather than Coronary artery spasms or Prinzmetal angina.

Why is it important to know if you have either microvascular dysfunction or vasospastic angina?

It's important because the treatment is different.

Vasospastic angina is less common than microvascular angina.

It is also possible to have both obstructive disease needing treatment by a stent and microvascular dysfunction or vasospastic angina.

I wish you luck for your angiogram.

You might find this website helpful too.

It was written by 4 patients with over 50 years combined experience of living with NOCAD. The group is supported by over 25 world expert Cardiologists.

internationalheartspasmsall...

[Ghost-233 in reply to Milkfairy]

Thank you Milkfairy for your excellent advice. I have looked at everything you have written and made a list of questions to ask hopefully I will get the opportunity to do that. Thank you again for taking the time to reply.