Hi all I have a telephone consult with my GP this afternoon regarding yet another recurrence of an undetected/undiagnosed heart condition that is has been going on since before 2019 and I aim to bring up the issue of angina. Can anyone suggest what tests I should request? On NHS site I tick most of the boxes for angina.
Furthermore, after reading a few posts here about angina it was mentioned that certain beta blockers are not suitable for people with Vasospastic angina. I have not been diagnosed with this condition as of yet. Can anyone please tell me WHY beta blockers are not suitable for those diagnosed with Vasospastic angina?
I have asked this question because I was diagnosed with hypertension early 2019 and prescribed beta blockers (amlodipine) and honestly angina symptoms, chest pain, tightness in chest, discomfort and ache under breasts, discomfort top of gut, headaches, pain left side of neck with rapid pulsating in neck artery is happening more often. Had horrendous attack last night after pushing myself too much during the day hence GP phone consult.
Been admitted to a+e on numerous occasions with symptoms i just mentioned. They just do tests to check I have not had a heart attack give me the all clear and send me home. No follow up...no referral to a cardiologist.
Really would appreciate some feedback
Have a wonderful day
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DizzyD
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As Milkfairy says, vasospastic angina and microvascular angina need a cardiologist with the relevant knowledge. amlodipine is a Calcium channel blocker and from your post it seems that it might have been prescribed for high blood pressure. Normal angina is caused by partial constriction of one or more of the coronary arteries. This impedes blood flow and can cause the pain. I had a heart attack 18 months ago, and subsequently have had symptoms not dissimilar to yours.
In order to diagnose what the problem was, the cardiologist did a CT angiogram.
Help Richard sincere thank you for your reply. Sorry to hear you had a heart attack. How are you now?
Correct me if I have got it wrong, are you saying that your symptoms, after you had the heart attack, are similar to the symptoms that I posted above and the cardiologist did a CT angiogram to determine the cause of your symptoms?
Yes that's right. The initial HA was caused by complete blockage of the Right coronary artery. Once that was cleared partly with a balloon and subsequently with medication ( anti thrombotic drugs) a subsequent CT angiogram showed the arteries were clear CT
I,m a bit confused!! If the CT angiogram revealed that your arteries were clear (thank God for that) what was causing the symptoms that you had which you claim to be similar to mine?
Does a CT angiogram involve pumping dye into the arteries?
So pleased you are getting the care and support you need.
Lol...hope I am not passing my confusion to you.
Once again, thank you....Have a rewarding day....Really appreciate your feedback.
You can have angina without any permanent blockages of your coronary arteries.
Clear coronary arteries doesn't mean you can't have angina.
NOCAD conditions include, microvascular and vasospastic angina, a possible cause of a MINOCA- Myocardial infarction non obstructive coronary artery
Microvascular and vasospastic angina are difficult to diagnose with routine heart tests which look for obstructive coronary artery disease.
Microvascular angina is caused by the small blood vessels in the heart not functioning properly.
While vasospastic angina is caused by transient, constrictions, narrowings vasospasms of the coronary arteries.
The problem is that these types of angina are often overlooked as too few Cardiologists have the knowledge needed to care for this group of patients.
Good news, is that Cardiologists are now learning how to perform the tests required to assess the function of coronary blood vessels during an angiogram.
In my case, because the CT scan did not reveal any blockage, the cardiologist offered a "normal angiogram". This is a procedure where a catheter is fed either through the wrist or groin to the area of the heart where the blockage might be. Contrast dye is fed through the catheter and x ray imaging is used to highlight the arteries. It's said to be the gold standard for diagnosing blockages in the main coronary arteries. Because it is invasive, they did not do this first time around. It does have the major advantage that if a blockage or narrowing of the artery is found, they can fix it there and then, in fact this was the procedure I had when I had the original heart attack. Because of technical complexities they were not able to clear the blockage at the time completely. Hence the follow up angiograms which revealed that medication had finally cleared the main arteries. Because I still get angina, the conclusion was that it was microvascular angina
As Milkfairy points out, it will not diagnose MVA or vasospastic angina.
I don't know what % of angina is of that sort, but I suspect it is in the minority. As far as I know, there is no "intervention" which can be done to fix small vessel angina. Treatment is via medication. Which I have been prescribed.
It is thought approx 30 % of angiograms show no significant blockages.A large majority of those may well have microvascular dysfunction, a smaller number vasospastic angina.
Nobody really knows as without an accurate diagnosis or audit the numbers aren't being counted.
This article was published recently, again suggesting that vasospastic angina isn't rare rather under recognised and under diagnosed.
In my case, Nitrates reduce my BP too much anyway (I fell over once). Cardiologist recommended Ranolazine I suspect because it does not reduce BP, which beta blockers tend to do After my MI I was put on Bisoprolol amongst other meds) and it made me feel like a zombie, . Coming off bisoprolol after a year increased my pulse to 70-75 from 60 and made me feel better. I can't remember if the angina I have coincided with withdrawing from the Beta blocker. So maybe I should get the angina properly diagnosed. I'm just about to start Ranolazine, I guess because the cardiologist has not the experience of MVD, I think he is prescribing it because it is not supposed to lower your BP and it is an anti anginal. One does get a bit frustrated with the absence of a proper diagnosis, rather than this trial and error approach
Richard I just read over messages again and light bulbs are going off in my head regarding your brief reference to bisoprolol. Hope you don't mind if I pick your brains. Over two weeks ago I started tapering off bisoprolol. Why?All the symptoms I mentioned in my initial post, appeared, or were made much worse once I started taking that drug in 2020. Been on a merry go round since I was like like a zombie, emotionally, mentally and physically. Been off it two weeks now and I feel more alive...taking back control. Like yourself, my pulse has increased...feels more natural. So pleased. Last night I had strong heartbeats (not afib) really unsettling, could not sleep so took a bisoprolol 2.5 which helped resolve the issue. Low and behold today I am back to zombified state kind of depressed feeling.
Question is, did you taper off bisoprolol or did your cardiologist just switch you to another brand of so which one.
Sincere thanks on advance
Have a rewarding day
BTW I literally thought I had dementia on bisoprolol along with amlodipine.
I tapered off. The cardiologist recommended that I did. I cut back from 2.5mg to 1.25, and then halved it again each with a week between. It's difficult dividing the 1.25 pill in half Bisoprolol the only beta blocker I have taken.There are a lot of posts here which talk to bad experiences if you stop immediately, but some people take as much as 10mg, so they may have worse symptoms if they don't taper.
Thank you Richard for priceless info. As of yet I am not seeing cardiologist so going it alone. My prescribed dose 2.5 from the start I only took 1.5 unless I had AFib attack which was rare then I took 2.5. I didn't even take 1.5 everyday but still side effects were awful. Over time I got kind of confused and thought the side effects were initial heart problem that had become worse. How on earth do people manage tapering off 10mg. I suspect I have angina which has not been diagnosed. Gonna go private. Info I have gained here on this site really helped. Plan to use bisoprolol as pill in pocket for AFib flare ups of any, until I see a private cardiologist. Gonna be waiting a long time to see one via NHS.
Hello Milkfairy thank you for your informatItsve reply which is very helpful. Really appreciate your help.
I had telephone consult with GP and finally I have been referred to cardiac clinic. Bit late in the day considering, I have mild stenosis, enlarged heart, afib, and hypertension which was diagnosed by a private cardiologist 2020 during covid lockdown. Can't afford private cardiologist anymore.
Despite numerous admissions to a+e since (with symptoms mentioned in my initial post) being diagnosed I have not been referred to an NHS cardiologist.
Furthermore, the GP prescribed Glyceryl Trinitrate for the chest pain so that,s progress. Oh I did say to the GP, "I suspect that I have angina". Surly this should have been picked up during all the emergency admissions to a+e. Can angina be detected with a blood test or ecg?
I will keep your reply because it is so informative and retain the important info regarding types of angina and use it when I go to first appointment with NHS cardiologist.
At the end of the day, my heart conditions (hypertension, afib, enlarged heart) were caused by being over prescribed levothyroxine for over 30 years. Grrr My endocrinologist told me this.
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