I'm new & need help re vasospastic an... - British Heart Fou...

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I'm new & need help re vasospastic angina

1Shishi profile image
4 Replies

Hi there,

I have chest pains (and left arm pain more recently) that started in Nov 21.

I have done a number of tests (ECG, CT Angio, Blood Tests, Chest Xray, sonography etc.) which have been normal. The only test that showed anything was a stress ECG after which my doctor prescribed Dilitiazam and GTN for suspected vasospasm.

Initially I responded to the medication but the pain has come back, spread to my left arm and increased in frequency. Having done some research I have found out that the only way to diagnose vasospastic angina is through an angiogram with acetylcholine. However, my cardiologists refuses to do this given the fact that I am young (39 years old), all other tests have come back normal (no plaque build up etc), and I'm generally very healthy. He has instead suggested taking more medication, using GTN tablet instead of spray and Stress MRI test to see if that shows anything.

I'm frustrated and worried. I don't want to take more medication when it hasn't been confirmed that I have this condition and as far as I understand stress MRI cannot confirm diagnosis.

I wanted to get a second opinion from another cardiologist, one that perhaps specialises in this area (any recommendations?), and also get help from this group - what can I do?

Thank you.

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1Shishi
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Milkfairy profile image
MilkfairyHeart Star

Hello 1Shishi,

Welcome to the forum.

I have lived with coronary vasospastic angina for nearly 10 years.

Mine was confirmed by an angiogram with acetylcholine in 2014. I was incorrectly assumed to have Microvascular dysfunction.

There are some centres in the UK performing this type of angiogram.

It needs to be carried out by an experienced and confident team in a centre of excellence.

Your Cardiologist may not have the appropriate training or skills to carry out an angiogram with acetylcholine.

Unfortunately the lack of knowledge about non obstructive coronary artery disease NOCAD leading to angina nonobstructive coronary arteries ANOCA can be a problem.

I have been fortunate as I have a very supportive and knowledgeable Cardiologist.

The forum guidelines do not allow us to name individual doctors or hospitals as such on the forum.

Where in the UK are you based?

However another way of finding a Cardiologist is to ask to be referred to a centre involved in research.

There is the PRIZE trial

clinicaltrials.gov/ct2/show...

Also another trial into how to diagnose ANOCA at St Thomas's hospital in London. You can email the research fellow directly, his contact details are at the bottom of the article.

isrctn.com/ISRCTN94728379

Finally there is a growing interest in this area of Cardiology. This paper was published yesterday, perhaps an article you could discuss with your Cardiologist?

heart.bmj.com/content/early...

Tricia7048 profile image
Tricia7048

Did you know you can get GTN patches as well? I use those and find its better than yet another pill. Yes the gtn pills are fine and work. I got diagnosed with your condition about 3 yrs ago as my angina was bad, but I discovered myself it was a side effect of Ramipril tablets! I got them changed and it improved, nothing like as severe as before. I hope you get a solution soon!

Milkfairy profile image
MilkfairyHeart Star in reply to Tricia7048

HelloTricia7048

I noticed on your profile that you live with Microvascular angina.

Microvascular angina and Vasospastic angina are types of non obstructive coronary artery disease NOCAD. They are distinct conditions causing angina non obstructive coronary arteries, ANOCA.

It's important to make this distinction as the tests and treatment are different for microvascular and vasospastic angina.

A severe coronary vasospasm due to vasospastic angina can lead to a heart attack. Using a short acting GTN spray can be very helpful to relax the coronary arteries in this situation.

GTN patches are longer acting and are better suited along with isosorbide mononitrate extended release tablets in preventing coronary vasospasms.

Tricia7048 profile image
Tricia7048

I know that but thanks

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