Is it heart related ie Angina or not

[Laspecia]

After having echo ( normal but small regurgitation) and CT angiogram now told no sign of CAD but still breathless on exertion and chest tightness. Being advised to stop Bisopril and Isosorbide and Aspirin. Dont know what to think or what to do next. Any suggestions welcone

[Hidden]

Dear Laspecia

Sorry to hear that you are still being worried with the symptoms you are showing.

In your last post you were told that you had angina and how shocked you were at the diagnosis { understandable }.

Now you seem to have had other tests that have ruled that out, so that is great news not that it helps you at the moment as you are still showing the same symptoms.

The change of meds is understandable as they were given with the impression that you had a heart problem { particularly angina } and as they have ruled that out those meds are not at this moment needed.

I am not medically trained but would now presume that your DR etc will now follow a different root in the hope of finding out just what these symptoms mean, certainly it needs more investigations.

Take care and I really hope that you get answers soon to help levitate your worries.

[Laspecia in reply to Hidden]

Thank you for your reply. I will see the GP once he has the letter from the hospital.

[Milkfairy Heart Star in reply to Hidden]

Please don't forget non obstructive coronary artery disease.

It is possible to pass all the tests for obstructive coronary heart disease and still live with angina.

Microvascular or vasospastic angina.

[Hidden in reply to Milkfairy]

Thank you for that, I was wrong to presume that all these tests are done, I am sorry about that. X

[Milkfairy Heart Star in reply to Hidden]

No problem, you are in good company, many Cardiologists overlooked these types of angina too 😊

[Milkfairy Heart Star]

Hello Laspecia,

Has non obstructive coronary artery disease NOCAD been considered?

Microvascular and vasospastic angina.

These types of angina are often overlooked when the tests for obstructive coronary artery disease CAD are okay.

I suggest you keep a diary of your symptoms as you stop taking your medication.

If you continue to experience your symptoms ask for further investigations to check for microvascular and vasospastic angina.

Breathlessness, is a common symptom that some women, in particular with microvascular angina can experience.

The BHF has this information about microvascular and vasospastic angina.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo....

[Laspecia in reply to Milkfairy]

Thank you. I did read about that but didnt want to seem like I was desperate for a diagnosis. I wish I had thought about it when the registrar phoned. I will do as you advise.

[Milkfairy Heart Star in reply to Laspecia]

Good luck.

My vasospastic angina took a while to be diagnose. I kept being told you can't have angina if your coronary arteries are clear.

Oh yes you can! You can even have a heart attack.

Unfortunately there is not enough awareness of microvascular and vasospastic angina amongst healthcare professionals.

Be prepared to be persistent and ask to be reviewed by a Cardiologist who understands microvascular and vasospastic angina.

[Serpente_12 in reply to Laspecia]

It is not easy to get vasospasm angina diagnosed. It took me 7 months, multiple trips to A&E, and 4 hospital admissions to get the right treatment. I had blood tests, ECHO, CTCA, MRI and all showed normal. One cardiologist even suggested me to see a psychologist instead. They finally give me medications for vasospasm angina after everything they tried failed to reduce my chest pain and me insist to try them. And these medications work for me and reduce my chest pain significantly. By the way, beta channel blockers like bisoprolol are contraindicated for vasospasm angina and will make it worse.

[Milkfairy Heart Star in reply to Serpente_12]

Hi Serpente_12

I have lived with vasospastic angina for 10 years.

It took me sometime to get my diagnosis too. The anxiety or it's in your head card was played with me by some Cardiologists.

I now have a confirmed diagnosis I had a specialised angiogram with acetylcholine to diagnose my vasospastic angina. This is the only way at present to confirm a diagnosis of vasospastic angina.

I hope your medication continues to help.

Whether medication works isn't necessarily the best way to diagnose a patient.

I am unfortunately resistant to my anti angina medicines. That resulted in being told I couldn't have angina and perhaps my pain was in my head by one Cardiologist.

I duly showed the Cardiologist my angiogram with acetylcholine results.

Vasospastic angina is along with microvascular angina a complex heart condition.

[Serpente_12 in reply to Milkfairy]

Hi Milkfairy.

Thanks for your message. I am taking Adizem, nitrate, and statins and they control my symptoms very well. My diagnosis came from eliminations of other causes, not directly from angiogram, as the cardiologist suggested against the invasive procedure and said even if it is confirmed by that the medications will be the same anyway. I was satisfied with that.

Earlier this year, I had a chance in an online alumni seminar of heart disease to ask a cardiologist from a heart specialist hospital about vasospasm angina, he admitted it is under diagnosed but about 1 in 5 heart attack patients they see do not have coronary artery blockages. So it is not that rare.

[Milkfairy Heart Star in reply to Serpente_12]

Hello Serpente_12

Research has actually shown that it is important to distinguish between Microvascular dysfunction and vasospastic angina. It leads to bespoke medical treatments.

pubmed.ncbi.nlm.nih.gov/317...

There is now an interest by interventional cardiologists to diagnose angina non obstructive coronary arteries, ANOCA by invasive testing.

As you say microvascular or vasospastic angina can cause heart attacks. Myocardial Infarction non obstructive coronary arteries MINOCAs are thought to make up 10% of heart attacks.

I was assumed to have microvascular dysfunction, when I was admitted to hospital 10 years ago, with a suspected heart attack.

I was prescribed beta blockers which can help those with microvascular dysfunction, I ended up in Coronary Care with much worse angina.

I discovered later that beta blockers are contraindicated if you have vasospastic angina.

I wanted to know why I was having my symptoms. As well as having chest pain at rest I also have exertional chest pain.

My angiogram with acetylcholine helped me access the care I need.

Unfortunately my vasospastic angina is resistant to treatment and I end up in hospital for treatment with IV GTN a couple of times a year.

It's always good to hear that the medications works for others. Long may it continue for you.

You were fortunate to be diagnosed so quickly, many patients mainly women have problems.

There are quite a few on the forum who have struggled for years to get a diagnosis.

Vasospastic angina is certainly under recognised, under diagnosed, under researched and under treated.

You might be interested in this website. It was written by 4 patients with over 50 years combined experience of living with microvascular angina and coronary vasospasms.

They are supported by 30 world expert Cardiologists.

internationalheartspasmsall...

[dunestar]

Hello Laspecia. Just to echo what Milkfairy has said about microvascular and vasospastic angina. I too had breathlessness and chest tightness. A more or less clear angiogram ruled out my main coronary arteries being the problem but the consultant flagged up microvascular angina straight away. I did have a stress echo before the angiogram which showed ischaemia, so they knew something was not right. Lots of people get dismissed after a clear angiogram, so it's important to press for your doctors having a clear pathway of further testing etc to get to the bottom of what the problem is.

[Laspecia]

Thank you for all your comments. I now feel more armed with questions for my GP. I am tapering off all heart medications and monitoring systems to see how it goes. Someone has even suggested it might be long covid but unless I am one of those people that always tests negative and has no symptoms I am dismissing that.

[ba69]

Hi LaspeciaSomething similar with me, after angiogram told angina, then at cardio appt told don't think it's angina and to stop isosorbide but stay on bisoprolol, waiting for more tests relating to electric impulses. Stopped meds last week and now sob, fluttering and some chest pain again, not sure what to think.

[Seena2019]

it would be good if you follow up and get Angiogram done. CT angio is not accurate.

[Milkfairy Heart Star in reply to Seena2019]

CT angiogram are considered to be accurate.CT angiograms are recommended by the National Institute for Clinical Excellence, NICE here in the UK.

[Laspecia]

Have now spoken to my GP after hospital letter arrived . He's now referring me to the respiratory physicians. I wont hold my breath waiting 😀currently no chest pain and only breathless on exertion so feeling good.