Coronary spasm duration

[Goldenheart]

Hi, can anyone tell me if theyve experienced coronary spasms that last hours. I had chest pressure. pain in breathing, pain in my left armpit, just sat reading, on Saturday night,around 9. It was still there at bedtime, midnight,and i had pain laying on my left side. I attended hospital, as i have a presumed diagnosis of spasms. I had blood test, ecg, chest x ray. All came back normal. And the doctor said no heart attack evidence, but it could have been a coronary spasm. I was under the impression spasms are shorter in duration?

[Milkfairy Heart Star]

I have clusters of coronary vasospasms.

A vasospasm will start gradually getting stronger and longer. They peak after an hour, then lessen with a dull ache. About an hour or so the whole process starts off again. These clusters of pain can last for a couple of days.

When this happens more than a couple of days, I go to hospital where I am treated with IV GTN and IV morphine. I am usually in hospital for about a week.

I have a confirmed diagnosis of vasospastic angina. I have a careplan, sometimes I have changes on my ECG, sometimes a small troponin blood level rise.

Have you got an appointment to see your Cardiologist soon?

You may need your medication reviewed.

[Goldenheart in reply to Milkfairy]

Hi Milk fairy, im scheduled for a specialist angiogram to test for microvascular angina, i got a phone call recently to inform me i could have a longer wait,as the hospital is struggling to obtain the necessary drug they need to test for it. ..i have been living with a presumed diagnosis only,for over five years, but its thanks to your wonderful advise that i did push for a second opinion,and im very grateful that i did get to the specialist you recommended. I had a phone consultation a couple of months ago, leading to the necessary test. At that point however,i didnt have symptoms at rest,which i had saturday night. To complicate the diagnosis,i do have costochrondititis, and lots of arrythmias. Hope your doing ok?

[fishonabike]

i am sorry to hear that you have experienced this and hope that Milkfairy's comment will be of help to you

but i would like to add a note of concern:

coronary artery spasm can occasionally trigger a Takotsubo episode (see BHF site for more info) - i would be concerned that spasm which lasts as long as yours did is a Takotsubo episode - how are you feeling now?

[Milkfairy Heart Star in reply to fishonabike]

Interesting about whether there is a possible connection between Vasopastic angina and Takotsubo syndrome.

Have you got any research articles about the possible association of coronary vasospasms and Takostubo syndrome?

I have lived with vasospastic angina for 10 years. My and my Cardiologist's understanding is that a prolonged coronary vasospasm can cause a heart attack, MINOCA, Myocardial Infarction non obstructive coronary arteries, rather than a Takostubo syndrome event.

My triggers are the cold, extreme tiredness, mental, emotional and physical stress.

I have had 15 admissions in 10 years. So far no evidence of permanent damage to my heart muscle. I do have a confirmed diagnosis and an admission plan. I also keep in close contact with my Cardiologist when I am in an unstable phase.

Anybody without this support needs to seek prompt medical review by a Cardiologist knowledgeable in treating patients living with microvascular and vasospastic angina.

I would also say it's a life of walking on a tight rope with this type of angina.

Takostubo syndrome can like a severe coronary vasospasm lead to ST elevations and raised troponin blood levels. However there are no changes to shape of the heart or acute heart failure with coronary vasospasms, the hallmarks of a Takostubo syndrome event.

Do you have a lived experience of vasospastic angina or an Takostubo syndrome event?

[fishonabike in reply to Milkfairy]

I do not have " lived experience" of CAS, but i have had a Takotsubo episode and am a member of an online support group for people with Takotsubo (TTS) - Several members have been diagnosed with CAS and other forms of INOCA after TTS (i won't get involved in a discussion of differences between INOCA and MINOCA here as this is not the time or place)

The diagnostic "change of heart" shape you refer to is not always observed at the time of the episode (usually by angiogram and/or echocardiogram) and often resolves quickly, in hours or days - but the resulting inflammation of the myocardium remains along with reduced ejection fraction and other clinical symptoms

There are published case studies of CAS involvement with Takotsubo - here is a recent one: hindawi.com/journals/cric/2...

[Milkfairy Heart Star in reply to fishonabike]

Thank you for the link.

However I feel as a patient living with an unpredictable type of angina, great care should be taken when posting this type of information.

It's perhaps a question for an expert like Prof Dana Dawson to answer.

We are not medically trained but a peer to peer support group.

I know the Takostubo Syndrome group well, as am a member too. I was initially thought to have had Takostubo syndrome event or heart attack 10 years ago, my angiogram with acetylcholine confirmed my diagnosis of vasospastic angina.

What we all need is more research into our heart conditions.

[Goldenheart in reply to fishonabike]

Hi fishonabike, thankyou for your concern and reply. I did get checked over at A AND E on Monday, i had an ecg, an x ray, a blood test, all came back clear. The uncertainty and unpredictability causes me a lot of anxiety.

[fishonabike in reply to Goldenheart]

it's understandable that you feel concerned about your condition, it is not a widely understood condition and many health professionals have no knowledge of it - also it seems to affect you in an unpredictable way - all this uncertainty is difficult to live with

i am sure that Milkfairy can point you toward some useful sources of support

i know that you may feel this won't help but some people with similar conditions find that breathing and relaxation techniques can be helpful in coping with episodes like this - the NHS has online resources you could try - it won't treat the condition but it can help you feel a little more in control if you have some coping strategies to turn to

[Goldenheart in reply to fishonabike]

Fishonabike thankyou. Yes Milkfairy has pointed me towards the right support, im so grateful for this,and the experiences of others all help. It can be a lonely path without,thats for certain. I do use the breathing technique, unfortunately in some episodes i nearly faint and nothing helps. But thankyou for your input.

[Milkfairy Heart Star in reply to Goldenheart]

Golderheart,

It was good to read in your first post, that all your tests came back okay and without showing a rise in your blood troponin blood levels.

I agree the challenge of living with an unpredictable type of angina, that is still not well understood by Cardiologists is tough.

I have found ways of managing this stress and anxiety over the years. However I have woobles too! Having the support of my family and Cardiologist help.

My careplan is so important, a copy is kept in the Ward Manager's office and it's on the hospital's electronic records system.

This is something perhaps you can ask for.

I am also about to start some more sessions with a Cardiac Psychologist to help me manage too.

Perhaps ask your GP for some further support?

Are you any further forward in obtaining a confirmed diagnosis and finding a Cardiologist to support you?

[Goldenheart in reply to Milkfairy]

Milk fairy, yes i do hope so. On your advise i did get a lengthy phone consultation with a proffesor you recommended.......i know i cant say on this forum which, but hes leading the facility to test for spasms,and he has empathy and understanding,and validation, which in itself was wonderful to hear. He said i will be tested for microvascular, he did offer to test also for coronary artery spasm, but i declined this,as im afraid it can be dangerous. But then again, i need clarification,its so difficult. Do you think, i know you have years of experience, coronary spasm can be a diagnosis of exclusion? And,as it can be intermittent, would it always be exposed via testing anyway? Also, thankyou again, your advice has helped enormously through this time of uncertainty!

[Milkfairy Heart Star in reply to Goldenheart]

I am so pleased that I was able to point you in the right direction.

Only you can say if any risk of a procedure, you are offered is acceptable to you. A process of shared decision making with a Cardiologist is needed.

It was important for me to have a confirmed diagnosis. All my other tests were normal. I wanted to know why I was having my chest pain. I had been told by too many Cardiologists that I didn't have cardiac chest pain. They wouldn't accept my presumed diagnosis which actually turned out to be incorrect. I was assumed to have microvascular angina. Even given beta blockers which arecontraindicated with vasospastic angina. I ended up in hospital.

This is a problem, that a presumed diagnosis isn't accepted by all the staff you may encounter. This can lead to you not receiving the care you need.

Microvascular dysfunction can be assessed by a perfusion MRI. However coronary vasospasms can only be diagnosed by acetylcholine being injected into the coronary arteries, during an angiogram.

You can have vasospasms in your small or large blood vessels. The treatment options are different coronary vasospasms and microvascular angina.

During my angiogram with acetylcholine I had spontaneous and acetylcholine induced coronary vasospasms. I had ST elevations and depressions and chest pain. It wasn't pleasant.

I don't regret having the test, but I am not going to ever have another one!

There is plenty of evidence to show that an angiogram with acetylcholine only increases your risks slightly. It isn't dangerous otherwise you wouldn't be offered the test.

My confirmed diagnosis means I now receive better care, especially in A&E and on the Cardiology ward.

I hope you are able to make the decision which is best for you as an individual.

Do say how you get on.