Clear Angiogram but angina symptoms persist

[Fonzo]

I have left axis deviation and following months of on and off chest discomfort (heaviness and occasional dull ache) and visits to my doctor, I got to see a Cardiologist. Given my ECG and left axis deviation he arranged for an Angiogram and put me on Aspirin (75mg), Atorvastatin (40mg) and Isosorbide Mononitrate (2 x 10mg a day)……all as a precaution until Angiogram results. Had the Angiogram 4 weeks later and clear and the cardiologist suggested I may have microvascular angina. I have another appointment with him in December. He suggested to my doctor I could increase the ISM dose and that given my BP and heart rate (which had been climbing), 1 x 1.25mg Bisopropol (Beta Blocker) should be taken. That was back late September. Given angiogram was clear I have been rather confused as to why I should continue with all the precautionary meds. I went to my doctor and we agreed perhaps the aspirin was no longer needed and he suggested I come off the ISM. Cutting a long story short….I have cut the aspirin out completely since end September……the ISM I stopped…then started again but find it makes me feel nauseated and dizzy and has little effect. What is clear is my cholesterol has more than halved and my BP and heart rate are under control. But my chest pain/discomfort is now focused on upper left chest and aside of heaviness can feel like someone has two fingers prodding me and I have a cold feeling often as if cool water is running over my chest. I aim to progress with Cardiologist in a few weeks and I guess until I get a diagnosis I don’t know what I don’t know. But my question is for those of you who have MVA and specially around the meds I have been prescribed. Do they sound right…does ISM offer relief for MVA? Like all who have posted……my life has changed quite a bit and I am trying to stay positive and healthy whilst still worrying about what exactly is going on!

[Silvertail]

I hope you get some answers soon. It's worrying when you don't know what's wrong. I have Microvascular Dysfunction and get angina and breathless on exertion. I believe that's what I've had most of my life. Doctors would listen to my chest and order an ECG which was always normal so that was that. In 2012 I had stress cardiomyopathy and ECGs showed LBBB with left axis deviation and 1st degree AV block. Cardiologists never mention these to me so I get the feeling they are nothing to worry about and I wonder why I am on optimal meds for heart failure/cardiomyopathy. (I've had four episodes of takotsubo cardiomyopathy - heart pumps out of shape, but eventually goes back to normal). So I wonder why I am on all these meds. One cardiologist did say if you stop all the meds and go backwards again, the meds don't work as well. Re the meds, I am on highest dose of Candesartan, Bisoprolol, Spironolactone, Crestor, Aspirin, I did have ISM, but it didn't do anything for me, so I use a GTN spray when needed. I'm interested to know how you get on.

[Fonzo in reply to Silvertail]

Thanks. I will certainly let you know.

[Fonzo]

I have certainly started the lifestyle changes, have lost weight and exercising a lot more. Hopefully a few more tests will clarify things!

[Milkfairy Heart Star]

Hello Fonzo,

Welcome to the forum.

Microvascular angina is a serious heart condition. It is thought to be due to the smaller blood vessels of the heart not working properly.

They fail to dilate in response to exercise.

Microvascular angina can lead to a heart attack or heart failure if left untreated.

Unfortunately Microvascular is not well understood and requires the input of a specialist. It is certainly a condition outside the scope of a GP's usual practice.

It can take sometime to find the correct combination of medication under the supervision of a Cardiologist not a GP, that will work best for you.

Microvascular angina can be diagnosed by a cardiac perfusion MRI or by an angiogram using adenosine to measure the coronary flow reserve and index of microvascular resistence. You can ask your Cardiologist about these tests.

The BHF has this information about microvascular and vasospastic angina which are both types of non obstructive coronary artery disease NOCAD.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo....

I live with vasospastic angina, I have transient constrictions of the large and small blood vessels of my heart. This reduces the blood supply to my heart causing angina.

I am prescribed many different types of medication including anti anginal medication, statins and an antiplatelet.

Your GP may have been a little too hasty to stop the medication prescribed by your Cardiologist.

Like any heart condition it can take time to learn to live with your condition.

You may find the information on this website helpful too.

internationalheartspasmsall...

There are quite a few of us on the forum who live with microvascular or vasospastic angina.

So hopefully, they will along to share their experiences with you too.

[Fonzo in reply to Milkfairy]

Thanks for the reply and very useful advice. A few weeks time and I will see the Cardiologist again. I will certainly query the tests.

[Bodyp]

Were you taking Atorvastatin prior to chest pain? I found when I was taking this I had a pain which radiated through chest to my back, it came on as a dull ache&increased. It lowered my cholesterol by half, however I couldnt tolerated the pain. Ive since been put on different drug. Just thought letting you know my experience. Only problem is The replacement drug has not lowered cholesterol enough. Good luck&hope you improve soon.

[Fonzo in reply to Bodyp]

I had chest pain/dullness before the Atorvastatin but seem to have it more now I am on meds! It has halved my cholesterol but I will discuss my specific chest pain with the cardiologist

[Poppy451]

Hi there

Maybe the isosorbate mononitrate dose is too low . I am also on that dose and it doesnt do much for me . Next time I see the doctor I will ask about increasing the dose. I have microvascular angina and spasm as seen on cardiac MRI and clear angiogram with spasms. I am due to have another cardiac MRI sometime in the future.