Angiogram with provocation test.

[Goldenheart]

Im scheduled for the above,to test for microvascular angina. Ive been told to stay on ranolazine, does anyone know if thats standard procedure. Ive been told to with hold Adizem.

[Milkfairy Heart Star]

Hello Goldenheart, You should take the advice of the team undertaking the functional angiogram.

Some hospitals ask you to stop taking your calcium channel blockers and long acting nitrates. This is because these medications help prevent coronary vasospasms and could effect the test results.

Ranolazine works in a different way.

My blood vessels are so trigger happy, I was told not to withold my Diltiazem and nicorandil.

I stopped taking my oral isosorbide mononitrate the day before.

I had spontaneous and acetylcholine induced coronary vasospasms. Lots of ST elevations and depressions on my ECG accompanied by chest pain.

Good luck for tomorrow, I hope you get an accurate diagnosis.

I felt relieved and validated to finally get a confirmed diagnosis.

Do ask for pain relief if you need some. I was given IV morphine.

[Goldenheart in reply to Milkfairy]

Hi Milkfairy, thankyou for replying. The assesment nurse told me to stay on the ranolazine, i did question it,as i thought staying on it may supress any spasms, hence not give a true result. She said the same as you,it works in a different way. I hope the test will be as effective as it can be, im not looking forward to it. But obviously i am looking forward to ,hopefully,getting some answers. Is it very painful?

[Milkfairy Heart Star in reply to Goldenheart]

The chest pain I experienced was no worse than my usual chest pain.It was more uncomfortable lying flat with the chest pain. They gave me the morphine as I was having ST elevations, a sign of acute myocardial ischaemia.

I just concentrated on my breathing and staying relaxed as possible.

I felt safe, there were eight members of staff in the cath lab. The Cardiologist was a very experienced Prof.

Getting my diagnosis made the discomfort worthwhile.

[Goldenheart in reply to Milkfairy]

Definately makes it worth while, and im very grateful that im having the procedure. Excited and nervous at the same time. Im nervous more so due to the arrythmias i have A fib, and another,still under investigation. A bit emotional too, ive waited a long time for this! Thankyou for all your kind support.

[Goldenheart in reply to Milkfairy]

Hi Milkfairy. Ive had the angiogram,with the test for microvascular angina. My main arteries are clear, and no microvascular dysfunction showed. I didnt have the test for coronary artery spasm,due to me having a fib,and other irregular rythmns. Hence, im feeling confused. The dctr performing it,also said,as coronary spasm wasnt exposed on a treadmill with echo,i had,about 3 year ago,that coronary spasm is unlikely . Yet,the dctr performing that test,said as its intermittent,i could have coronary spasm. I get the feeling that different dctrs,still,as wonderful as they are,have contradictory opinions on spasms. Is a diagnosis by exclusion the next step,in your much respected,opinion? Many thanks.

[Milkfairy Heart Star]

I can understand your confusion! You seem to be left with more questions than answers.

It's a pity you were unable to be given acetylcholine to see if you have coronary vasospasms.

You can have microvascular or coronary vasospasms.

The COVADIS Coronary Vasomotor Disorder International Study Group has this information.

covadis.online/definitions/...

"Suspected vasospasic angina’ is diagnosed if nitrate-responsive angina is evident during spontaneous episodes but transient ischaemic ECG changes are equivocal or unavailable and coronary artery spasm criteria are equivocal."

It is very difficult to catch ECG changes during a spontaneous episode of chest pain due to coronary vasospasms.

Though one nurse did as she put it ' go spasm hunting' when she performed consecutive ECGs when I had chestpain. She caught the shift in my ECGs which impressed the Cardiologist no end.

I am not sure I'd agree that a stress echocardiogram would flush out coronary vasospasms either.

I had a stress echo in September. I passed with flying colours. The chest pain started afterwards and lasted for a few days.

After my perfusion MRI which again showed no problems, I ended up in A&E with ST elevations and depressions.

Confused the staff.....but your coronary arteries are unblocked 🤔

Next step is to ask to see a guru of microvascular and vasospastic angina or if you cannot travel, the team caring for you discuss your case with them.

I'll message you their names as we're not supposed to name Cardiologists on the forum.

[Goldenheart]

Thankyou Milkfairy. My long search to pinpoint whats going on continues . Your experience and support gives me positivity.

[Milkfairy Heart Star in reply to Goldenheart]

I am sorry it's turning into such a saga!