How is angina diagnosed ?

[Westie2012]

I get chest pain every day when I’m walking up to the school , I’m waiting to see my respiratory consultant regarding test results from a few different breathing tests and still waiting to have an exercise stress test because I have a pacemaker and have ongoing chest pain and breathlessness on exertion so my cardiologist wants to see if anything heart related is causing my symptoms . I feel like my symptoms could be possible angina, I’ve had a ct angiogram that was normal , recent blood tests were ok too . If all tests were normal would this rule out angina ? ,

[Milkfairy Heart Star]

Not necessarily as these tests will not always be able to diagnose angina.You can also have angina without obstructed coronary arteries. Microvascular or vasospastic angina.

The BHF has some useful information about angina.

bhf.org.uk/informationsuppo...

[Heartfairy in reply to Milkfairy]

Hello Milkfairy I hope you don’t mind me contacting you but I have been reading up on micro vascular angina. The reason being, three weeks ago I was admitted into hospital with chest pain which happened on exertion. Following blood tests my troponin levels had increased so I was told I’d had a heart attack. Following a “traumatic” angiogram I was told the culprit artery was too small to stent so was given a cocktail of meds to take. I am finding that I still have chest pain, not to the extent I had before (probably eased a bit my the medication) but I thought I’d have seen some improvement by now. As the artery was too small and I also have a narrowing in another small artery this got me wondering and reading up on micro vascular angina which apparently is often overlooked in women especially during menopause. So I was wondering how you were diagnosed? Did you seek a second opinion and what suggestions or advice can you give me as perhaps I am in denial but im not convinced I’ve had a HA but am thinking it’s more likely to be unstable or micro vascular angina. I was told by the cardiologist how surprised he was that I’d had a heart attack as he classed me as low risk and when I asked him if I’d definitely had one he said “well the troponin levels indicate you’ve had one” but after further reading troponin levels can increase due to a few things. I look forward to hearing from you and anyone else who is able to advise. Thank you ❤️🧚🏼‍♀️

[Milkfairy Heart Star in reply to Heartfairy]

Hello,My journey started 10 years ago when I was admitted to hospital with a suspected heart attack.

At the time because my coronary arteries were unblocked, I was told incorrectly I couldn't have angina or a heart attack.

I was then presumed to have microvascular angina.

Microvascular angina can be caused by the inability of the small blood vessels to dilate or stay dilated in response to exercise, microvascular dysfunction.

It maybe that your small blockage was an ' innocent bystander ' and your problems could be due to a dysfunction of your blood vessels.

Another cause of angina without blocked coronary arteries is vasospastic angina.

This is the condition I live with.

I have transient constrictions of the large and small blood vessels of my heart.

Microvascular and vasospastic angina are types of non obstructive coronary arteries, NOCAD.

Also referred to as angina/ ischaemia non obstructive coronary arteries ANOCA/INOCA.

My vasospastic angina was confirmed by an angiogram with acetylcholine which induced my coronary vasospasms. I actually had spontaneous vasospasms during both of my angiograms.

It's not unusual for the arteries in the wrist to go into spasm, especially in women, we have smaller blood vessels and a little more skill and finesse can be required to stop spasms happening. This maybe what happened during your last angiogram.

I suggest you ask your Cardiology team to consider that you may have had a MINOCA, Myocardial Infarction non obstructive coronary arteries and to consider whether you may have microvascular angina.

internationalheartspasmsall...

MVA can be diagnosed by a Cardiac perfusion MRI or during an angiogram when they measure the coronary flow reserve CFR, index of microvascular resistence IMR and fractional flow reserve FFR.

Ask if these measurements were taken during your recent angiogram.

I have posted an infographic below, from a recent article which I suggest you discuss with your Cardiologist.

internationalheartspasmsall...

Microvascular and vasospastic angina are still poorly understood, under recognised and overlooked causes of angina and heart attacks. You may need to travel to see a specialist.

You also need to be persistent too! It took me a while to get my diagnosis and then find a Cardiologist to support my ongoing care.

Good luck.

Send me a DM if you would like any further information 🙂

[Heartfairy in reply to Milkfairy]

Hello again Milkfairy. Thank you so much for all that information, it has certainly given me something to think about, read up on and ask further questions. I know it’s not great to have a heart condition but it’s certainly encouraging to read that you’ve continued living life with your diagnosis for 10yrs! Well done you that’s absolutely amazing. I think when things are so new and so raw I question whether I’ll see my next birthday, that’s how scared I am but I need to get past that and remember everyday I’m gaining a bit more strength than the day before. Thank you again and please take care ❤️🧚🏼‍♀️

[MustyK in reply to Heartfairy]

I have mircrovascular angina. It took a while before it was diagnosed way back in 2017. The medication and the GTN spray do help tremendously. It took a bit of time to sort out the right dosage of the medication, and that is normal ( we are very similar but also different). I lead a perfectly normal normal life. So do not worry too much about it, many people have it and live normally. Take care

[MustyK in reply to Milkfairy]

Thank you for an excellent explanation for both conditions. Take care

[DanniC88]

Can I ask do you take any medication?

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Dear Westie2012

Hello to you, just to remind you that Im not medically trained but I do { did } suffer similar pains as you and also have a pacemaker fitted.

One thing that stands out to me is the fact your Dr has not referred you back to the pacemaker clinic to see if your unit is working at its full potential or needs a tweak.

I had Angina type pains before these tweaks that they put down to damage done by the bypass as nothing showed up with tests, strange that the pains disappeared after the tweaks, but they would properly put that down to mental not physical so I remained quite.

My pacemaker is connected to the clinic by my mobile phone, now it seems to be working the best it can, no more pain so far { 4 months }

Hope that this helps in anyway

Take care

[Pmj63]

Please also enquire about possibility of cardiac sarcoidosis with your cardiologist ...I don't know what symptoms one has but sarcoidosis does affect lungs too