Crescendo Angina v Unstable Angina

[Gibson01]

I was diagnosed with unstable angina a couple of years ago, which after various tests was classified as Refractory. This week I had chest pains in a new place ( left side on the cusp of armpit and collar bone.) I asked my GP is this angina or something else? He referred me to the local A&E department. The A&E doctor called it Crescendo angina and expressed concern that the change in pattern indicated I was likely to have a new HA.

After 26 hours in A&E in a chair and on trolley, Cardiology dept refused to get involved saying they only deal with acute cases. I'm appalled and thinking of complaining to hospital CEO. The poor junior doctor in A&E who had to tell me this was mortified.

Anyone else had this experience?

[Milkfairy Heart Star]

I would consider raising your concerns with your GP and the Patient Advisory Liaison Service, PALS of the hospital. Did you have your ECG done and bloods taken to check your troponin blood levels?

[Gibson01 in reply to Milkfairy]

hi milk fairy, thanks for replying. The A&E team did the usual routine of did blood tests ecg and chest ex ray. All were fine. So the only positive thing they could tell me was that I was not having a HA. Which I was pretty confident was not happening anyway.

I am just so frustrated with cardio’s attitude, and traumatised by the 26 hours in A&E.

[richard_jw]

Pals is probably the right place. I talked to them once (I had been in A&E with chest pains for 12 hours) and they sprang into action and got me admitted). To be fair this was not the fault of medical staff which it sounds like in your case, rather the unavailability of a bed in an a cardio ward. I have also found however that cardiologists are sometimes less than helpful. I don't know if it's simply that they are overworked, or some other issue. It's also true that junior docs do not have the level of knowledge of a good cardiologist and what this could be is poor communication. I see that A&E did what they usually do, (make sure you have not had an MI, and talk to cardiology. This is pretty much what they have done for me on several occasions.

[Gibson01 in reply to richard_jw]

Thanks Richard. I have encountered the Cardiologist in question previously and the report of the junior medical doctor does not surprise me. There are a lot of status issues with cardiology in this hospital and with the cardiologist in question. Its disappointing that the senior medical doctor did not support the junior doctor in her request for assistance.

I've never formally been discharged from the care of the cardiology department, they do one follow up call after 6 months and then don't contact you ever again!

[Wingnutty]

What is the definition of an acute case??? I find this an absolutely disgusting attitude of cardiology. I have also been treated badly by a cardiologist and it was only by luck that I didn't die, but it was very different circumstances. It seems to me that they want you to die because there is one less patient to treat then. I have recently been told that I won't be given any scans or tests until my angina becomes unstable despite explaining that it is getting more difficult to walk any distance. I was discharged from cardiology a few years ago and have not seen a doctor since then. The receptionist is the gate keeper to stop you seeing your GP and your GP is the second gatekeeper to stop you seeing a cardiologist. The whole system seems to be designed around keeping the patient away from help.

[Gibson01 in reply to Wingnutty]

Thanks for your reply Wingnutty. I would have thought that it would be better to intervene before your angina becomes unstable, rather than wait for that to happen and then intervene. I am in a similar (perhaps more advanced position) I have unstable angina which is classed as Refractory (meaning it persists after treatment - 5 stents in my case). After numerous visits to A&E I was given another angio which identified a narrowing between two stents in the LAD, that was reported as not significant and manageable via medication. Except no additional medication was prescribed! The cardio in question then reported that the cause of Angina was probably not cardiac and I should see a chest man. The chest man I saw privately laughed and said to me that its your heart !! I saw two further cardiologists privately (both respected senior figures in UHSM) who said its your heart and the narrowing might well be significant. Another angio was arranged which nearly killed me (they forced a 2cm long clot into the top of the left artery) The angio was stopped and the clot extracted. A few weeks later they gave me a CPET scan which confirmed the blood flows in the heart as normal. No further surgical intervention required. And no routine monitoring to see if the condition is deteriorating. So now I have Refractory angina and all that can be done is to manage (ignore?) the pain. Pain Management consultant explains that the angina pain feels similar but is a slightly different mechanism to the HA, and prescribes behavioral therapy to manage my response to the pain. So when I have chest pain I have to tell myself that I am not having/going to have an HA even though the majority of the medical professions immediate reaction would be otherwise. And the punchline is, if it does turn out to be an HA, is that the first one was accompanied by a cardiac arrest. So the next one will probably be my last.

[Wingnutty in reply to Gibson01]

So sorry to hear that Gibson01. It really does sound like managed decline until you are 'out of the way' and no longer a problem to them. This must be happening all over the country. The only consolation I have for you, it that you are not alone in this. You have done everything possible to get help, but it is not forthcoming.

[Milkfairy Heart Star in reply to Gibson01]

I have lived with refractory vasospastic angina for 10 years.My coronary arteries are unblocked. My coronary arteries go into transient, temporary constrictions. A severe prolonged coronary vasospasm can cause a heart attack or arrthymias.

The only treatment option is by medication. I don't respond to my numerous medications.

I agree, it's difficult to not become anxious when you're in alot of pain.

I need to go into hospital about once a year when my vasospasms become frequent and unstable. I have an infusion of IV GTN and IV morphine.

Those of us living with refractory angina are a conundrum for Cardiologists. Some just regard it as a nuisance for them, forgetting the impact of refractory angina on our quality of life.

It takes an astute Cardiologist with a bucket full of compassion to care for us.

I hope you are keeping warm.

The cold us one of my triggers of angina.

You might find this article interesting.

academic.oup.com/eurheartj/...

[Gibson01 in reply to Milkfairy]

Hi Milkfairy, thanks for your thoughts. I've been told that the cause of my angina is not vasospasm, but not on the other hand have been offered no diagnosis of the cause. I have completely lost confidence in the cardiologists at my local hospital and to some extent the Northwest Heart Centre to whom they are affiliated.

I've asked BHF to advise if there is a centre of excellence for Refractory Angina treatment to whom I can be referred.

[Milkfairy Heart Star in reply to Gibson01]

Sadly, there are only a few Refractory Angina centres in the UK. I did find going on a Pain Management Programme helpful.

I also use a Transcutaneous electrical nerve stimulation TENS machine, which takes the edge off my pain.

There are also invasive techniques such as Stellate ganglion block or Spinal cord stimulators, but there's very little firm evidence to say they help, long term.

A new possible novel treatment is a coronary sinus reducer. Again experimental, there a few places carrying out trials.

There are Refractory Angina Centres, in Liverpool, Bradford and London.

rbht.nhs.uk/our-services/re...

royalpapworth.nhs.uk/our-ho...

Those of us with Refractory Angina are a poorly served.

I now do have a very supportive Cardiologist, only after I was diagnosed with PTSD due to being left in severe pain too many times.

[Gibson01 in reply to Milkfairy]

thanks milkfairy, I thought Liverpool was one of the centres. I might give that a try. Bradford is also possible for me. My mental health has also suffered as a result of the angina, the trips to A&E and the effort of convincing uninterested cardiologists that I need attention.