unstable angina

[Gigi1958]

hello all,

I have been doing great for ages since my heart attack and stent fitting in Oct 2020. There is some damage to me heart but i was told in May after a scan that it is nearly back to mormal. However I recently attended a&e due to a little intemittent increased chest pain and breathlessness. I have been diagnosed with unstable angina, which if i,m honest has rather frightened me as it sounds like another HA could happen anytime soon. I have been given isosorbide 10mgs twice daily which i,m due to start tomorrow. Does anyone on here have stable angina who could give me some info on thier own experience of it.

many thanks in advance.

Gigi

[Yumz199725]

I don't have any advice or any experience but I hope you getting all the support and meds you need ❤️

[Milkfairy Heart Star]

Hello Gigi1958

I have lived with a type of unstable angina for 10 years. The only treatment option I have is by medication.

Have you got an appointment with a Cardiologist to review you since your trip to A&E?

It maybe necessary to review your medication to help manage your symptoms better or to offer you some further tests.

The BHF has this information about Angina.

Perhaps give the BHF helpline ad speak to one of the cardiac nurses.

bhf.org.uk/informationsuppo...

[Gigi1958 in reply to Milkfairy]

hi milk fairy

I have been given a prescription for Isosorbide 10mgms twice a day, which i,m starting in the morning. The A&E dr told me he would write to my gp and ask him to refer me to the cardiology dept. I don,t know how long it will take, which is why I have asked for information from people who suffer with unstable angina and how they manage it and the anxiety which comes with it. Thank you for your reply.

Gigi

[Milkfairy Heart Star in reply to Gigi1958]

Perhaps make an appointment with your GP to make sure the referral to Cardiology gets done ASAP.

Have you been given a GTN spray ? This can be very useful to help manage an episode of chest pain.

If you are worried or concerned, you can always ring 111 for advice too.

I found it helpful to keep a diary of my symptoms so that I could spot my triggers of angina.

Very common triggers are the cold, emotional, mental and physical stress.

If you start experiencing chest pain at rest, your chest pain isn't relieved by rest or after 3 GTN sprays, 5 minutes apart then ring 111 or 999.

Isosorbide mononitrate can give you a headache at first. The headache does go overtime, usually in about 2 weeks.

[Gigi1958 in reply to Milkfairy]

ok thank you

[Justjune1959]

Gigi 1958hi I to have unstable angina about 4 weeks ago I had an episode where I found myself at the bottom of the stairs don’t know what happened I had a routine appointment with my doctors when I told her about it she said I need to go to hospital well I was checked over put on new medication and I am waiting for an appointment with the cardiologist my fear is not how my angina is because I suffer from an auto immune disease which causes inflammation and when I had my angiogram the consultant told me he wouldn’t risk putting in a stent so I may just have to live with it I take my time doing things otherwise I have to spend time in bed

[Gigi1958 in reply to Justjune1959]

thank you for your reply

[devonian186]

You need to be proactive on this and take measures to ensure you see a cardiologist as soon as possible. This may mean chivvying your GP as otherwise things drift on. Is there an assessment unit at a close by hospital, if so can you persuade your GP to make you an appointment there?

[Gigi1958 in reply to devonian186]

Yes, I will chase the referral to the cardiology dept.

Thank you

[snafuval]

Hi gigi1958,

I am in almost the exact same situation as yourself, HA in 2016, stent fitted a small stroke a year later, and then nothing until october this year when i suddenly started getting breathlessness and chest pains ,

a trip to A & E and a few days in hospital, and a lot of, is it a another HA or angina, eventually i was discharged and told I just had angina, and it was put like that rather dismissively,

I am now on a tablet form of the GTN spray, bisopradol and soluble aspirin, on top of the blood thinners and heart tablets i was already taking,

My point above is that angina doesnt seem to have the same sort of follow up procedures I got with the HA and the stroke, no follow up with cardiologist, in fact the only follow up apart from talks with my GP's to get sick notes has been an Echo cardiagramme to check the physical side of my heart, which i am getting tomorrow, I suspect if that shows nothing wrong ther will be no further follow up apart form GP.

I was very anxious after the diagnosis, especially as for just over a week after coming out of hospital I was still getting chest pains, each time dealt with by GTN spray , eventually that wore off, but I was extremely tired, and was having to have afternoon naps and still quite breathless, I did then manage to speak to a GP who explained things a bit better than the hospital doctor, the main gist of it was Angina is mainly dealt with by medication, but it is quite strong medication and your body has to get used to it, if they reduce the medication then there would be a high probability of the chest pains coming back.

I have persevered and the tirednesshas slowly dissapated, as well as the breathlessnes, it is now 2 months, and I still not feeling great , but I am feeling a lot better than 2 months ago. The anxiety is still there and i seem to get stressed at the smallest thing, luckily my doctor has signed me off till February, so I am getting plenty of time to adjust, and I am now able to walk into town and get the bus back, I live on a steep hill and still can't manage that yet.

one last thing some of the medication can affect your blood pressure quite a lot mine reduced it and I was getting dizzy spells, to reduce this my GP suggested to try and reduce anything that may lower blood pressure more , like hot showers / baths (reduce temp) don't jump out of chair and be careful bending down, at least until your body gets used to the medication, which may be months rather than weeks.

I am sorry this is quite long but I hope something here helps and the main thing is you are not alone. I hope you have some family or good friends around as I have found that invaluable to help take my mind off of things. and this site has helped a lot.

[Gigi1958]

hi

Thank you for this information. I will see how I get on with the new meds. I will also practice to ease my anxiety. Gigi

[Gibson01]

Gigi, I have a similar story to others. HA with cardiac arrest at home in 5 stents to major arteries. Good recovery and OK until Unstable Angina started in April 2020. Numerous trips to A&E, further angiogram revealed narrowing between stents in LAD which cardiologist said is not significant. Treated with increased meds ( amlodipine, isorbide mononitrate, ivabradine) made no difference. Ranolazine had no impact. Further tests (CPET) scan said blood flows in heart are ok. Vasospastic and micro vascular angina ruled out. Nicorandil - added to medication which seems to have helped but not fully controlled the unstable angina which can happen at any time. Cardiologists don’t seem to know the cause and have labelled the angina as Refractory, meaning persisting after treatment.

The experience that I have gained from all of this is:

It was really difficult to be taken seriously by cardiologists, I had at least three trips to A&E before they decided to investigate.

The trauma associated with each trip gets worse, and t hat increases anxiety.

There are a range of different steps in medication, any one of which might relieve the symptoms for you.

Cardiologists can have widely different opinions, I have one says a bypass is needed, others that no intervention is necessary.

Unstable Angina, (sometimes called Crescendo Angina ) and Refractory Angina are not well understood by the general medical profession. If you report any type of chest pain the GP will send you to A&E with all of the associated trauma.

It’s hard to identify the factors which trigger a UA episode, stress is an obvious one.

There seems to be little provision of a holistic approach to treatment

The strain on your mental health and on your partner is significant, be prepared for anxiety and depression.

I am sorry if this is a depressing tale, hopefully it won’t turn out this way for you. Strongly recommend that you expedite appointment with cardiologist.

Good luck!

[Gigi1958 in reply to Gibson01]

hello Gibson01

Thank you for this information. Every little helps. I am a very positive person but I do like to hear peoples different stories and points of view.

Gigi

[Milkfairy Heart Star in reply to Gibson01]

Hello,I am in a similar position living with refractory vasospastic angina.

The effect of living with refractory angina which is then not acknowledged or treated well can leave it's mark.

I am on top doses of Diltiazem, Isosorbide mononitrate, nicorandil as well as statins and clopidogrel.

Have you ever been offered an infusion of GTN?

This can help when you have an episode of severe crescending angina whatever the underlying cause.

I have been admitted 15 times over 10 years. Usually for about 8 days for this treatment to settle my symptoms.

I have a written careplan to guide the staff how to manage my severe episodes of coronary vasospasms.

I raised my concerns about how my lack of appropriate treatment was affecting my mental health.

I have access to a cardiac psychologist and attended a pain management programme.

I use a Transcutaneous electrical nerve stimulation TENS machine to help with my pain and hot water bottles.

Did you have functional testing of your coronary blood vessels?

Did they use acetylcholine to rule out coronary vasospasms?

On a positive note. I am aware that there is going to be a trial into a possible treatment for refractory angina starting soon.

[Gibson01 in reply to Milkfairy]

hi again Milkfairy.

Thanks for you response. Not sure if acetylcholine was used, I did have CT angiogram using chemical to stress test heart, and consultant said this would have induced vasospasm if that was the problem.

Also had CPET scan in a similar way.

I've not been offerred an infusion of GTN. I'm lucky that the pains have not been so severe that the hospital or I have felt this is needed.

After much delay, I had initial appointment with pain management doctor in October and after chasing outcome I have initial appointment with pain management nurse tomorrow. It's a telephone appointment, so not sure what that will achieve! I suspect another pointless triaging appointment.

Have written to PALs after the 26 hours debacle in A&E a couple of weeks ago.

Will let you know how I get on.

[Milkfairy Heart Star in reply to Gibson01]

I am not sure that what your Cardiologist said to you about how to diagnose vasospastic angina is correct.

acc.org/latest-in-cardiolog...

My vasospastic angina was confirmed by an angiogram with acetylcholine which induced my coronary vasospasms.

Here's the BHF information about vasospastic angina and how it's diagnosed.

bhf.org.uk/informationsuppo....

It's not great trying to get help.

I had to wait 2 years to see a Pain Management Psychologist only to be bounced back to the Cardiac Psychologist .

I really hope you can find the support you need to live as well as possible with your refractory angina.

Good luck with PALS.

I do now have a supportive Cardiologist, though at his own admission he's no expert.

However he listens and is empathic.

[Gibson01 in reply to Milkfairy]

thanks milkfairy. GP has written to cardiologist to request follow up appointment. I’ll definitely raise this again. Not sure about another invasive angiogram, the last one caused a 2cm clot in the left artery which mercifully was removed extracted via the catheter. Very painful and traumatic. Could not believe that hospital discharged me the next day!

[Milkfairy Heart Star in reply to Gibson01]

Oh, I never want another angiogram either!

[LilySav in reply to Gibson01]

Hi Gibson02,,Replying to an old message so noy sure if you see it...just noticed your comment about angiogram pain and trauma.

My partner had an angiogram 2 yrs ago after a suspected bout of Unstable angina. Some blockage etc but nothing that needed stenting.

However, as he rested after the procedure, the pain 'in' his heart and elsewhere, headache, extremities etc got worse and worse. He couldn't bear to be touched or have his hand held eve. It was very, very odd and frightening.

He was given basic painkillers which didn't touch it and only around midnight (procedure was late afternoon) did they give him a low dose of morphine. They kept him in overnight.

Next morning when I phoned the hosp, pain gone, come and pick him up.

To this day we don't know what caused the excruciating pain ... nothing in his notes.

I wonder if the angio was a bit rough?

He too has said he never wants one again unless he's under general anaesthetic.

[Gibson01 in reply to LilySav]

Gosh LilySav that was 2 years ago! I am happy to say that I am in a much better place now. Last year I requested and was given a referral to a London hospital cardiologist who is an expert in treating INOCA. He recommended a further angiogram with physiological and acetylcholine provocation testing. I was apprehensive but he reassured me that any risk of clotting would be managed. He personally carried out the angio and all went well. I received a diagnosis of Vasospastic and Microvascular Angina. My medication was adjusted and (8 months later) I am feeling very much better. The spasms are infrequent and well controlled and my breathlessness on exertion is reduced allowing me to be more active.

I can understand your husband’s reluctance to have another angiogram. I can report that 4 of the 5 that I have had went well. I was given intravenous Fentanyl for any discomfort during the 2nd and 4th. Don’t let his experience of one uncomfortable angio put him off having another if it is necessary for diagnostic purposes or emergency treatment. The alternative can be a lifetime of pain or worse!