unstable angina

[Maninblack]

We have a friend who has unstable angina and has been in hospital countless times but nothing happens other than being given intravenous gtn and morphine. He also has low blood pressure which prevents him being given medication that may help but would lower his blood pressure causing dizziness. Has anyone experience of this and can offer any advice. Thank you.

[Milkfairy Heart Star]

Hello, I have lived with a type of unstable angina for over 10 years. My angina is due to temporary transient contrictions in my coronary arteries

I have been in hospital 15 times for treatment with IV GTN and morphine.

Does your friend know why they are experiencing their angina?

The usually treatment for angina caused by permanent blockages in the coronary arteries is by stents, bypass surgery or medication.

Vasospastic and Microvascular angina which are types of non obstructive coronary artery disease can only be treated by medication. These types of angina are difficult to treat and some of these patients need to be admitted frequently for treatment with IV GTN.

Unfortunately there are some people who live with refractory angina, which means their angina is resistant to treatment despite having stents, surgery or medication.

[Maninblack in reply to Milkfairy]

Thank you for your reply. Our friend has stents but I believe he may have a narrowing of an artery at the back of his heart. We will have to see if anything comes of this latest stay in hospital.

[richard_jw]

I have angina albeit stable. I'm told that it might be microvascular angina because there is nothing of note to be seen on a normal angiogram I also have low BP. So nitrates are not possible because the symptoms you describe.

The cardiologist recommended ranolazine as an anti anginal. It works in a different way and apparently does not affect the BP

Does your friend actually have a diagnosis? I mean is any sort of intervention possible?

In my case it's not possible because in microvascular angina the ischemia is in the small vessels not the main coronary arteries

Also I have to say that I have difficulty tolerating ranolazine.

Also from what you write my symptoms may be less severe than those you describe

[Maninblack in reply to richard_jw]

Thank you for your reply. I am afraid all I know is that he has unstable angina. I asked his wife what has caused this but all she knows is it’s unstable. He is in hospital at the moment on morphine and intravenous gtn. This has been going on for a few years.

[Gibson01]

I've struggled with unstable angina since 2020. Numerous trips to A&E and tests have been inconclusive as to the cause. Fortunately the pain is not so great that I have needed intravenous GTN or Morphine. Ranolazine does not work for me but a cocktail of isosorbide mononitrate, amlodipine, and nicorandil have helped. (These may not be appropriate for someone with low blood pressure) The cardiologists have labelled the angina as refractory and seem to have lost interest. They tend to prefer anything where there is an obvious quick fix! It's possible that it is vasospastic angina as Milkfairy has discussed but they do not appear to have tested for this.

Sadly, your friend will be suffering physically and mentally from the condition. Aside from the pain and trauma of repeated hospital visits, quality of life is diminished, confidence suffers and depression sets in. It's very difficult to get support from the health service for this condition.

The only advice I can offer is to persevere with the cardiologists in trying to identify a cause (and therefore potential treatment). Also try to manage the pain by avoiding any obvious triggers. Mindfulness and meditation have been suggested as a way of calming the mind to reduce stress and anxiety levels.

Good luck.

[Maninblack]

Thank you for your reply. I am really anxious for my friends as they are just going round in circles. He came out of hospital on Christmas Day afternoon and is now back in for exactly the same condition and same treatment. They are trying different meds. Fingers crossed something will work at least to give him a better quality of life.