It's me again. I apologise for posting so regularly in the last few weeks.
It's been an eventful week 😕
I was admitted to the hospital on Saturday night. I had chest pain, left arm pain and a very high heart rate. I panicked and called an ambulance. I was told it could be a 40 minutes wait but they arrived in 7 mins. I felt like I was dying and the panic was unbearable. The paramedics were fantastic. They gave me 300 mg of Asprin and GTN spray. I was shaking violently and HR was close to 200BPM.
One of the paramedics thought I was in SVT.
I was taken to the hospital and I was surprised that there was no waiting around to hand me over to the hospital.
My ECG'S and Troponin markers were normal. However, my HR remained in the 120-130BPM for over 3 hours. I was admitted and saw several different doctors who all had different plans and opinions.
However, on Monday I was seen by a Cardiac Nurse after he had discussed my case with a consultant cardiologist. He said that they caught Atrial Flutter on the ECG the paramedics did. He wanted me to start on Asprin and beta blockers. However, when he discovered that I have a very low resting HR, he went to speak to the consultant again. It was decided that they won't risk a beta blocker and started me on Asprin.
The plan moving forward was to have my CT Angiogram as planned for today. I will be booked for an Echocardiogram, Stress Test and referral to Electrophysiology.
However, the Cardiac Nurse said he didn't think I had too much to worry about from CAD. Having looked at my test from over the years he feels I am very low risk.
As some of you will remember the plan that was in place for my CT Angiogram from my last post.
I followed that plan and did my best to control my HR. Unfortunately, when I arrived at the hospital it was the same story again. HR was 110-120. However, I was confident the scan would be done with HR control medication because my cardiologist was running the list today. Then I was told that my Cardiologist is off sick today and the doctor covering refused the scan because he believed they won't be able to control my HR. I requested that they at least let me onto the scanner table because my HR does drop when I'm laying down. Sadly, I couldn't change the doctor's mind.
I was annoyed and lost my temper but I was mostly angry at myself. I was not rude to the staff but I made it clear how unhappy I was.
In a state of desperation, I walked to Cardiac Department to speak to the Cardiac Nurse. He was not at work but another very kind nurse spoke to me.
She did an ECG and then arranged for me to spark to the cardiologist on duty.
I explained how frustrated and anxious I am feeling. The cardiologist suggested a Myocardial perfusion scan would be a good idea for me. The scan would be done at stress and rest.
My questions are:
Has anyone had a Myocardial perfusion scan and what was their experience of the scan?
Is Myocardial perfusion scans as good as a CT Angiogram?
Should I be pushing for an invasive Angiogram?
One of the Cardiologists I saw when I was admitted to the hospital agreed that I should have an invasive Angiogram if the CT Angiogram attempt failed again.
I am a little confused because different cardiologist seems to have different opinions I don't feel qualified to determine whose advice to follow.
Ali
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IamAli_R
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Hi Ali - don't apologise! - really sorry that you had a repeat of the problem with getting the CT done, hope someone else can advise on the perfusion scan. All the best!
Aw just read your post and you been through so much. How come the angiogram keeps failing sounds soooo stressful hope your able to have a successful one and they get to the bottom of the issue why your heart rate keeps going so high.
It's stressful and my mental health is now suffering.
It's a CT Angiogram. It's a CT Scan of the heart to see if there are any blockages. The scan can't be done if the heart rate is above 65BPM. I've had 3 failed attempts now because I can't slow my heart rate.
Yes, I followed the plan to the letter. I did additional preparation by trying to relax and meditate using visualisation techniques and box breathing to give myself the best chance to have the CT Angiogram. I am desperate for clarification and have done everything asked of me to get a clear answer.
I have been honest and told the whole story.
Why do you imagine I might not be telling the whole story or not being honest?
Hi Ali i have had all of the above procedures and tbh once you get over the first one it gets easier my first one was the perfusion mri which i was so nervous about my bp and hr was high and i asked them to stop the perfusion part where they speed up your hr,the next was the ct angiogram which felt more relaxed as the machine wasnt so claustophobic plus they give you beta blockers to bring the hr down and it was over pretty quick. the result of that was i had to have an angiogram i was so nervous that i didnt think they would go through with it as my bp was 200/100 and hr was through the roof but with loads of gtn and sedative got through it and when i had next one didnt need anything .stick with it you will get there eventually .
The funny thing is I don't feel anxious and it doesn't feel like my heart rate is running fast when I'm there. I've had full-body CT scans in the past without any issues.
They won't give me a beta blocker because I have mild asthma. I wouldn't have an issue having the scan if they didn't need my HR to be around 60 BPM.
On a positive note, I had a call from my cardiologist this morning. He apologised for not being at the scan yesterday. He said he will send me an appointment for next week to see him face-to-face to discuss a way forward.
I'm wondering why they won't give you beta blockers, how low does your heart rate go at rest? Mine used to be around the 55-60 mark and at first bet blockers took me down to 45-50 mark. They said that was fine for the short term whilst I was having tests and ultimately waiting for bypass surgery. If I were you I would press for them and see how it goes. You can always stop them.
It does sound like anxiety is taking over your life. I would go and speak to your GP and see if you can get something to relax you. Health anxiety is a known illness and you deserve to get sorted. Also, refer yourself for talking therapy which the GP will give you a brochure for.
I've had every MRI, CT and other tests going including a perfusion scan which shows the rate of blood rushing through your arteries. It's a normal scan, nothing to get anxious about. It wasn't believed I was getting Angina as everything came back normal. The only tests which showed a problem was a CT Angiogram and ultimately a Catheter Angiogram. I think you really need these to pit your mind at rest.
What are you symptons except for a high heart rate? Do you get pain on exertion? Anxiety can mimic heart related issues. You say your last episode resulted in a normal ECG amd Troponin levels. Let that give you comfort. You know now you can get symptons without there being anything wrong. Anxiety can raise your heart rate as you know and maybe that's why it remained high in hospital.
Obviously I'm no expert and don't profess to be. If I were you I would:
-Press for beta blockers
-Then try and get CT Angiogram when your heart rate is generally lower
- Talktonyour GP.
- start a new hobby/meet friends more/take your mind off your health
- get talking therapy (I'm having it at the moment to help with health anxiety)
Wow, you really have had the full work up. I hope you are in good health now.
My cardiologist was meant to be running the list on the day of my scan and he was planning to give me a beta blocker. But he was off sick and the doctors covering didn't want to give me a beta blocker because I have mild asthma. My resting HR is between 49-55BPM. That scares most doctors about giving me HR control drugs.
I have anxiety and health anxiety. I've had talking therapy in the past and that was great. Generally, my anxiety is fairly well controlled. I took Diazepam on the morning of the scan. I am aware of the terrible symptoms anxiety can cause.
I took your advice and I'm meeting friends for dinner tomorrow evening 🙂
Hello IamAli_R, I’m sorry to hear of the difficulties with your treatment and I appreciate your concerns. I’ve had two CT angiogram scans, in 2018 and three weeks ago. My heart rate was in the 50s and they were able to do the scans without administering an IV beta blocker (bisoprolol). It could be that your elevated heart rate is partly a nervous response - you’re expecting it to be high and so it ends up that way - a bit like white coat syndrome. I wonder if relaxation techniques may help you lower your heart rate. I know that they can administer an IV beta blocker to temporarily lower your heart rate - but they would need to keep you in the unit for 30 minutes or so until the effects wear off. Good luck and here’s wishing you a successful scan soon.
Funnily enough, I have resting HR in the early '50s when at home, and that is why this is so frustrating for me. Yo7 must have been super relaxed when you had your scan.
You've hit the nail on the hard. I'm expecting my HR to be high and trying so hard to control and the pressure to keep my HR low is pushing my HR high. I am desperately trying to keep my HR low for the scan. I try box breathing and meditation. I even tried visualisation to prepare for the scan but the pressure just gets to me. I don't feel anxious either and just have a high HR.
I think you may have misunderstood my post. I believe you may be confusing an invasive Angiogram and a CT Angiogram. The CT Angiogram is a scan using a CT scanner. They have to have a heart rate of around 60 BPM to get clear images.
My post makes clear that I did follow all the instructions for each appointment. My regular cardiologist was due to be running the CT Scan for this appointment in light of the two failed attempts, but he was off sick. The doctor who was covering for my cardiologist didn't know my case and wasn't comfortable following the plan my cardiologist had in place and had shared with me in writing. I showed the doctor covering the scans the letter from my cardiologist but this doctor didn't agree with the plan in place. I was desperate to have the scan and tried to convince the doctor to follow my cardiologist's plan but he wasn't comfortable doing that.
My cardiologist called me this morning and apologised he was not at the scan as planned.
I would say that you are wrong in your assumptions about my case. I would not dream of wasting appointments because I am aware of the pressure on the NHS. I also believe that if you are going to suggest that someone might be being dishonest then the least you can do so to read the post carefully and make sure you understand all the facts. I think it's also unfair to judge me and question my honesty based on a post you read last. I am only mentioning this because you have questioned my honesty twice in two posts.
Just a thought.Not everyone has a straightforward experience of their cardiac tests.
Any test result is dependent on the equipment used which can vary in age and manufacturer in each hospital.
The results need to be intrepreted by the various computer algorithms in some cases or healthcare professional.
The experience or professional background will influence this interpretation.
Finally, not all patients can be given beta blockers. I can't , beta blockers dangerously destablised my heart condition.
I can't be given Ivabradine either because I take high doses of Diltiazem.
The adenosine I was given during my perfusion MRIs induced my coronary vasospasms at rest afterwards as did the exercise during my stress echo.
My invasive angiograms also induced coronary vasospasms.
I would hope the forum is a place where members can seek support and understanding in a safe non judgemental space.
Overcoming anxiety and learning to reduce your heart rate through breathing and relaxation techniques takes practice and isn't always straightforward to do.
So kudos to IamAli_R for trying to prepare for the procedure as much as they could. I really hope they are able to get through the appropriate testing soon.
Have you considered Post traumatic stress disorder?
I am challinging your assumptions which as you said yourself is important to do.
"I agree that this forum should give support but it should also question when things don't quite look right otherwise misinformation can cause more harm than good as I'm sure you are aware"
I have been a member of the forum for many years, over a decade as a heart patient with numerous admissions to hospital lasting weeks.
So just my particular view from my bed.
I feel we will have to agree to disagree on our interpretation of what we see.
It is great that you have had many angiograms without any issues. It is also great you have had CT Angiogram (CTCA) without any issues with bringing your heart rate to 60 BPM for the scan. I am struggling to control my HR despite trying medication for the previous two attempts.
My Cardiologist told me that he runs a regular CT Scan list and I have no reason not to believe him. He wanted me on his list for the 3rd attempt CTCA. I know you have only had one CT that wasn’t done by a Radiologist because it was deemed necessary. Have you thought about the fact that maybe my cardiologist also deemed it necessary to be present at my scan?
Yes, I read your reply carefully and answered your queries. You said you have never known 3 unsuccessful CTCA attempts and that may be so, however, that does not mean it does not happen.
Regarding your concerns about me being able to go through a TOE procedure I can reassure you that I’ll be just fine. I have had a number of Endoscopies without any issues, so I’ll be fine with TOE procedure if required. If you actually read my original post, you’ll see that I have asked if I should be pushing for a Coronary Angiogram rather than a CTCA, and I am by no means traumatised by the idea. I think having a high HR during a normal angiogram won’t be a problem either. I would have happily have the CTCA if it could be preformed at a higher HR.
I think there was no need for your condescending and aggressive tone to Milkfairy. I think most people will agree there are better ways to get your point across.
I am sorry to hear that you had a such a difficult time and spent such long stretches in hospital. I genuinely hope you are in a good place now health wise. However, your experience of spending time in hospital and interacting with patients having successful invasive angiograms does not mean that I am being dishonest in my posts. Your experiences do not invalidate my experiences and my current struggles. Just because you have not seen 3 failed attempts at CTCA or experienced something similar it does not mean that such events never take place.
My 3rd attempt at a CTCA was not as an inpatient. I was discharged with plan to have the CTCA along with pending referrals for a new finding of Atrial Flutter. I have explained this in my original post. I am sorry that you cannot take this at face value but that does not mean its not a fact.
You keep referring to a post from last year. I am a different person going through a different situation and as I said its unfair to judge me based on someone else’s post from a year ago.
Once again just because something does not look right to you it does not mean that it is incorrect. I have done nothing for you to label me as dishonest. What would I achieve by being dishonest on here and providing misinformation?
I made the point about the covering doctor in the replies to the same post. I was stating facts. The covering doctor did not agree with the plan by my Cardiologist. The refusal to use beta blockers for Mild Asthma was from the 1st attempt and that’s why is why ivabradine prescribed to control my HR. The 3rd attempt failed because my Cardiologist was off sick and the covering doctor did not agree with his plan and did not think he could bring my HR down. That is clear from my post and replies.
“Why was a Cardiologist doing a routine angiogram and not a Radiologist who is expert in carrying out this procedure.”
I have explained why the cardiologist was doing this scan above. It was clearly not a routine scan because there are issues with my HR control.
“As I have already stated, tell the whole story and be honest, drip feeding information and people saying with good intentions "There there, you have been through a lot" isn't going to help anyone.”
I think its reasonable that I did not go into my entire medical history in my post. I included information that I thought was relevant to the questions I had. I did not drip feed information. I answered the questions people asked in the replies. You are only person who had an issue with the detail, accuracy and my honesty from the post. I am not looking for sympathy by being dishonest as you are suggesting. I had genuine concerns and question that others have been kind enough to answer.
“Ask me anything on my experiences and I will give you an honest answer which can be backed up with documentation.”
If you posted on here asking questions then I would have no reason to think you are being dishonest and ask for documents. My default position is that people on this forum are genuine, and everybody does their best to support each other. I would not dream of asking people to provide documents to prove they are being honest.
I genuinely do to understand what I have done that make you think I’m looking for sympathy by making up stories. I do hope that my answers satisfy your need for a full and clear explanation.
Dr M called Mr Ali on the 20" December 2022 and explained that he would really like tore-attempt to get the CTCA done again and this time with a trial of a smaller dose of
Ivabradine which hopefully will hopefully make the side effects less. Dr M advised
taking Ivabradine 2.5mg twice daily three days prior to the CT scan and if his heart rate
drops and he starts to feel symptomatic then to reduce this to once daily. On the day of the
scan he should take lvabradine 2.5mg in the morning and another dose on the way to the
hospital. Mr Ali has some Diazepam at home and he was advised to take this on the
morning of the scan also.
I will re-request the CTCA asking Dr M to actually perform the scan as he is aware of
Beta blockers and mild asthma are an interesting one. I have severe uncontrolled asthma, and only recently have been taken off bisoporol, a cardio selective beta blocker. One asthma consultant said no issue as it is a cardio selective beta blocker. My present asthma consultant prefers me not to be in it, but has not banned it.
I would have a chat with your asthma consultant as to whether it is that critical for you to avoid a short term beta blocker, and whether it is down to using the correct type of beta blocker.
I thought all people with asthma couldn't be on beta blockers I was told I couldn't be on them because I'm asthmatic and so I'm calcium channel blockers I'm on verapamil.
Because I have mild asthma I don't see a consultant. I use to see an asthma nurse when but because I have not had any issues with my asthma for a long time I have not seen her. This was one of the reasons why my cardiologist said he would be OK to give me beta blockers if needed. But sadly he was ill on the day of my scan. I am going to see my cardiologist next week to put a plan in place moving forward.
In 2021 a couple of studies came out, see Google, looking at cardio selective beta blockers. These contradicted the view that this particular type of beta blockers were a total no go for asthma sufferers.
My first asthma consultant in 2021 interpreted the studies to mean that cardio selective beta blockers like bisoporol are fine. However I have more confidence in the view of my 2023 asthma consultant that you can use bisoporol but there needs to be a good reason as he would prefer me not to, as cardio selective are better but not perfect from an asthma perspective.
So is the gain from a cardio perspective of bisoporol worth it for an unquantifiable asthma contra indication.
In my case I am a bit ambivalent, I am starting to lose control of my BP a bit, but is that because I am not taking bisoporol or because of my out of control asthma.
I would do your research on Google, then discuss with your gp.
I’ve debated long and hard with myself regarding whether to say something but considering the facts I feel it is the right thing to do.
Whilst I support your desire to understand more about IAmAli_R’s situation if you feel there are some anomalies (which the details of this situation are not relevant to any of my experiences, and so I feel I can’t add any value there specifically), I do get a sense that the tone of your replies have been quite “hostile” at times, for lack of a better word.
I appreciate that you have also said that MilkFairy is also more than capable of defending herself but I just wanted to acknowledge IAmAli_R’s point that your responses haven’t, in my opinion either, been very friendly.
The reason I was drawn to the post was because it stated hospital admission and another failed ct attempt and, like you, I was curious to understand why and learn more but instead I discovered what on my first read felt like a rather heated debate over the legitimacy of this individual’s circumstances.
By all means, seek to understand more and yes, if something doesn’t feel right then we should all feel able to speak up but from a place of kindness and compassion as we are all here for many different reasons and ultimately this is meant to be a “safe space”.
I won’t comment any further Gimble and I wish you all the best; from your previous experiences mentioned within this thread, it sounds like you have been on one hell of a journey! I genuinely hope that I haven’t come across as rude, and that you are doing ok.
I have thought long and hard about continuing to reply to you. But I think I should given that you are painting me to be dishonest and possibly someone who is trying to garner unwarranted attention.
I have read your post and have done my best to answer your question and address your concerns.
“The reasons you gave regarding the various angiograms doesn't make it clear which one it was, it reads like it's all about the 3rd attempt, eg your responses to Slip0000 and Ada-eve as well as myself.”
“Where do you state in your original post that you were discharged? Again it certainly isn't clear.”
I am talking about the 3rd attempt because I wrote the post after getting home. I have obviously had the same issues at all 3 attempts of a high HR. I do explain that the 3rd attempt failed because my cardiologist wasn’t there as planned.
I did not explicitly mention that I was discharged but I did say that when I arrived at the hospital my HR was high again in my original post. I think its reasonable to assume that I had been discharged if I mentioned arriving at the hospital for the scan.
“As for Milkfairy, she has shown previously that she is more than capable of defending herself and at no point has she stated that she felt I was condescending or aggressive towards her. We have agreed to interpret your posts differently and she certainly doesn't need anyone putting words like condescending or aggressive in a post on her behalf.”
I am sure that Milkfairy is more than capable of defending herself, but I think its important that I point out that I felt you were being condescending and aggressive.
“You have also stated that you have no problem with having a TOE but a CT scan somehow sends your HR sky high.”
What I actually said was that my HR was too high to complete a CT Angiogram. I have mentioned serval times that in order to carry out a CT Angiogram the HR needs to be around 60-65BPM. I had full body CT scans in the past without any issues because those CT scans did not require HR control. I would not have any issues with the CT Angiogram if HR control was not required. I said that I have had an Endoscopy without any issues and as TOE is a similar test I imagine I’ll be okay with that. I think most people would agree that having a HR 100-120BPM is hardly sky high.
“You have said that you don't feel anxious but that you panicked and called an ambulance.”
I said I did not feel anxious at the CT scan. It is clear in my original post that I panicked after getting chest pain, left arm pain, high HR and that is why I called an ambulance. It was just as well that I did call an ambulance because they caught Atrial Flutter on ECG. You are clearly conflating two different events to make a point. As you will agree that anxiety is not a constant and tends to come and go, and when I was at CT Angiogram I dint feel anxious, but I must have been because my HR was high.
“You have said that you lost your temper and became angry but were not rude to staff.”
This is true. It is possible to be angry and still remain polite. We all display anger and frustration in different ways.
“You have said that you have had 3 failed attempts to carry out an angiogram, but your posts only refer to 2 angiograms, one on the 19th December and another on the 26th January,
How long ago was the other one and is it relevant to your current situation?”
The 1st attempt was made in 2018 and it didn’t go ahead due to high HR, but they did do a calcium score in 2018 which I mention in my post.
“You have asked for peoples experiences of having a CT angiogram but you have said that you have had full body CT scans in the past, Why would you want to know about the experiences of others when you have had several similar ones in the past.”
I asked people to share experiences of CT Angiogram who had problems with HR Control too. Full body and CT angiogram are two different test and I think it was fair to ask people to share their experiences of how they managed high HR during CT Angiogram.
“You have posted the letter from 20th December, is that from your Cardiologist or is Dr M your Cardiologist? Radiologist are qualified Doctors who are specialist in diagnosis and investigation. The letter is a request that Dr M perform the CT scan not that he is the Cardiologist. You have said that your Cardiologist was doing the scan but you have also said that he was merely going to be present at the scan, which is it?”
Dr M is my cardiologist, and he does run CT Scan lists. It is obvious that Dr M would be present if he is doing the scan. However, I apologise if this caused any confusion, and I could have made that clear.
“Maybe you and others can see the anomalies that I have pointed out. I await your lengthy response.”
I am not sure this is the lengthy response you were expecting but I have done my best. Any anomalies in my post were not an attempt to mislead people and were just innocent mistakes. I am happy to admit my written communication is not the best and needs improvement. I would like to make it clear to you and anyone else reading this that I only post on here seeking advice and learn from peoples experiences to help me manage a very difficult time in my life. I do not post on here to mislead anyone, garner unwarranted sympathy and to waste anyone’s time. I will do my best to make sure that my future posts are clear and will try minimize any inconsistencies.
Just a reminder here are the questions I actually asked in my 2 posts:
I would be grateful if you could all share your experiences of CT Angiogram
I would also love to hear from anyone who had a similar issue of high HR when attempting a CT Angiogram, and how they managed to control HR
Has anyone had a Myocardial perfusion scan and what was their experience of the scan?
Is Myocardial perfusion scans as good as a CT Angiogram?
Should I be pushing for an invasive Angiogram?
One of the Cardiologists I saw when I was admitted to the hospital agreed that I should have an invasive Angiogram if the CT Angiogram attempt failed again.
I am a little confused because different cardiologist seems to have different opinions, I don't feel qualified to determine whose advice to follow.
I hope this clears up any unintentional confusion caused by my posts.
In response to whether anyone has had a myocardial perfusion scan - I have. It was a relatively straightforward procedure for me however, I did find that I reacted very badly when they used dobutamine in order to induce the effects of stress on my heart. As a result of my HR going up very quickly with subsequent chest pain, the test was stopped. I was then rescheduled to have it done again but this time with a different drug (can’t remember the name) and I got on much better the second time around.
However, a substance may not always be used to mimic the effects of exercise/stress on your heart during the procedure and some cardiologists also ask that you run on a treadmill to raise your HR. It might be a question worth asking your cardiologist before the procedure so that way you are prepared for either the injection or the treadmill and it also gives you some reassurance.
I was then asked to eat a fatty meal - side note, fasting was required for me beforehand. Once I had eaten, they took me in for the actual scan where they injected me with some radioactive substance so that they could clearly see my heart. This was to rule out ischemia. After that, I was pretty tired from the scan but that was about it.
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