One thing about the medical therapy plan within my recent diagnosis that my myocardial bridge is responsible for my angina does not make logical sense to me but would like to run it past yourselves for views / advice.
So the cardiologist recommended diltiazem to max dose tolerable “to aim for a heart rate of 60 to reduce heart rate, maximise diastole, and reduce compression”.
I get that increase in heart rate, minimal diastole blood flow and increased compression (of my LAD) brings on the angina - any exertion going from sitting to standing then walking / undertaking simple activities brings on angina increasing in intensity dependent on what I do and for how long including just walking.
Note emotional triggers while sitting raise my heart rate and leads to angina - this is usually the dull ache type though.
the above medicine did not work (so I have no meds that work, awaiting decision on surgery which cardiologist already said was unlikely to happen) and caused intolerable side effects (posted about before) my thought / question is:
how can I possibly live a normal life let alone exercise if my heart rate has to stay quite low near on resting level to avoid the angina?
I think the answer is “no”, which is ok I’ll learn to live a new life but just wondered if I’ve missed something / looking at this wrong?
my logic tells me I can’t exercise or if I did I’d be in a lot of pain and then be incapacitated. I wonder too if I’d be increasing the wear and tear on my heart because it has to work hard to do anything?
To lose weight (it took some guts for me to write those words bearing in mind recent posts) I am focusing on diet. I’m not going on a diet hoping that makes sense, I’m changing life long habits.
any insight or own experience especially if you too are limited in what you can do due to your heart is very much appreciated.
A rock and hard place comes to mind.I am slowly weaning off my IV GTN and my angina is back.
I have had my respite of no chestpain for a few days
This is how it has been for me now since I vasospastic angina entered my life over 10 years.
I also have to keep my heart rate in the goldilocks zone not as limited as yours though.
Have you been offered Ivabradine?
Whilst in hospital because I am on a cardiac monitor I have been able to see my heartrate drop, when I practice my breathing and relaxation techniques.
Perhaps try alternative ways of moving and controlling your breathing at the sametime?
I find Tai Chi and yoga both invaluable in helping me to reduce my heartrate and blood pressure.
I also found Cognitive Behavioural Therapy also helps.
Perhaps ask to be referred to a Pain Management Service that offers input from Clinical Psychologist and physiotherapists who understands pain.
As patients we don't fit easily into most angina pathways.
I am a ' spooner' it's a technique to pace your activities and slowly increase what you can do.
I do sometimes ' borrow ' spoons from the next day if there is something important I need to do.
I have over borrowed recently and this contributed to my admission.
I have learned to potter with style.
I have lots of sympathy with Sisyphus.
Out of interest why are patients living with myocardial bridges advised not to take nitrates?
People living with heart failure also face similar challenges to us.
Maybe one of the many wise heads of the forum can share their thoughts with us too.
thanks for explaining, my oxygen levels fall below 90% in day time on occasion so best not make it worse.
I have assumed no exercise but I will give seated arm curls ago with a very light weight or none at all to start with, can also give the leg raises a go too.
I imagine just keeping my muscles engaged and moving how ever little will do me good? So I’ll give it a go.
Thanks much appreciated, things can sometimes seem hopeless.
Lots there for me to look at and understand further, need to look these up though. Not been offered ivabradine but a quick google of this and MB found the following and worth mentioning at next appointment (haven’t read fully but says has been shown to be effective especially where BBs don’t work (I can’t take re asthmatic).
I found the following explanation: “nitrates are contraindicated as they can accentuate systolic compression of the bridged segment by vasodilating the adjacent non-bridged coronary segments and worsen symptoms.” I would not claim to understand it though.
I think I’m concluding from your advice I have to learn ways and techniques to work round / manage the condition and it’s impact on me and manage.
I get the overdoing then paying for it, I did that today but I don’t have severe outcomes you face and have to go through ❤️
Thanks
thank you, it’s a tell it like it is response and I appreciate it, because it answers my question.
I need to deal with and work with the “stick” I have rather than keep pining for the one I want / had before! I want to reduce the heart wear and tear as much I can help it. I went years without this congenital heart defect rearing it’s ugly head which is why it’s even more frustrating.
I think we all remain hopeful of solutions even when fairly unlikely. But you never know.
Yes no park runs but a slow stroll between park benches might be doable.
👍
Got it, thanks for explaining in plain words, much easier to understand but appreciate we’re not the audience for those medical articles. 👍
Hi Fish face,I’ve been wondering these things too.I’m waiting for an aortic valve replacement and have been told not to exert myself.I can walk steadily but feel very tired going up hill.
My heart rate sometimes goes really low even without medicines.I’m taking bisoprolol now to ease symptoms and support my heart.Im going to a slimming group to support me to loose weight and to avoid putting weight on , my metabolic rate must be low due to very slow walking and slow pulse rate.I told the person who runs the group that Im there for health reasons.
When I hear about people doing runs and hikes it sounds great but would really harm my heart the way it is at the moment.
yea it looks like from responses as well we’d do more harm than good, I think we need to keep moving somehow and work on weight through diet. Hope slimming club brings success.
Since early 2022 when symptoms started to get much worse, I’ve stayed at the same weight for a year now - I’m going to grab that as a success. Least I’m not making it worse I guess! Hadn’t thought of that till know. Thanks!
My symptoms are nothing like your which sound extremely incapacitating so I empathise/sympathise with you. I was found to have a Bridging Artery probably 13 years ago from an angiogram carried out as I’d had an “angina like pain” since aged about 12. I’d never been tested for heart issue despite nearly collapsing on school cross country run complaining of pain and being unable to breathe. I was only tested and diagnosed for asthma. During the AF diagnosis route an angiogram revealed the BA but that it’s also kinked (no need to stent as it runs a clear flowing artery. I’ve always proposed since diagnosis - surely if the artery is kinked in the first place, then runs through the muscle, could it not be that on exercise the muscle contracts more & at higher speed so could this be squashing the artery more and maybe at the kink also thus lowering the blood supply & oxygen =angina type pain? (My heart is actually apparently smaller than normal) so, everyone doubts it’s the BA causing pain but that it may be the heart working harder to get the amount of blood round due to its size. Currently still have the arrhythmia and getting breathes on any incline, stairs etc One thing that did cause the pain when younger - could not do the dance “The Twist” and also about 20-30 years ago if I used the cross trainer at the gym the arm action caused the pain but to use it for just legs did not! Really hope your doctors can help
it’s hard to tell but there is a real tendency for doctors to think bridges are benign (that’s how they are trained) and many doctors just don’t know much about it. I had a medical consultant who’d been around a bit said he’d never seen anyone with my condition.
Only an angiogram with dobutamine and IVUS can most clearly diagnose for sure looking at blood flow. If everything else is well controlled and you’re still getting symptoms there could be justification to rule it out through testing but it does need a cardiologist who isn’t even an expert but can think outside the box,.
There is a cardiologist who knows a lot and is expert at testing (happy to message of you are ever interested).
My diagnosis was a process of elimination till nothing else could be found and I was referred to this doctor for testing.
people with bridges also have arrhythmias as well as microvascular issues / endothelial dysfunction. But it’s difficult to say if the bridge causes or these things exist in their own right.
all they can say is yes or no to the bridge impacting blood flow and therefore is a likely cause especially in the absence of any other cause. If there is a kink I can agree with your logic.
I used to do an exercise dvd many years ago now and the trainer said that raising your arms to chest level or above makes the heart work harder so maybe that might be the thing with chest pain on cross trainer????
Have you had an MRI scan or a percussion scan of your heart? I had one last year with the radioactive dye, that’s where they found I had a small heart. They also used a drug (can’t recall its name) but it speeds up the heart as though it’s being exercised. Nothing was reported on that, just a few other issues. Just had another thought just now - wonder if it is a positional issue that causes it ie when twisting or walking up hill etc that might not compute when just lay flat and straight on the scanner table. Perhaps you could send the details via the chat should the need arise in future (still trying to get everything else sorted that’s just going on & on. Good luck in your search and any subsequent treatments x
I’ve had a nuclear heart scan with adenosine and radioactive marker and this was clear for vasospasms - scan done to rule out rather than say anything about the bridge.
Positional - only a test that emulates your heart working harder like walking up a hill is likely to show the impact on flow. Lying flat and still for me anyway brings no symptoms. My heart rate was pushed to 145bpm and I was stated as significantly symptomatic. My heart felt like it was going to jump out my chest it was thumping so hard!
I think you have a far more severe form of this than I do. I don’t think mine is severe enough to want to proceed down a surgical route. I think you are right about it not really being understood.
Unfortunately I don't have anything to add because your situation is so completely outside of my experience. However, I just wanted to respond to say that you are in my thoughts and prayers and I sincerely hope that there is a resolution to your situation in due course.
if I were in the US there might be more chance of surgery but not so much here but at present there isn’t enough known which surgeons can do it - although some names are now coming through so yes there can still be hope. 👍
I haven't had experience of your problems, but I too am trying to lose weight and also need to increase my activity levels. I've made small lifestyle changes, mainly aiming at portion control, incorporating more fruit and veg, and being very aware of fats and sugars. I also struggle to do much, but that is down to muscular/skeletal issues. I can't just go for a walk, as the mobile phone signal is really poor where I live and I wouldn't be able to summon assistance should I need it. My grand plan is to buy a treadmill, then I can have a little walk whenever, I would be able to literally do a couple of minutes at a time, multiple times a day. Every little bit will add up, and eventually I will be able to do more.The only flaw in that is the cost of livibg keeps getting in the way, but I will get there in the end.
thank you for sharing how you are approaching this, I guess smaller changes bit by bit aren’t so intimidating so probably more successful, I’ll work on that basis I think. I get your concern about being out on your own, we have to be sensible and practical. Hope you get that treadmill very soon, sounds like a good plan and a good alternative for not being able to get out as much. ❤️
I was diagnosed with that myocardinal bridge as well back in 2016. Have heart rate up around 75 and found this article on ways of treating it which could actually improve everyday life!! Well wishes
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Very low resting heart rate
Heart rate spikes when painting
Heart rate recovery after exercise. 
Anxiety or possible heart rate problem 
Can't get heart rate up
