For the last month or so I have been having angina like symptoms but unusually nearly always when resting and they seem to be relieved if I go for a walk. Have had clear Echocardiogram; ECGs and angiogram. Symptoms are intermittent and I tend to occur every second or third day.
Cardiologist has prescribed Bisoprolol; atorvastatin; and aspirin and I have just started taking isosorbide mononitrate (the latter seems to have side effects of headache; blurry eyes' dizziness etc that are frankly worse than my original symptoms).
Has anybody else experienced angina that only seems to occur when resting? What was your diagnosis/outcome?
I should be grateful for any advice as am currently struggling with the medication and wondering if I should be taking them anyway as I don't seem to have a proper diagnosis...
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vivie1
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Normally angina gets worse with exertion but your angina improves when you walk. Have you mentioned this to your cardiologist or GP? I had something similar happen to me after I had a stent put in a couple of years ago. After the procedure (and for a long time after) I had some symptoms of angina (a feeling of vague breathlessness and a tight chest) when resting which would often lift when walking. Or if it didn't lift, it didn't get any worse when I was walking. The cardiology nurse thought it might be anxiety related with the walking easing the anxiety. I never really got to the bottom of it and eventually it did ease though it did come back now and again.
Thank you so much for your reply. I get a dull ache in centre of chest when sitting, sometimes preceded by feeling of lightheadedness, or "wooziness" and sometimes the ache is replaced by intermittent sharp stabs, which can be in different locations around my chest. Symptoms tend to ease if I get up and walk around; or take the dog for a walk, but they often return when I come back and sit down again. I did wonder if it was anxiety....although of course, the main thing I am anxious about it this!
I have lived with vasospastic angina for nearly 11 years.
I can exercise however I will experience my chest pain later in response to exercise or other stressors such as the cold, emotional and mental stress later at rest, especially during the night.
Vasospastic angina along with microvascular angina are types of non obstructive coronary artery disease NOCAD.
These types of angina are not well understood and often overlooked by Cardiologists.
It's important to know whether you have microvascular or vasospastic angina as the treatment required is different.
As a someone said without a diagnosis Cardiologists are shooting in the dark with their medications.
I suggest you ask your Cardiologist to have the appropriate tests to determine the cause of your angina without blocked coronary arteries.
Or ask to be referred to a specialist who does carryout the testing.
The BHF website has this information about microvascular and vasospastic angina.
You may find this website helpful too. It was written by four patients who have over 50 years combined experience of living with microvascular and vasospastic angina. They are supported by 30 world leading Cardiologists.
There quite a few of us on the forum who live with either vasospastic or microvascular angina so hopefully they will be along to share their experiences with you too.
Thank you very much for your reply - I have followed up on all the links and feel much better armed now to try and fight for a proper diagnosis rather than drug trial and error (although I appreciate that I may need to endure quite a bit of that!)
Hi - welcome to the forum. I have similar issues to you. Tend to get angina like symptoms at rest not exercise. I was initially put on ISM (it does get better after a couple of weeks), Atorvastatin 40mg and Aspirin 75mg before an angiogram showed no CVD. I was then taken off ISM and placed on a beta blocker with aspirin and Atorvastatin. I developed a sharp stabbing pain in my left upper breast at rest or when sleeping. In short after a while I returned to cardiologist who took me off beta blocker and put me on calcium channel blocker Diltiazem. Initially things got better but recently the stabbing pain has returned and my glands feel sore. I believe this could be the result of the combination of medication I am on. The cardiologist suspects Microvascular angina but is completely against further testing which I think is strange. I am left to research what possible interactions might be giving me the ongoing occasional sharp pains and sore glands. So, my advice like others is insist on more tests. I will be going private shortly as I feel I am simply not a priority. But this thing can make your life miserable so it will be worth it. For now I am going to alternate a lower dose statin and cease taking the aspirin (which can act as a vasodilator when combined). The Diltiazem has lowered my BP and removed the chest heaviness I was experiencing. Be aware of anxiety also as this can certainly make things worse so meditate or talk to someone (Dr can refer) as this definitely helps.
Thank you so much - that is really helpful as I was beginning to feel very alone and baffled as all my tests suggest my heart is ticketey-boo and yet my symptoms don't really seem to fit any other non-heart related cause. I did wonder whether the whole thing may be due to anxiety, although I think it would have been more likely to have happened a few months ago when my life was more stressful. They do seem to be trying to diagnose using medication rather than the other way around. Its reassuring to know the ISM side effects get better as I would currently be tempted to take my chances with the chest pain! I shall try to be patient yet persistent. I really do appreciate the support and advice.
Hi, l am still learning just like you. I started isosorbide mononitrate 25mg on Monday, experienced bad headache, tightness in back of neck, dizziness, it was a fight to open my eyes because my eyelids were so heavy. 3 days in the symptoms are so much better. They do say it takes up to 2 to 3 weeks for your body to adjust to them. Hopefully this helps.
Oh it helps a lot - thank you. I am only on day two and quite frankly was tempted not to take this mornings (I did). Headache, dizzy, blurry eyes. And my chest pains actually seem worse! Hopefully we will both be raring to go soon.
Hi, keep going with the medication if you can. When I first started taking it I only took half a tablet (30mg) of Monomil xl, which is an extended release tablet. I had dreadful headaches that went on for weeks. I spoke with a pharmacist and he said things would improve if I kept taking it. I even went to the optician to get my eyes checked! It was a good 8 weeks before my headaches completely went, then I was able to double the dose. If you have any concerns speak with a pharmacist or your GP.
thank you - I shall keep pushing through. Quite disconcerted that the chest pains seem to be getting worse if anything. Did the medication work for you? Did it take a while to start working?
Hi, I knew 30mg would not be enough for me. I noticed a difference with the angina within 1 a week or so. A significant improvement came when I increased it to 60mg. My cardiologist said I could increase it to 120mg and add Nicorandil if needed, but I'm worried that would drop my blood pressure too low.
I am only 4 days in (although it seems like an age!) so I suppose I should try and calm down. It really does help to discover I am not alone in this, so thank you.
You are most definitely not alone in this. If the pain doesn't improve or gets worse contact your GP or cardiologist but we all know that can be easier said than done.
I also live with coronary spasms. My diagnosis however, is quite recent and I was only diagnosed in 2022 despite being symptomatic with chest, back and arm pain on rest for 1.5 years. The later diagnosis meant that I had unfortunately experienced a really bad coronary spasm which triggered an NSTEMI and seems to be a result of having a congenital heart defect called a myocardial bridge.
In terms of exercise, I have found that for myself, slowly building my tolerance level up to how much I can physically cope with, without overdoing it, helps in order to build my endurance, stamina, and fitness back up. For example, if one week I go on a walk for 30 mins every 2 days, the following week I’ll slightly increase this to 40 mins. That way, I’m slowly introducing my body back to physical activity. I always carry my GTN spray with me. It doesn’t work every time however, it’s safer to have it.
If you were given a GTN spray, as I can see you haven’t listed it so I am not sure, it can provide temporarily relief from the pain that you experience. The rule is one or two sprays under the tongue 5 mins a part. This should be done up to 3 times if the pain hasn’t subsided. If after those 15 mins, the pain is still present, it’s a trip to the hospital to have it investigated. Perhaps you can discuss this with your cardiologist if you currently do not have one.
Thank you for your reply. I do have a spray and it works sometimes, but only temporarily and the pains come back again after about half an hour. Do you mind me asking how you eventually got your diagnosis? Is there a specific test that I can ask for? (I have a suspicion that I will also be just experimenting with medication and enduring resting chest pains for a year or so )
vivie1 you could ask for long-acting nitro tablets which release nitroglycerin throughout the day slowly if you feel the spray doesn’t work. The tests vary I believe depending on specifically what type of angina they are looking for. Unstable angina is hard to test for because it does not have an obvious pattern or triggers like stable angina for example.
I had an angiogram done and they determined from that that I have had a coronary spasm, and then diagnosed with vasospasm.
In the U.K. the best way to test for vasospasm is through an angiogram which uses a drug called Acetylcholine to induce spasms.
However, you may have a type of unstable angina which is different. The tests I’ve previously had are:
1. a holter monitor test, where my heart beats were recorded for a certain amount of time on a small wearable device.
2. Echocardiogram
3. CT scan to rule out blood clots to the lungs
4. ECGs
5. Myocardial perfusion scan to identify areas of ischemia (narrowing of the heart arteries)
6. Angiogram (to see any blockages)
7. Blood tests
Due to unstable angina being difficult to diagnose, I have started to monitor my own heart rate and BP from home since my diagnosis. So when I am resting for instance and I am experiencing chest pain, I either monitor my heart rate on my Apple Watch or on an oximeter. This can provide very useful information to your cardiology team. I also make a note of my triggers, such as stress which is a big one for me. Keeping a log of your symptoms, their frequency, and your triggers can help better equip you to advocate for yourself.
Thank you so much for giving me so much of your time and sharing your experience. I ts really good to know what I should be asking for. The diary is a very good idea - I seem to have Bad Day; Moderate Day; Good Day and then the cycle starts again.
Unstable angina is usually considered to be a sign that obstructive coronary artery disease is developing into acute coronary syndrome and possible heart attack, rather than coronary vasospasms.
I have lived with vasospastic angina for over 10 years and mine was diagnosed by an angiogram using acetylcholine in 2014.
Testing with acetylcholine is still not commonly available in the UK, though more centres are now taking part in the iCorMicA study which involves invasive testing for microvascular dysfunction and coronary vasospasms.
I have included the criteria for vasospastic angina from The COVADIS Coronary Vasomotor Disorder International Study Group who are a group of expert Cardiologists caring for and researching microvascular and vasospastic angina.
They are the leading authority of the definitions of coronary vasomotor disorders.
The BHF website information about angina list four types of angina
Another very useful resource is this website written by 4 patients with over 50 years experience of living with microvascular and vasospastic angina. Their information is evidence based and has been reviewed by the 30 Cardiologists who support the group.
Just a reminder that content on HealthUnlocked does not replace the relationship between you and your doctor. Please avoid making any changes to your medication or advising others to do the same, without speaking to a health professional first.
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