Microvascular Meds

[Fonzo]

Having had an angiogram last September which showed no CVD but still suffering from chest heaviness/pains I was placed on Atorvastatin 40mg, Aspirin 75mg and Diltiazem 2 x 60mg. Initially things improved but after 6 weeks I developed a sharp pain , occurring occasionally in my upper left chest usually at rest. This has gotten worse and I am wondering if the combination of meds is the issue. Certainly they all have a moderate (significant) left of interaction. I have lowered my dose of Atorvastatin to 20mg and will try this alternate days going forward (my LDL is really low now) but I wonder if the aspirin in combination could be causing a vasodilation. Has anyone on this combo or similar had any experience of this? Any advice? I have written to my cardiologist but no response. My doctor refers me to my cardiologist.

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hello if you’ve had a change in pain I’m hoping you sort immediate help like 111 or 999? I had started a new med and I believed increased pain was due to it (I was right) but gp insisted I got to A&E.

regards meds if your not getting response, how about discussing with pharmacist might shed some light if you haven’t already?

I’d also stick to the medical plan rather than change dosage yourself, but you know your body and it s your decision. I’m the kind that will only change if instructed to.

There are several experts who can advise better and will be along soon, in meantime hope the link to another post may help - it’s three years old but I think still relevant. Look out for Milkfairy’s responses.

healthunlocked.com/bhf/post...

Hope helps but I’d encourage you to see someone about your new pain and perhaps stick to the medical plan until you get to see your cardiologist but feels like you need help sooner.

You probably know all this so apologises if not adding anything.

[Milkfairy Heart Star]

Hello Fonzo

There are thought to be two causes of non obstructive coronary artery disease NOCAD.

Microvascular and vasospastic angina.

The possible treatment options are different.

Has your Cardiologist given you a diagnosis?

Have you been offered any formal testing to determine whether you have microvascular or vasospastic angina?

Or have you asked to be referred to a specialist who understands how to manage these conditions ?

I was presumed at first to have microvascular angina, prescribed medication that made my symptoms worse.

However my angiogram with acetylcholine showed I have coronary vasospasms in my coronary arteries and microvascular vessels.

Taking part in research is another way of getting an accurate diagnosis and being reviewed by an expert in this field.

This study is taking place in London

isrctn.com/ISRCTN94728379

This study is opening up centers throughout the country. Where are you based?

clinicaltrials.gov/ct2/show...

[Fonzo in reply to Milkfairy]

thanks - my cardiologist seems really reluctant to conduct further tests but has placed me on the meds I mentioned. I will force to issue and ask for further investigation. If no luck will go private.

[Milkfairy Heart Star in reply to Fonzo]

I am sorry it sounds as though you do need a second opinion.

Going private may not necessarily be the best option as the person you pay to see may still have limited knowledge about microvascular and vasospastic angina.

I would also recommend that you have the testing done in a larger centre of excellence by an experienced team. This you'll find in the NHS.

Over 11 years I have had all my tests and care through the NHS.

I have been fortunate to have been reviewed by world leading experts in microvascular and vasospastic angina.

Ask your Cardiologist to refer you to centre that is involved in the iCorMicA study. There are centres in London, Cambridge, Leeds, Manchester, Wolverhampton, Newcastle, Sunderland, Bournemouth and other sites being added who are now doing the relevant testing.

clinicaltrials.gov/ct2/show...

I am actually in hospital at the moment, I will be going home later today.

I have a wonderfully supportive Cardiologist and team looking after me. It's disappointing to still hear that others living with microvascular and vasospastic are not able to access the care they need.

However sometimes you need to be persistent.

Good luck!

[MustyK]

As ever the response from Milkyfairy is excellent. Perhaps it is time you saw another cardiologist. I had similar symptoms and medication to you. Then my GP (not my cardiologist) added Monomil XL 60mg (Isosorbate slow release) and GTN spray (for "emergencies"), and the chest pains reduced dramatically. If you do not see another cardio, at least have a conversation with your GP. Good luck