Coronary artery spasm

[Acompletesurprise]

Recently diagnosed and interested in learning more about condition. What can I do? What should I not do?

[Milkfairy Heart Star]

Hello Acompletesurprise

Welcome to the forum.

I have lived with vasospastic angina for over 10 years.

My coronary vasospasms were diagnosed by a specialised angiogram.

The BHF has this information about vasospastic angina and microvascular angina a related angina without obstructed coronary arteries.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

You might find this website helpful it lists some triggers and coping strategies which may help.

internationalheartspasmsall...

There are quite a few of us on the forum who live with microvascular or vasospastic angina and I am sure they will be along to share their experiences with you too.

[Acompletesurprise in reply to Milkfairy]

Thank you for your reply - very reassuring. I have found the website you mentioned and read the bhf articles regarding the spasm but am still confused. When I am in pain can I exercise? Can I go for a long walk? Or is it trial and error where error could be another 10 days in hospital. Whilst in hospital I had X-rays, CT scans, angiogram, echocardiogram and finally an MRI scan. It was the angiogram which revealed the coronary artery spasm and I came home as a walking pharmacy having gone in with zero medication. I am still waiting for the MRI scan report so am unsure as to the final complete diagnosis. It seems extraordinary to spend so much money on all these tests and then be allowed home without this.

[Milkfairy Heart Star in reply to Acompletesurprise]

The cardiac MRI checks your heart muscle. It can also diagnose microvascular dysfunction a cause of microvascular angina.

Did they suspect you had a heart attack without obstructed coronary arteries known as a Myocardial Infarction non obstructive coronary arteries MINOCA.

Did the actually see a coronary vasospasm during your angiogram?

Have you been referred to cardiac rehabilitation? They can help you slowly build up your exercise. Start off slowly and gently, if you get chest pain stop

Vasospastic angina is a less common type of angina so nit many Cardiologists have indepth knowledge of microvascular and vasospastic angina.

The usual advice is if you have chest pain you don't exercise and you rest.

Take a spray of GTN . If you have no relief of your chest pain after 3 sprays 5 minutes apart then it's time to call 999.

It can take time to find the correct combination of medication that will help you best.

[Acompletesurprise in reply to Milkfairy]

Thanks. They suspected a heart attack and, I believe, thought that they would insert a stent during the angiogram. But there was no need as the arteries were not blocked. And, yes, they saw a coronary artery spasm during the angiogram. I was not prescribed any spray but given medication for the spasm (Diltiazem) and plenty for the potential heart attack - at the stage when I was sent home the MRI report was not yet available. So the additional medications were Ramipril, Clopidogrel, Atorvastatin, Asprin and finally Lansoprazole so that the stomach didn't get upset by the heart drugs! I came home some 3 days ago. The MRI report is apparently available but the consultant has not, as yet, refined his working hypothesis of coronary artery spasm and maybe heart attack. In desperation, I rang the Ward sister who checked the records and said that the MRI report was available and confirmed that I had not had a heart attack. So I suspect that some of the medications are not necessary but until the final consultant report is written am in limbo. I have asked to be referred to cardio rehab but that is in the gift of the consultant as it is not normally available to those who haven't experienced a heart attack.

The chest pain is a dull background ache as if someone is pressing a bruise.

I feel in limbo. Should I stop some of the medication? Can I drive? Is this pain normal?

[Milkfairy Heart Star in reply to Acompletesurprise]

It's really important not to stop taking any of your medication until you have spoken to your Cardiologist.You need these medications to prevent you from having a heart attack by helping to prevent coronary vasospasms.

I am lots of medications too for this reason.

I suggest you do not drive either until you have a confirmed diagnosis either. You could invalidate your insurance.

After a really severe episode of coronary vasospasms my heart feels bruised.

Your heart has been through alot.

I acknowledge how bewildering you may feel at the moment. It's unfortunate that you weren't given mire information before you were discharged from hospital.

Perhaps give the BHF helpline a call and speak to one of the cardiac nurses on Monday.

bhf.org.uk/informationsuppo...

If you are worried or concerned about your ongoing symptoms ring 111 for further medical advice.

[Acompletesurprise in reply to Milkfairy]

Thanks - your prompt reassurance is really helpful. As yet I haven't driven and have no intention to until told otherwise by consultant who is obviously very busy with those in hospital. I just hope he gets back to me early next week so that I can move forward - his secretary must be getting tired of my daily phone call. And, yes, I haven't stopped any medication but suspect that all are no longer required. That's a good idea - to contact one of the BHF nurses! Meanwhile, I shall rest and hope that the background pain abates a little.

[Milkfairy Heart Star in reply to Acompletesurprise]

Perhaps take each days as it comes.Any life changing diagnosis can feel as though your world has been turned upside down.

Be kind and patient with yourself.

You may well need to be on medication from now on. Vasospastic angina is a serious heart condition.

Perhaps join the Facebook support group suggested on the BHF information I sent. You'll get lots of support from others.

[talipia in reply to Acompletesurprise]

Hi Presume the aspirin you take is the enteric coated one?. I had a dull persistent ache /pain in left chest area (was taking 75mg aspirin with water last thing at night) When I changed to 75mg enteric at lunchtime with food,all dissapeared.

[Acompletesurprise in reply to talipia]

No - a low dose dispersible one. Another side effect of one of the medications is constipation. Is this common? Is so, any ideas on handling it?

[talipia in reply to Acompletesurprise]

Likewise, less of a problem, as I now double/triple up on my brekkie fluid intake,not just one cup of tea. It was those dispersibles which gave me that pain sensation.

[Acompletesurprise in reply to talipia]

Thanks for that. Will increase fluid intake and see if that helps. And will wait until get final diagnosis to discuss medications with someone!

[CarolingTeacher in reply to Acompletesurprise]

Everyone has different things that work for them. Here’s what has worked for me. Walk—it makes a difference to be a little bit active. Be sure to drink lots of water—and include foods with fiber. I like a salad (every day or so with a dressing w/heart healthy oil—important) , and a small handful of nuts as a snack is nice, and I like a bowl of Wheaties now and then. Good luck to you!

[fishonabike in reply to Acompletesurprise]

I know Milkfairy will correct me if she feels I am offering the wrong suggestions, but (speaking as an ex-nurse as well as someone with experience of a heart condition) i would not recommend continuing with exercise if you have chest pain or discomfort

The pain is caused by the inadequate supply of blood to your heart muscle, this means it does not get enough oxygen or fuel to keep it functioning as well as it should - pain is a warning that something is wrong and you need to act on that warning

as time goes on you should learn what your limits are, and until you are advise otherwise, by specialists in cardiac rehab, you should avoid levels of activity which bring on symptoms

it's important to stay as active as you can, so you will need to be patient with yourself while you work out your limits and balance your need for activity with your need to avoid causing yourself pain - this is not easy for someone who is used to lots of activity, so I wish you well

[Heartattackvictim]

I think Milkfairy has covered it all and their advice and encouragement, and using the BHF resources have been invaluable. But I will add my experience.

I've had two NSTEMIs (7 days in hospital on each occasion) and also a two day stay after a bad attack. It has taken almost three years to get the meds 'right'. I was very active 59 year old (see bio) at time of first NSTEMI, but with patience and building exercise up slowly and keeping to the med regime (I've never missed taking them in all that time) I can report I'm still jogging (as opposed to running), cycling lots and have identified triggers (stress/emotional upset) of any attacks. I recently spent 7 weeks in NZ doing long walks with no issues.

Listening to my body has been important and I lead a good life (now aged 63). Looking forward as opposed to backwards has been important for me.

All the best, John

[Milkfairy Heart Star in reply to Heartattackvictim]

Hello, Heartattackvictim It is is great to read how well you are doing.

I see you have been to New Zealand.

I wondered how you managed with the flight?

Did you take several flights, how log was the longest flight?

I note from your bio that your diagnosis is microvascular angina rather than vasospastic angina?

Have you had any formal testing to determine which one?

Microvascular and vasospastic angina are related conditions however the causes and treatment options differ.

My vasospastic angina is resistant to treatment and my Cardiologist recommends I take only short hail flights.

I am determined to get to Australia though so it's encouraging to read that you made it to NZ.

[Heartattackvictim in reply to Milkfairy]

Ah, I have no definitive diagnosis but at my first review the consultant replayed my first angiogram and said that the smallest vessels were the problem and my blood flow sluggish - hence the drugs. He then added Monomil to my list of meds after my second review (that took place over the phone because of Covid) and a letter was subsequently sent stating "the diferential diagnosis here is either microvascular coronary artery disease or coronary artery spasm". I think I need to update my bio to reflect more accurately my condition! On my latest two day stay in hospital (a few days after returning from NZ) I had a CT Angiogram (and echocardiogram) and from this I was then also prescribed Ranolazine (375mg twice a day) which has cut my spasms almost entirely.

As regards the flights we did them in one go: Manchester-Frankfurt-Singapore-Auckland (and same coming back). On the outbound journey we only had two hours in Frankfurt and Singapore airports; and, on the return we had 4 hours in Singapore and Frankfurt. I wore compression socks for the entire flights and made sure I walked about during the flights and also at the airports. We booked aisle seats so it was easier to get up and walk about without disturbing any other adjacent passengers.

[Heartattackvictim in reply to Milkfairy]

Ah, I have no definitive diagnosis but at my first review the consultant replayed my first angiogram and said that the smallest vessels were the problem and my blood flow sluggish - hence the drugs. He then added Monomil to my list of meds after my second review and a letter was subsequently sent stating "the diferential diagnosis here is either microvascular coronary artery disease or coronary artery spasm". I think I need to update my bio to reflect more accurately my condition! On my latest two day stay in hospital (a few days after returning from NZ) I had a CT Angiogram (and echocardiogram) and from this I was then also prescribed Ranolazine (375mg twice a day) which has cut my spasms almost entirely.

As regards the flights we did them in one go: Manchester-Frankfurt-Singapore-Auckland (and same coming back). On the outbound journey we only had two hours in Frankfurt and Singapore airports; and, on the return we had 4 hours in Singapore and Frankfurt. I wore compression socks for the entire flights and made sure I walked about during the flights and also at the airports. We booked aisle seats so it was easier to get up and walk about without disturbing any other adjacent passengers.

[Milkfairy Heart Star in reply to Heartattackvictim]

Thanks for the information.

I am so symptomatic that I need to use oxygen during flights.

I would need to rest for 24 hours after each 6 hour trip.

With travel insurance it's not going to he cheap!

[Heartattackvictim in reply to Milkfairy]

That sounds really tough. I took out travel insurance that excludes USA, Caribbean and cruises to keep the cost down. Our flight times were in excess of ten hours for the two longest legs.