is there such a thing as ‘not a full blown HA’?

[Manhattan1]

just wondered if anyone else has been told this in A&E?… a bit curious.. last year i was admitted to A&E by ambulance after suffering severe left arm paid emanating across left shoulder.. after ecg and troponin of 12.. young doc said ‘we don’t think you’re having a full blown HA’ i was stupid enough not to enquire what he meant 😂 anyone else had a similar experience and actually had the wherewithal to ask questions? 😂

[Manhattan1]

was discharged the following morning from acute assessment ward.. Consultant who was doing the rounds said she had a word with Cardiology and they were happy enough to let me go home.. no follow up.. i thought troponin had to be 14> to indicate a HA? anyway.. if it happens again and i’m told the same thing… i’ll ask the question.. ‘what does that mean exactly’? 😂… thanks for your response👍

[Milkfairy Heart Star]

Good question.

I was once told by a Cardiologist that you can have a little bit of a heart attack but not be a little bit pregnant.

When I was in hospital recently, I had very similar troponin blood levels and ECG changes.

As I have vasospastic angina it was thought to be due to severe episodes of coronary vasospasms.

[Manhattan1 in reply to Milkfairy]

but would that cause the severe left arm pain?

[Milkfairy Heart Star in reply to Manhattan1]

Cardiac chest pain is not always central chest pain.It can radiate to other places.

I feel my angina in an area to the bottom left of my sterum, upper left chest, a band of pain like a cheese wire cutting through the left side of my chest, upper left back pain, left sided neck, face and left shoulder and arm pain.

Even stomach pain.

We're all different!

[Manhattan1 in reply to Milkfairy]

troponin level of around 12?

[Milkfairy Heart Star in reply to Manhattan1]

The evidence suggests this warrants further investigation. Have a look at my response to thatwasunexpected above and the link to Prof Nick Mills research.

Normal healthy people don't usually have troponin levels above 5 ng/L

[Hidden]

Five years ago, following a virus, I went for a walk during which I developed mild chest pains. I thought I had a chest infection, and so via 111 and a drop in GP surgery (long story, good job I drive) I ended up at my local A&E where they told me I had had an NSTEMI and was kept in hospital for four nights, where I had several ECGs and an angiogram. So although I had felt a bit 'under the weather' I had still undergone an event classed as a HA .

[Manhattan1 in reply to Hidden]

hope you’re on the mend.. did the angiogram result in having to undergo an angioplasty?

[Milkfairy Heart Star]

Since the use of high sensitivity troponin testing, it is now known that women have lower levels of troponin in their blood when damage to the heart occurs.

The levels are also dependent on the reference lab used and what type of troponin is being measured Troponin I or T .

In the US they use different units too.

It is not always easy to diagnose a heart attack.

Medicine isn't an exact science.

bhf.org.uk/what-we-do/news-...

[Etzel]

Many years ago with my HA the consultant gave me a comparison with roads, you get motorways, A roads, B roads and minor roads. My blockage was in the dirt track road to the farm! It makes it so much easier to understand.

[El-Tel1990 in reply to Etzel]

My one was on a motorway but luckily enough there were traffic signals way before I came to a halt ! Great analogy

[RailRover]

At least it wasn't on Runway 1 at Heathrow.

[Milkfairy Heart Star]

The Bristol protocol has been superseded following the research by Prof Nick Mills.

heart.bmj.com/content/107/2...

"The risk of myocardial infarction or cardiac death at 1 year is five times greater in patients with intermediate cardiac troponin concentrations compared with those below the rule-out threshold (5.3% vs 0.7%).19"

I am one of these patients. My troponin levels rise alittle during my episodes of coronary vasospasms but thankfully so far not enough to say I've had a Myocardial Infarction non obstructive coronary arteries MINOCA.

Here's a more upto date acute coronary syndrome pathway from Oxford University Teaching Hospital.

[Manhattan1 in reply to Milkfairy]

many thanks👍

[fishonabike]

There are cardiac events which cause raised troponins which may or may not hit the "heart attack" threshold - I am surprised that you were simply discharged with no further explanation or investigation as some of the potential alternatives can cause ongoing problems

I have had an episode of Takotsubo, which could be classed as "not quite a heart attack" because they is no permanent obstruction of any coronary artery, however it has equally high mortality rates and there can be complications - so i'm sure that you can understand why i feel it is suprising that you seem to have bee treated so casually

I am not questioning the decisions made at the time or wishing to cause you undue concern, but for your own sake you might want to ask your GP to explain their interpretation of the records forwarded to them by the hospital - you may even want to request copies of your records from the hospital

By the way women are more frequently affected by "not quite heart attacks", so if you happen to be a woman you may have good reason to look into this🤔

[Manhattan1 in reply to fishonabike]

yes.. i’m a 68yr old female.. didn’t receive a discharge letter on that occasion.. would usually include most of the information around the admittance.. treatment and possible diagnosis.. i’m keeping a careful eye on any chest pain.. arm pain etc.. i’ve actually been suffering from a virus for the last 10 days.. making me a bit breathless and tired .. keeping an eye on that as well.. many thanks for your reply

[Milkfairy Heart Star in reply to fishonabike]

I was told, originally 10 years ago, that because I had clear coronary arteries that I couldn't have a heart attack or angina....

This view has certainly changed thank goodness. During my latest hospital admission I had my troponin blood levels checked frequently during my 12 day stay.

For the ultimate guide of how the many different types of heart attacks are diagnosed see this link to the Fourth universal definition of myocardial infarction (2018)

See section 19 for Takostubo syndrome.

It's complicated !

academic.oup.com/eurheartj/...

[Manhattan1 in reply to Milkfairy]

yes was told the same.. well by 1 Cardiologist.. after a CT angio which showed mild atherosclerosis of LAD i was told by a lovely female Cardiologist that inwas to stay on prescribed meds for angina and they were the best protections against a HA.. a few months later i had an invasive angiogram. same mild atherosclerosis of LAD.. but another Cardiologist said not enough to cause angina and he took me off Isorobide and Tildiem but to keep taking aspirin as anyone can have a HA!.. oh but to take gtn if i had chest pain!

[Milkfairy Heart Star in reply to Manhattan1]

It really is time for Cardiologists to acknowledge that non obstructive coronary artery disease NOCAD exists!

I am based in London and I am the prize specimen when I am in hospital now.

The medical students came to see me during my last admission.

From my history alone they worked out what was causing my chest pain.

One bright spark asked

' do you have coronary vasospasms!'

Are you able to ask to be referred to a Cardiologist who understands NOCAD?

Another option is to see if a hospital close to you is taking part in the ICorMicA trial.

clinicaltrials.gov/ct2/show...

More and more centres are taking part in this trial.

[Manhattan1 in reply to Milkfairy]

when inwas in for the invasive angio at Golden Jubilee hospital in Glasgow.. i was asked to sign a form agreeing to be contacted to take part in research.. but obviously i haven’t been lucky enough to be chosen to take part in that particular trial… just my luck lol

[Milkfairy Heart Star in reply to Manhattan1]

That's such a shame.There are other centres opening up in Scotland, perhaps contact the team running the trial and see if you can take part?

[Manhattan1 in reply to Milkfairy]

the thing that really confused me.. when the Cardiologist at FVRH .. the one i first saw 4 years ago, he was the one who called me to say the blockage wasn’t enough to cause angina and he stopped the 2 meds.. but i told him that 4 years ago at my first consultation he believed i had MVA.. i asked him if there was a chance it might be that.. he then asked if during the invasive angiogram they had did the test for MVA.. he then must’ve lioked at the notes and he said ‘ mmmm no they didn’t’.. and then ended the telephone call by saying i still had ischaemic heart disease.. continue taking aspirin and don’t ignore chest pain as anyone can have a HA! lol

[Milkfairy Heart Star in reply to Manhattan1]

🙄

[Manhattan1 in reply to Milkfairy]

that’s how i feel 😂

[fishonabike in reply to Milkfairy]

indeed, Milkfairy - what is rather tragic is that, 10 yrs on, there probably are still medics who believe that if your arteries are clear it can't be angina, and if your troponins have not crossed the threshold it's not serious - worse still, that is not classed as misdiagnosis when they say it to patients and they pack them off with a "no further action" label!

[Milkfairy Heart Star]

I am so sorry to hear about your aunt.

[Hatchjd]

in 2019 I had a similar event to yourself. I had jaw aching and a fast pulse. I am a retired nurse and decided to go to A&E to be checked. My father and brother had heart attacks in their 30’s

My tropin went from 10 to 13 over 3 hours. I also had ST flattening on EKG usually related to ischemia. I was given several aspirin and I felt fine after half an hour. They decided to keep me overnight and treadmill stress test me the next day. This was positive for blockage/ischemia and an angio followed. I received 2 stents for - 90% LAD and 80% LCX blockage . I also had a 40% LCA not treated. The angio showed recent plaque rupture with bleed in the LAD and my discharge diagnosis was NSTEMI.

I was fortunate that my local hospital were diligent in following through with treatment even though my initial symptoms and findings were not classically diagnostic for heart attack

I am 3 years post stent and a recent ekg and echo were normal with no evidence of heart muscle damage found.

[Manhattan1 in reply to Hatchjd]

thank goodness you went to A&E… so like myself.. you had a troponin of 12?.. but probably the difference is my 2 angiograms only found mild atherosclerosis of the LAD.. but i was also told by the lovely female cardiologist at FVRH that it only takes a small puece of plaque to break away to cause a problem.. the thing that really concerns me is the possibility if i do have MVA.. if the smaller arteries decide to tighten up to the extent they could cause a serious disruption to the blood flow i might be in a bit of serious bother lol.. many many years ago i was admitted with chest pain and on the discharge letter diagnosis read ACS.. no follow up required