Hello to you all. Just a little question about angina.For over a year I've been suffering with chest pains which start in my neck, it lasts about 5 minutes and is in the centre I Ended up in A&E a couple of times after visiting my gp. I was given a gtn spray to help which it does. I always get the pain while at rest and sometimes it wakes me in the early hours.I was referred to a cardiologist where they did a heart scan and said all was fine and referred me back to gp. She is going to write back to him to query something else. She said not all conditions show up on the scan. I just wondered if anyone out there has a similar experience who can shed any light on it please. I've had 12 in 13 months.
I live with vasospastic angina, it is with microvascular angina a type of non obstructive coronary artery disease.
I experience most of my chest pain and other symptoms at rest, especially at night. This is a classic symptom of vasospastic angina and it's unfortunate that the Cardiologist you saw missed this important symptom.
Microvascular angina and vasospastic angina are often overlooked and undiagnosed. The usual tests often miss these types of angina. I had a specialised angiogram to diagnose my coronary vasospasms.
Microvascular angina tends to effect women more than men.
The BHF website has this information about microvascular and vasospastic angina.
I suggest you have a look at the information and discuss the articles with your GP and perhaps ask to be referred to a Cardiologist who has some understanding of microvascular and vasospastic angina.
Thank you for the reply and all of the information. I will be chasing the gp up then. I found it strange they are willing to let me carry on using the gtn spray if all is OK. The A&E doctor actually said something about a spasm. Do you find you are being woken up by the pain?
I am treated with medication. Calcium channel blockers, long acting nitrates, nicorandil, GTN patches, clopidogrel and statins.
I am often woken at least once or twice a night by chest pain.
I am unfortunately quite badly effected and need to go into hospital for treatment with IV GTN and morphine from time to time, especially when my coronary vasospasms become unstable.
I also have 2 other vasomotor disorders, Migraine and Raynauds Phenomenon.
Vasospastic angina is rare, while microvascular angina is more common just under recognised.
The treatment for microvascular angina is different to that of vasospastic angina. Beta blockers can help but can make vasospastic angina worse.
Nitrates may not work as well for people living with microvascular angina.
Microvascular dysfunction the main cause of microvascular angina can be diagnosed by a perfusion MRI and in some cases a stress echo.
Most people living with vasospastic angina are able to exercise however will experience chest pain later in response to triggers such as the cold, mental and emotional stress, at rest.
I am so sorry to hear how you are affected by this. It sounds like a lot to deal with. It's so strange how it just happens out the blue. I've never had one while being active. I have lupus too so was beginning to put it down to that.
Hello again. I thought I'd give you an update. I got sick of waiting to see the cardiologist so last night went to a private hospital for a consultation. I can claim the money back luckily. Through "clinical findings" he's pretty sure it's microvascular angina and he's going to write to my gp to do me a prescription for ranolazine. I showed him my notes I've been making since December 2021. Do you know if this medication will stop all the attacks and maybe lower my heartrate as its always quite high. Just sitting writing this and it's 84. When I move around it's over 100. He said he didn't want to give me beta blockers as it may bring on a Lupus flare but said the ranolazine may bring it down. Do any of you hearties take this drug and are there any bad side effects?
Also Milkfairy you said maybe it could be to do with my lupus but he didn't even suggest it could be that. I suppose I'll give this new drug a try and hope it works eh.
Hi. Thanks for replying. Wasn't sure if it would get lost. He only offered meds. He said see how you get on with those but I'm a bit wary to take it what if he's wrong and I don't have it. I would prefer more tests but maybe he's just going by all my notes I kept. I only get the pain at rest apart from once in Hong Kong airport! I'll let you know and thanks again for the reply.
Was your test done with an exercise test.Years ago though very fit got angina and an ecg at rest showed as normal.My doctor was not satisfied and insisted on an exercise test where changes were apparent.Then 31 had triple bypass in 1977 I am now 77.
Don’t know if this is relevant in your case and your age but that was the simple way I found out thanks to a great doctor who was well versed in emerging heart problems.
am glad to see that Milkfairy has picked up on your post
in addition to that may i suggest that you keep a few notes about your chest/neck pain while you wait for the next stage: note when it happens, what you were doing, how long it lasts, what helps it what makes it worse, is frequency increasing or stable .... that sort of thing - it can be helpful to have some "evidence" to give doctors
i hope you get a firm diagnosis and some helpful treatment soon
Yes I have been keeping notes since Dec 2021. I will show them if I get another appointment. I has an ecg and all was fine. Same with the bloods, troponin level was 8 then 14 but they said that's OK. Hopefully get to the bottom of it. I've had a lot of stress over the past couple of years. I'm not sure I'd that has an impact 🤔
There is growing evidence that a troponin blood level of 5ng/L and above are of clinical significance. ' normal' ECGs and lower troponin blood levels does not rule out microvascular dysfunction and coronary vasospasms.
Where are you based in the UK?
There is a study taking place iCorMicA which has centres opening up all over the UK.
The trial is researching how to diagnose microvascular dysfunction and vasospastic angina more accurately.
it's about time that "they" accepted that troponin below current "clinically significant" levels does not always mean there is nothing significantly wrong - this may have led to untold numbers of missed diagnoses and the resulting misery
Agree 100%! That’s my downfall—when I go for an appointment and I can’t answer some of those questions, resulting doctors not being able to diagnose me. Great suggestion!
Hi I had a HA 3 years ago had stent fitted saw my cardiologist 6months ago as still getting chest pains more so at rest. Did an other angiagram and I have microvascular dysfunction he said I have lazy blood which is a nice way to describe it. Blood moving slowing I'm on isosobide mononitrate and Ranolazine which does help hope you get it sorted soon
Yes, your story sounds like mine. I would go to the doctor and tell about my chest pain, so tests were ordered, doctors noted some things that they said were elevated or a slight variance from normal, but they always told me they were nothing to be concerned about. I even reported to the ER a few times with chest pain. One time, it was a significant clot in my pulmonary artery. The last time I went to the ER (this past February), all of the tests they ran showed nothing significant, though my troponin level was slightly elevated. One doctor supposed it was musculoskeletal. On a hunch, the cardiologist sent me for an angiogram. He said that it may be nothing, but it may be something…so let’s take a look. It turned out that I had a 70% blockage in the (widow maker) ventricular artery, so a stent was placed there during the procedure. No other blockages were noted. Once again, none of the other many tests I underwent detected any kind of blockage, thus the doctors had continually sent me home. This was my story. Yours may be different. I still have chest pain and now I’m going through the process of searching for answers. I wish you well and hope you find your answers very soon.
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