Arteries or electrics of my heart? Which one is causing me problems or are they both? Or is it gastric?

[Bradshaw278]

My heart history is quite extensive . Had ablation 2019, stent 2019, coronary spasm 2020, pacemaker for complete heart block 2022. Plus prostate cancer 2021 and bleed on brain as the result of collapsing due to blood thinners.Before Christmas was doing hour and half in gym, felt fine. Since January have had situation where if I go to the gym, come home and have meal then later that night I get dull ache in chest, shortness of breath, dizziness. Have been to A and E few times but treponin tests similar at 19/20. So I go home and am fine until any unusual exertion and then cycle begins again. Could be angina but in the past the exercise seemed to remove that. I take Isosorbide Mononitrate 60mg each day plus apixaban and then statin and small dose ramapril. I have generally low heart rate and blood pressure plus vascal vagal syndrome where I can pass out so given the blood thinner it is not a good idea to have big doses of medication which lower my blood pressure

I am awaiting an appt. with the heart hospital. I enjoy the exercise but did some quite mild exercise yesterday but same dull ache and tightness in the chest resulted later in the day after my main meal. I am on Lansoprazole 30mg in case it is a gastric problem .

I also have ishaemic heart disease in other places beside where my stent is. Stent is four years old now.

Any thoughts welcome.

[Tos92]

Hi Bradshaw278

I’m sorry to hear about your heart history, sounds like you’ve been through a lot over the last couple of years.

I saw that you had a coronary spasm in 2020. Were you ever tested for vasospastic angina? I have vasospastic angina and it is treated with calcium channel blockers (note: can lower blood pressure even more) and GTN. Vasospastic angina is usually determined through an angiogram where a stress agent, acetylcholine is administered. Some people are also diagnosed if significant changes are seen in their ECGs.

Also, I can see that you have ischaemic heart disease. This is where the arteries narrow and struggle to supply oxygen to the heart. Usually, a GTN spray helps relieve this type pain if it as a result of ischaemia.

Maybe you can discuss some of the above with your cardiologist and see what they have to say. I’m not sure why you’ve not been given a nitrate like the GTN as you mention you have pain on exercise.

There are others on here with the same conditions as yours so hopefully they’ll be by to share their opinions.

In the meantime, take it easy on the exercise until the pain is better managed by your cardiologist.

Good luck! Tos

[Milkfairy Heart Star in reply to Tos92]

Hello Tos92

Have you had an angiogram with acetylcholine?

"Vasospastic angina is usually determined through an angiogram where a stress agent, acetylcholine is administered."

This information isn't quite correct.

Acetylcholine is a chemical that can be injected into the coronary arteries during an angiogram to induce or stimulate coronary vasospasms.

It is not ' stress agent ' like adenosine which is used to assess how the blood flows through the small blood vessels of the heart.

Normal coronary arteries should dilate in response to acetylcholine. If the coronary arteries constrict, ECG changes are seen, accompanied by the person's usual chest pain then coronary vasospasms can be diagnosed.

This type of functional testing of the coronary blood vessels is not widely available at the moment in the UK.

The BHF has this information about vasospastic angina.

bhf.org.uk/informationsuppo...

Ischaemic heart disease also includes microvascular and vasospastic angina.

The umbrella term for microvascular and vasospastic angina is Ischaemia/Angina non obstructive coronary arteries, INOCA/ ANOCA.

[Tos92 in reply to Milkfairy]

Hi Milkfairy

I am currently being considered for this test by my cardiologist here in the U.K.

Thanks for clarifying that it isn’t a stress agent and rather, a chemical.

[Milkfairy Heart Star in reply to Tos92]

Good luck!

I had an angiogram with acetylcholine nearly 10 years ago.

I had spontaneous and acetylcholine induced coronary vasospasms, a very excited Cardiologist, because I had such dramatic ECG changes and lots of chest pain.

Thank goodness for IV morphine 😊

[Bradshaw278]

Thank you, all of you, for your comments. I have taken note about the acetylcholine testing and shall ask about it. I seem to become stable if I restrict my activity but I don't want to do that and do not understand how my condition regarding exercise suddenly changes.