Letter from Cardiologist- Advice please

[IamAli_R]

Hello, everyone.

I hope you are all well.

I'm sorry about posting so regularly.

I received the letter below this morning. The letter is from my cardiologist after a recent telephone appointment.

This contains a little more detail about my recent Myocardial Perfusion Scan, 24-hour monitor, and ECGS.

My sensible brain is telling me that the letter below is reassuring, but my anxious mind is pushing all sorts of negative narratives.

I would appreciate your experienced and measured thoughts on the letter below.

"Diagnosis: History of SVT (previously on Verapamil 120mg SR)

Atypical chest pain since 2016

Normal stress echocardiogram (2018)

Normal ETT (2016, 2018) with chest pain prior to exercise which is worse in recovery time.

CTCA 2018 only calcium score was performed which was 6 located on proximal LAD.

Baseline ECG: sinus rhythm with early repolarization across all leads.

Atypical chest pain/ normal troponin twice (Hospital 22- 23 January 2023)

ECG (08/03/2023): Asymptomatic SVT with HR of 172 bmp.

Myoview scan (22 March 2023)

Likely small mid anterior wall ischaemia (<5%)

LVEF 64% with a stroke volume of 78ml.

No ischaemic transient dilatation (TID score 1.0).

24 hours tape 09/03/2023: Episode of symptomatic SVT with HR 163bpm (AVRNT?!)

Ulcerative colitis

Mechanical costochondritis ( Rheumatoly Team 2019 )

Medication :

Atorvastatin 80mg od, Pentasa and Lansoprazole

I today reviewed Mr Ali after we had quite a few discussions during his previous admission and face-to-face appointment when we performed an ECG (31/01/2023).

Mr Ali continues to have atypical chest pain and he is very concerned regarding his cardiac issue. As you can see from our records, he was seen on numerous occasions by not only different cardiology consultants but also most recently by our Inreach Team and Nurses who reported investigations.

However, recently he was arranged to have another exercise test on 8 March 2023 when his ECG recorded SVT with a heart rate of 175.

24-hours tape (09/03/2023 showed minimum and maximum heart rate of 57 and 177bpm, with mean heart rate 79bpm. during the day mean HR was 85bpm and during the night HR was 67bpm. There is episode of symptomatic SVT for which I think is episode of AVRNT.

Today we had a discussion with the aim to reassure him to not have any cardiac issue

regarding significant narrowing of the heart arteries (CAD), causing these palpitations and fast heart rate, which he has now been complaining of for more than five years. We agree to arrange conventional angiogram in order to rule out significant CAD.

Just to remind you, Ms SB saw him previously and he was reassured based

on the event recorder. Therefore, I would like to refer him again for Electrophysiology expert opinion in clinic either L or Harefield Hospital

I request today an outpatient conventional angiogram and I will see him in six months' time with the results of that. I will ask our team if any slot is available as a part of DNA on a conventional angiogram list to call Mr Ali who is very keen to attend as he lives near the hospital."

Thank you

Ali

[Milkfairy Heart Star]

Perhaps ask why a conventional angiogram and not an angiogram to assess how the blood vessels function. Do the small blood vessels dilate and stay dilated in response to extra demands or do the larger blood vessels constrict in vasospasms?

This type of testing can be carried out during a functional or physiological study angiogram

Then both obstructive and non obstructive coronary artery disease can be checked for.

I speak from the experience of being told I couldn't have a heart attack or angina because my coronary arteries are unblocked.

I was falsely reassured that it wasn't my heart.

My diagnosis of vasospastic angina was confirmed following an angiogram with acetylcholine which induced my coronary vasospasms.

Sometimes when you have a rarer heart condition you may need to be persistant.

[IamAli_R in reply to Milkfairy]

Hello Milkfairy,

Thank you for taking the time to reply.

Would the hospital consider tests not recommended by the cardiologist?

The type of angiogram you are recommending sounds intesting. Imigh5 try and contact the cardiac nurse to ask them about your suggestion.

[Milkfairy Heart Star in reply to IamAli_R]

You can always ask for a second opinion from another Cardiologist.

Unfortunately a functional angiogram is not widely available.

Many Cardiologists and cardiac nurses are unfamiliar with this type of testing too.

[IamAli_R in reply to Milkfairy]

Oh if they are unfamiliar then it will be tricky.

Maybe I can ask about a functional angiogram when I get an appoint at Harefield regarding my SVT.

In the meantime I can have the normal angiogram and see if that shows anything up.

[Milkfairy Heart Star in reply to IamAli_R]

Harefield and Royal Brompton hospitals are now part of Guy's and St Thomas's Hospital Trust.

Functional angiograms are carried out at the Royal Brompton and St Thomas's Hospitals.

[IamAli_R in reply to Milkfairy]

I will ask when I get an appointment at Harefield.

Thank you for helpful advice. I really appreciate it.

[IamAli_R]

Hello Anne,

Thank you for taking the time to reply.

Trying to get the SVT diagnosed has been a mixed bag. Some doctors have said its SVT and others have disagreed and said its just sinus tachycardia. This has led to much confusion and I have never had a clear plan to deal with the fast HR's. I am hoping that this time there is clear evidence of SVT and I will be given a firm diagnoses and a plan to deal with the issues.

My anxiety is being triggered by the evidence of the small blockage and I mind is playing all sorts of terrible worst case outcomes.

You are right about trusting the doctors and letting them lead. I am trying to my best to control my anxiety because I agree with you that it does a lot of damage.