Advice Pls…

[Miocardial_1]

I had a sudden heart attack in December 2022 aged 43. Everything came as a surprise as I’m not over weight and I am generally healthy. I was fitted with 2 stents. I completed my 8 weeks of rehab and was discharged from the hospital appointments at 3 months.

After my heart attack I kept getting a pushing sensation in my heart area and a numbness down my left arm. I got this when I was having my heart attack but it was a lot more painful at that time.

I was originally on isosobide mononitrate but the cardiac nurse stopped it and said they felt it was not related to the heart attack. Previous to my heart attack I never had these symptoms.

7 months on I am again getting these symptoms. When I use the GTN the pain goes away. I spoke to my GP who asked me to speak to the cardiology department. The cardiology department say that I should speak to my GP. I feel nobody is helping.

Anyway this week the pain got really bad and my left arm was very numb also. I went to A&E. My ECG was normal. They said my bloods were all normal too. The hospital Dr said he’s not sure why I’am getting this pain. The cardiologist came to see me and I explained that the pain is intermittent and using the GTN makes it go away. It happens sometimes when I am driving, sometimes when I’m at work and even sometimes when I am sleeping.

The hospital cardiologist prescribed ranolazine 375mg to take twice a day. 3 days on it’s not made any difference yet. I appreciate I may need to give it some time.

Do any of you experience chest pains and numbness in the left arm? What have you been advised? What medication helps? I just feel that nobody wants to help and it’s getting me down a little now. It has to be heart attack related as it’s the same as what happened when I was having my heart attack and I didn’t have it before the heart attack!

I appreciate any advice.

[Milkfairy Heart Star]

Hello,

I live with vasospastic angina, my coronary arteries go into transient constrictions, vasospasms.

When I have a severe coronary vasospasm I experience chest pain accompanied by numbness and tingling in my left arm and fingers along with aversion to light and noise.

I get most of my symptoms at rest especially during the night. Emotional, mental and physical stress can trigger my angina too.

Some people have blocked coronary arteries and angina without blocked coronary arteries, vasospastic or microvascular angina.

Vasospastic angina is rare and often over looked, it's difficult to diagnose.

As vasospasms are transient ECG changes are difficult to catch.

I do have ECG changes usually though.

Perhaps ask your Cardiology team to consider whether vasospastic or microvascular angina could be a cause of your on going chest pain.

The BHF has this information about these types of angina.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

acc.org/Latest-in-Cardiolog...

[Miocardial_1 in reply to Milkfairy]

Thank you

[Miocardial_1]

Thank you

[richard_jw]

The cardiologist is probably assuming that what you have is microvascular angina. It happened to me. I was getting symptoms of angina, and the cardiologist did an angiogram some 18 months after the original heart attack. I was awake, and he showed me that all the main cardiac arteries were clear of any obstruction. So he said "well there you go, it must be microvascular angina. "

He prescribed Ranolazine. This seems to be the drug of choice for microvascular angina. It works in a different way to "normal" nitrate based anti anginals. As I remember it, the dose was increased after some weeks to 500mg twice a day. Apparently that is the normal procedure.

In my case, GTN did not help with the pain. so that might be something to ask your cardiologist. (i.e. is GTN effective with microvascular angina?)

It might be worth asking for an actual diagnosis of the problem to rule in or out microvascular angina (or another variant) rather than making the assumption that it is. Maybe you should give the Ranolazine a chance first, but titrated to 500mg.

The other thing worth saying is that the gold standard for diagnosing "normal" angina where the large blood vessels are partially occluded is an angiogram. The cardiologist can see the arteries on a big screen. You have effectively had one in Dec last year when they put the stents in. The cardiologist may be reasonably assuming that things have not changed much since then. Has anyone revisited the recording which was done then?

It also seems odd that GTN helped, but isosobide mononitrate did not given that they work in a similar way (i.e. they are both nitrates). There are variations on the isosorbides for instance some are longer lasting than others.

I would give the new meds a chance to work, then if you are still symptomatic, go back to the cardiologist.

[Miocardial_1 in reply to richard_jw]

Thank you

[Milkfairy Heart Star in reply to richard_jw]

Interestingly there is growing evidence that seems to show that nitrates are not always an effective treatment for microvascular angina. While nitrates remain a mainstay of treatment with calcium channel blockers for vasospastic angina.

Vasospastic angina is due to the transient contrictions of the coronary arteries and in some cases the microvessels.

While microvascular angina is thought to be due to the inability of the small blood vessels to dilate or stay dilated in response to exercise, microvascular dysfunction.

While the umbrella term for these conditions is ischaemia/ angina non obstructive coronary arteries INOCA/ANOCA they are distinct with different treatment options.

Vasospastic angina isn't a 'variant' of microvascular angina. Though in the past vasospastic angina was referred to as variant angina as typically patients experience their chest pain at rest.

I don't use GTN spray as it doesn't help me. It stops my coronary vasospasms briefly then causes worse rebound vasospasms.

Ranolazine as you say seems to help patients with microvascular rather than vasospastic angina.

The gold standard way to diagnose microvascular or vasospastic angina is by functional angiogram rather than a 'oh your coronary arteries are clear it must be microvascular angina '

I was presumed to have microvascular angina as it's more common than vasospastic angina. I was given the incorrect treatment and landed up in hospital with severe coronary spasms.

[Miocardial_1 in reply to Milkfairy]

Thank you again for more info 😊

[cocobearbhf]

Give the ranalozine longer to work. I was given it a few weeks ago (375mg twice a day) to combat ongoing chest pain (after NSTEMI and 3 stents) and it has taken a few weeks to gradually improve the chest pains. But after a few weeks I can tell the difference.

The dr has just upped my dose to 500 to try to get further benefit , but you do need to give it 2 to 4 weeks to measure it.

[Miocardial_1 in reply to cocobearbhf]

Thank you

[Kwakkers]

Hallo, Frank here. Numbness in the left arm? Yep. got that a while back. My daughter and son, both doctors were sitting round the birthday table when I leant over to my left. "Hey dad....." said Tom.

Turns out that I`d been eating the wrong foods (WELL, it WAS a bloody birthday!) and the sudden rush of cholesterol had triggered it. Avoid burgers (ouch) and certain seafoods. Check online for a list.

Watch your alcohol intake and exercise. I drink tonic water (yea, Boring) and swim at the local pool. Feel bloody marvellous.

Listen to your body, act accordingly.

Ta-ra chuck.

Frank.

[Miocardial_1 in reply to Kwakkers]

thank you Frank. I will check this out!

[Miocardial_1]

Hi,

Just to update. 9 days on after taking the Ranolazine I feel good. No chest pain. Some days I am more tired than others but on the whole I’m feeling good 😊.

Now I need to get this medication on repeat from my GP. Let’s hope it’s straight forward.

I hope you’re all doing well!!