Struggling with Angina

[Arizona18]

Hi, Have had two nstemis within two years followed by two angiograms with clean arteries. Default diagnosis small artery disease. Ongoing, relentless chest pain regardless of trying various combination of meds. Also, have had numerous non-invasive procedures, but no solid answers there...New interventional cardiologist recommended a catherization procedure known as reactivity testing. Wondering if anyone has had this test and, if so, could share experiences. Thanks so much.

[Milkfairy Heart Star]

Hello,

Welcome to the forum.

I have lived with vasospastic angina for over 10 years.

My coronary arteries go into transient constrictions, coronary vasospasms and leads to lack of blood supply to my heart muscle.

Functional angiograms are recommended as a way of diagnosing microvascular dysfunction or coronary vasospasms.

I had a functional angiogram in 2014.

My small blood vessels work properly so I don't have microvascular dysfunction.

Acetylcholine a chemical, was injected into my coronary arteries, I had spontaneous and acetylcholine induced coronary vasospasms accompanied by chest pain and ECG changes.

I found knowing why I have my symptoms helped me psychologically to live with my ongoing angina.

It also means I am given medication tailored to treat my vasospasms.

I also have a admission plan to guide the staff how to care for me when I go into hospital.

Heart attacks which occur without blocked coronary arteries are increasingly referred to as Myocardial Infarction non obstructive coronary arteries MINOCA.

Possible causes are microvascular dysfunction, coronary vasospasms, spontaneous coronary artery dissection SCAD, a blood clot or small piece of plaque blocking a coronary artery.

The BHF website has this information about microvascular and vasospastic angina.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

Here's some more information about MINOCAs

internationalheartspasmsall...

There are several other forum members who live with microvascular or vasospastic angina, a few have also had functional angiograms and hopefully they will be along to share their experiences with you too.

[Arizona18 in reply to Milkfairy]

Dear Milkfairy,

I thank you tremendously for this information and noteworthy firsthand experiences. Yes, Dr. did use and and explain acronym MINOCA to me. I will read every link you cited . I do have a question though? Was recovery much different than after "usual" angiogram requiring no stents, etc. Thank you and enjoy your day. You have been a Godsend. Kindly, Sylvia

[Milkfairy Heart Star in reply to Arizona18]

They used my femoral artery in my groin when I had my angiogram with acetylcholine done. This meant I was on bed rest for hours afterwards.

The worst bit was having to wait to go for a pee. I don't believe it's humanly possible to lie flat on a bedpan and pass urine 😳

It's now more usual to use the radial artery in the wrist so no bed rest required!

My advice is don't forget to go for a pee before going to the cath lab just in case the Cardiologist has to use your femoral artery.

I stayed in hospital overnight for observation. My vasospastic angina is very unruly. I had spontaneous and acetylcholine induced coronary vasospasms. I was given IV morphine. I also had more chest pain afterwards.

I suggest you rest well and have someone with you in the first few days afterwards.

Good luck!

I hope your procedure goes well and you get a confirmed diagnosis.

[Just-Wanna-Run]

Hello, I too have had an angiogram and I've been diagnosed with microvascular dysfunction. I found the angiogram was a fascinating procedure. I loved seeing my heart beating on the screen. If you're very anxious, I think you can ask for a mild sedative to relax you but I didn't need it. I had the cannula through my wrist. I have very narrow arteries so there was a little bit of pulling on my arm to get it past my shoulder but it didn't hurt at all. They injected something, but I'm not sure if it was just the dye or it was acetylcholine, but there was a bit of a cool rush. They spoke through the process and explained everything they were doing. My main arteries were clear so they measured the pressure in the heart and found the returning pressure from the microvessels was low, hence my microvascular dysfunction diagnosis. I was in the recovery room for a couple of hours with a pressure bandage on the wrist, a cuppa and a sandwich. I didn't have to stay in overnight but they said that I should have someone at home with me for the first night.Following my diagnosis, all my meds changed and the angina is better controlled now.

[LSCE]

Hello, I too have had 2 NSTEMI within 5 months, clear coronary arteries. My microvascular studies and other investigations also okay. Unfortunately my cardiologist didn't perform the reaction test to check for vasospasms and won't. I'm on treatment that was changed 8 months after my 2nd HA when I know I had a 3rd HA but never went to hospital. I am now on meds that manage my angina and no HA or very severe angina for 18months. I hope you get a diagnosis and the correct med's to manage your condition. Milkfairy is the expert on this topic. In my experience if you don't have blocked arteries and cardiologist can't find an explanation they may dismiss your symptoms as caused my something else. I've sort of given up on finding a diagnosis based on cardiologist attitude. Good luck and let is know how you get on.