I am new to this world but would be grateful for some insight to help my mum. A week ago mum was admitted to hospital for what they are saying is Minoca. ECG and troponin levels showed this, and subsequent angiogram 4 days later showed no obstructions etc. Dr cardiologist discharged mum saying you appear to have a healthy heart, this is most likely Minoca and take aspirin. That was it. I immediately started researching Minoca and now have concerns about mum just being left to “continue life as normal” as per this dr.
She sees a different cardiologist as a follow up tomorrow - can I count on them further investigating the actual cause of thr heart attack or will is it commonplace to dismiss women given this label?
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Mish80
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I’m sorry your mum has had a suspected MINOCA (myocardial infarction in non-obstructed arteries).
I had one last year which was triggered by a coronary artery spasm of my myocardial bridging, where the artery tunnels inside my heart muscle instead of sitting on the surface. A part from coronary artery spasms, microvascular dysfunction or small blood vessel disease, a blood clot or even minor plaque build up are other potential causes of a MINOCA. Did they say what caused hers?
In terms of care after the MINOCA, I’m based in the U.K. however, my heart attack happened abroad. In terms of tests or treatments that have been done since coming back to the U.K., I have either had to advocate or really push the doctors to do them. I went private after realising that my condition was not being prioritised and the waiting times were very long. I was told in a recent cardiology appointment that coronary artery spasms, also known as vasospastic angina is not routinely followed up in patients which gave me the indication that I would be left to it in other words. I have been asked to be referred to a specialist since and I am still waiting to hear back.
There are specialists in MINOCA’s and it would be wise to see if you can make an appointment with one for your mum as I have learned that seeing a cardiologist with limited knowledge on our condition does not always allow us to get on the right treatment plan.
I also find that I have triggers for my spasms and angina such as stress, high or intense emotions, the cold, and some types of physical exertion. It might be a good idea to ask your mum to log her symptoms and any triggers she can think of.
There is a Facebook group that I am on which has recommendations for cardiologists who are specialists in MINOCA in Australia.
Thank you so very much for taking the time to reply. This is all very fresh - literally only a week ago and mum discharged from hospital with the word Minoca used with an “off you go” from the dr. No investigations on what the cause of the Minoca is have been mentioned at all.
So besides an angiogram there have been no other tests. I’m assuming I’ll need to advocate for these…. Did you have a cardiac MRI? How did you work out the underlying cause was the spasms? Mum definitely has major work stress that most likely was a trigger. She also got diagnosed with a leaky heart valve in 2018 which has had very little follow up.
I’ve had a similar approach by doctors here in the U.K. as well. Finding a specialist can really help in getting the appropriate care for her.
I paid privately to have an MRI with perfusion done. This can show something called ischaemia, which is a narrowing of the arteries, restricting blood flow to the heart.
My myocardial bridge was seen spasming on my angiogram. The proper testing for coronary vasospasms is by having an angiogram with acetylcholine. It is not often performed however. There are other tests available which may support the diagnosis of vasospastic angina as well which a specialist would be able to tell you.
I'm sorry to hear about your Mum, I hope you keep pushing for answers. I too had a MINOCA two years a go, plus blood clots showed in my blood. I was left to get on with it. I've tried pushing for a real diagnosis, as I'm sure it would help manage the condition. I'm with the Facebook page for MINOCA and I have learned more on there, and this forum than I did from the cardiologist.I certainly felt like I was bottom of the pile, when it came to heart attacks, even the Cardiac Rehabilitation Team forgot about me, and lied about it - sigh.
I still get chest pains, and I only take an Anadin Extra which has aspirin in.
I don't think it's right or fair to leave patients in the dark with not enough information on MINOCA heart attacks. Good luck to your Mum, and please let us know how you get on xx
I have to admit I just googled that and it was quite interesting, although I don't fall into the expected group for it I do wonder if my MI was something similar. I always remember after the angiogram the consultant saying think of your arteries as A roads, B roads etc, you had a blockage in the dirt track road leading to the farm!
The one thing I would try to clear up is just aspirin, I got that plus beta blockers, statin etc.
Ahh im sorry to hear what your mum has been though 💔😰. Can only imagine what you must be going through. Wish your mum all the best with her appointment and hopefully cardiologist will be able to answer all her questions on what follow up care is required. Keep us posted xx 😘
I am sorry to hear your mum has had a heart attack without blocked coronary arteries a MINOCA.
When I was admitted to hospital over 10 years ago I was incorrectly told I couldn't have angina or a heart attack because my coronary arteries are unblocked.
I had an angiogram with acetylcholine which induced my coronary vasospasms and my vasospastic angina was confirmed about 10 years ago.
It's important to determine why your mum has experienced a MINOCA. As the treatment options are different for each possible cause.
Common causes are microvascular angina, coronary vasospasms, spontaneous coronary artery dissection SCAD, a blood clot or small peice of broken off plaque blocking an artery.
Another cause is when there is a mismatch of the supply of blood the heart needs.
This can happen when there are arrthymias like a very high heart rate or atrial fibrillation.
Another possible condition that can mimic a heart attack is Takostubo syndrome.
The term MINOCA was first developed by a team in Australia, by Prof John Beltrame at Adelaide University.
I suggest you ask the Cardiologist tomorrow to offer the appropriate testing to say why your mum had a heart attack and contact Prof Beltrame for further advice.
There is another patient group website that was created by 4 patients with over a 50 year combined experience of living with microvascular or vasospastic angina and MINOCA. This group is actively working with researchers into microvascular and vasospastic angina and MINOCA.
The website lists several Australian based Cardiologists who are knowledgeable about MINOCAs
Ischaemia non obstructive coronary arteries INOCA is an umbrella term for microvascular and vasospastic angina.
Ischaemia is when there is a lack of oxygen supplied to the cells of the body due to a lack of blood supply.
Myocardial ischaemia in microvascular angina is thought to be due to the inability of the small blood vessels being unable to dilate or stay dilated in response to extra demands like exercise.
In vasospastic angina the Ischaemia is due to the transient constrictions of the coronary arteries.
I am in the UK. Since my diagnosis of vasospastic angina I have good care.
I see my Cardiologist at least twice a year.
This is something I had to at first advocate for.
The BHF has this information about microvascular and vasospastic angina.
It includes a link to a long established Facebook group that formed the International Heart Spasms Alliance.
Functional angiograms to test for microvascular and vasospastic angina are now more commonly being offered. There are at least 25 units in the UK offering these types of angiograms.
The Coronary Vasomotor Disorder International Study Group COVADIS gives the recommended way of confirmating a diagnosis of vasospastic angina.
Update: the cardiologist that mum saw today didn’t mention the word Minoca until mum did, said that her angio was clear so come back in 5 weeks to do a stress test. This is bs isn’t it ? Not taking a Minoca heart attack seriously or bothering to determine the underlying cause to then effectively treat it?
I am sorry to hear that the Cardiologist who you saw hasn't considered the importance of further investigating your mum's MINOCA.
Has you mum been offered a cardiac MRI?
A cardiac perfusion MRI looks at the heart muscle itself to see if the heart has been permanently damaged or if inflammation is present due to myocarditis.
In some cases it can help diagnose microvascular dysfunction however not coronary vasospasms.
A stress test can help see how the heart responds to exercise.
Here in the UK we can raise concerns about the care we receive. Do you have such a process?
If so perhaps ask to speak to the Head of Cardiology to discuss your concerns
Here's a link to another article about MINOCAs written by UK world experts.
You say in the replies your mum has a very stressful job and that could have triggered her MINOCA. Is her BP high? I had a Minoca 3 weeks ago that I know was triggered by stress as was in a meeting at the time and forgot to take my nitro spray with me. Was your mum prescribed a GTN spray?
At the moment her workplace is very stressful yes - she is stubborn and at the cusp of retirement but just can’t seem to leave yet despite a heart attack. I’ve no doubt a work incident last week was a trigger but my gut says there is an underlying physiological problem also. Her blood pressure was in the normal range. Sorry - I’m not sure what a GTN spray is. All that was prescribed was daily aspirin..
GTN us taken at the onset of chest pain along with aspirin. I am really surprised they did not give her that. This is my 6th heart attack but have a normal heart apparently. Only this recent one was was called a Minoca. I have had a diagnosis of Microvascular Angina and previous attacks were down as caused by Vasospasms.
A GTN spray stands for Glycerol Trinitrate it’s a spray for when chest pain occurs you spray 1-2 puffs under the tongue close your mouth breathe normally wait for 5 minutes to see if pain has gone if the first lot of puffs don’t stop the pain you repeat the 1-2 puffs again if that doesn’t work you can repeat for third time if still in pain then you should go straight to A&E as could be a suspected heart attack
I realise that your mother was given a diagnosis of MINOCA and i hope that the information already give above is helpful, but you might also want to check info on Takotsubo Syndrome (aka Takotsubo Cardiomyopathy, Stress Cardiomyopathy)
Thank you - yes I’ve read about all the potential cause of the heart attack and associated conditions - I just don’t know why thr cardiologist isn’t doing all the tests to find out what is going on.
most cardiologists know very little about non-obstructive ischaemia as it has only recently been recognised thanks to improved diagnostic technology - you and your mother need to get informed an get assertive with your doctors who probably have very little experience with this type of heart disorder
wome's heart health has been neglected for years, but it is becoing more widely accepted that we can have different patterns of heart problem - unfortunately expertise in the field is thinly spread - we need to get pushy about this as it affects far more lives than breast cancer
Women and heart disease is an issue that for far too long has been neglected. I have now been a heart patient for 11 years with 17 admissions for an acute cardiac event so far....
My Cardiologist tells me that MINOCAs and Takostubo syndrome are now being discussed.
My vasospastic angina is now treated much better. I have a careplan which I co wrote with my Cardiologist.
The change seems glacial though.
I feel I'll be pushing up the daisies before there is equity in access to cardiology care for women.
I have a very supportive Cardiologist who listens. I work with him in an equal respectful partnership. He really does try to put his patients' needs at the centre of care.
He is a researcher and Prof at a leading UK university. This helps as he has a curiosity about my rare heart condition.
Go on to Facebook and request to join "prinzmetal/Coronary artery spasm support group". You will find lot of information there. And specific information related to Australia. Good luck
I’m sorry to hear your mum has been through this. I had a MINOCA in May. My ecg was fine on arrival to hospital but my troponin level was about 590! I was kept in hospital to be monitored in the coronary care unit for two days. Whilst there I had an angiogram, an echo and referred for an out patient mri. I left hospital with 8 different tablets to take daily along with a spray and I was referred for heart rehab which I have been doing. They still don’t know what’s caused mine (they think maybe a temporary blood clot). I hope your mum gets some answers - I am still worried as I don’t really have a definitive answer on what caused mine.
hi.. sorry to hear about your mum.. i also had an angiogram (2 actually.. Non invasive CT angio and an invasive angio). mild atherosclerosis found in LAD.accroding to one Cardiologist not bad enough to cause angina.. according to another might be angina lol.. anyway when it first started having chest pain on exertion 5 years ago was told there was a chance it was Microvascular angina.. but after the angiograms in 2020 .. phone consultation with Cardiologist asked if they had tested for MVA.. obviously he was looking at the results.. and he muttered ‘mmmmm no they didn’t’ and that i’m afraid was the end of the conversation lolol.but told to continue with aspirin and use gtn for chest pain... still get chest pain now and again from walking up hills.. moving about the house.. but have accepted that unless it’s unbearable then i won’t be dialling 999
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