Advice on chest pains pls.

[Miocardial_1]

I had a heart attack in December 2022. I was 43yrs old. Ever since the HA, I have had intermittent chest pains. Sometimes worse than others. Sometimes it comes on when I am asleep, sometimes when I am at work and sometimes when I am driving etc. sometimes it is mild and sometimes it’s a pushing sensation.

On Thursday night (12/10) I had to go into A&E as the pain was unbearable. I was seen quite quick for triage, bloods and ECG. All of the tests came back clear. Troponin levels were normal.

In December after the HA I was taking Isosorbide Mononitrate 60mg but they were stopped in March after a heart Stress Test. In July I was prescribed Ranolazine 375mg by a cardiologist. It was helping and was increased to 500mg twice a day. It was stopped by another cardiologist because he says that it masks the symptoms of a heart attack and any problems you might have with your heart.

Apart from the ECG and bloods at the hospital nobody has done any other tests since March 23. The GP cannot explain the pain and says he needs cardiology input. When the GP has requested info/an appointment from the cardiologists they are saying that the Stress Test was clear and an appointment is not needed. They are saying the Stress Test was good so the pain is not possible.

I am now without tablets for the pain and been advised by cardiology to use the GTN up to 4 times a day should I need it. I’am 44yrs old now and just want to get back to my normal life and routine without this pain. It’s like the GP cannot help and cardiology are too busy to really do anything. What am I supposed to do? They say they cannot find a reason for the pain but it’s destroying me slowly.

Does anyone else have a similar experience and what would their advice be?

Thanks in advance

[Milkfairy Heart Star]

Hello,

Has your Cardiology team considered that coronary vasospasms maybe causing your symptoms?

I have for 11 years lived with vasospastic angina which is a rare and often overlooked cause of angina.

My coronary arteries are unblocked.

It is possible to have ischaemia/ angina without unobstructed coronary arteries known as INOCA/ ANOCA.

My stress test was normal, I can exercise however, I experience chest pain at rest later in a delayed response to exercise.

I experience most of my chestpain at rest especially between midnight and 6am in the morning which is a classic symptom of vasospastic angina.

Vasospastic angina is caused by the transient constrictions of the coronary arteries leading to a lack of blood supply to the heart, angina.

The BHF has this information about vasospastic angina.

bhf.org.uk/informationsuppo...

It is possible to have obstructive coronary disease and vasospastic angina at the sametime.

[Miocardial_1 in reply to Milkfairy]

Thank you for your prompt reply. The cardiology team have not considered anything yet as trying to get an appointment has been a nightmare. Thank you for the link. I will look at this and see what I can do next

[Milkfairy Heart Star in reply to Miocardial_1]

Your words "They say they cannot find a reason for the pain but it’s destroying me slowly."

resonate with me so much. It took me sometime to get my diagnosis and find a Cardiologist to support me.

I was admitted to hospital 11 years ago with a suspected heart attack. However because my coronary arteries are unobstructed, I was incorrectly told I couldn't have angina or a heart attack.

I was fortunate to find a Cardiologist who knew how to carry out the specialised angiogram to test how my coronary blood vessels function.

Your pain is real, unfortunately at present it seems that your Cardiology team do not have the knowledge or expertise to investigate why you are having on going chest pain.

[Miocardial_1 in reply to Milkfairy]

Thank you!!

[LSCE]

Hello, heed Milkfairys advice she is an expert on INOCA/ ANOCA. I have the same problems as yourself, cardiologist telling me my pain is not cardiac. I am on isosorbide mononitrate max dose, helped for a while, then also added in a calcium channel blocker, much improved since then. My symptoms are now manageable with GTN. Good luck.

[Miocardial_1 in reply to LSCE]

Thank you. Yes I’ve been told this pain cannot be cardiac related. But I never had it before my HA or stents! What you both say makes sense.

[Milkfairy Heart Star in reply to Miocardial_1]

You may find this article helpful. academic.oup.com/eurheartj/...

[LaceyLady]

have you been tested for Haemochromatisis, genetic liver disorder where you overload iron? I have it, Compound variant as I had 2 genes.

It can cause physical issues too.

haemochromatosis.org.uk

[Miocardial_1 in reply to LaceyLady]

Thank you

[Davey77]

Do you have any back problems? Knots in my shoulder blades often cause bad chest pains before I even feel them in my back and tension from driving or working on the computer can cause it. Got so bad last week, I almost called 111. Saying they can't spot anything so your pain is not possible is not a useful response from a professional.

[Miocardial_1 in reply to Davey77]

Thank you

[richard_jw]

It sounds like A&E did the "normal" set of tests to determine if you had a heart attack. In the early days after my MI I presented in A&E several times and they did the normal tests (Troponin, ECG, possibly a chest x-ray). and determined that I was not having a heart attack.

3 months after my STEMI they did a stress echo, and could see no issues with the large coronary arteries i.e. they were not blocked. I was still having symptoms, and they did an angiogram which is the gold standard for diagnosing blockages in the large coronary blood vessels. This showed no problems, so they made an assumption that the issue was a blockage in the small vessels which they called microvascular angina. For this they prescribed Ranolazine.

Reading your Bio, it seems that GTN helped If so it may point to angina, with me, GTN did not really help at all. You had 2 stents inserted. This would have been done via an angioplasty, and it would show clearly the state of all the large vessels as they were some 9 months ago.

The fact that they prescribed Ranolazine might mean that the think it is Microvascular angina. Ranolazine works differently to other anti anginals and is often used to treat microvascular angina. I have to say it did not help me.

There are a lot of maybes here. What you need is a diagnosis. The gold standard for diagnosing large coronary arteries is an angiogram. I had a check angiogram a year after my STEMI. The cardiologist as he was doing it basically showed me the pictures on the large screen and said I told you so, no blockages. He said then it was "probably Microvascular angina, and I should take ranolazine".

As Milk Fairy says there are different forms of angina, and it's possible to diagnose them and treat them with some success. However it's not normally done. I can only speculate as to why.

In your case given that nitrates work, I would use them or ranolazine but push hard for a proper diagnosis

[Miocardial_1 in reply to richard_jw]

Thanks Richard

[Cavalierrubie]

I am just shooting in the dark really, but do you have any gastric problems? Sometimes the pain can be very bad and mimic heart symptoms. You really need to keep pushing this until you get some answers and not suffer in silence. Ask your gp if you can have a second opinion with a different Cardiologist. Your gp can also ask for an urgent referral if you ask for this. Don’t be fobbed off. Only you know how you feel.

[Miocardial_1 in reply to Cavalierrubie]

Thank you