Hi, I am a 45 year old female and I had a anterior stemi heart attack in September, I had a stent and balloon fitted.For the last few weeks I have been getting chest pain that wakes me up early in the morning and sometimes in the evening, which I use the gtn spray, and goes very quickly. I have ended up going to A and E several times and a few admissions, with my troponin at 32, after 12 weeks post heart attack.
I am still off work and I don't feel like I am getting back to a normal life, I get chest pain after about 3 minutes fast walking.
I have been prescribed Isosorbide Mononitrate 60 mg twice a day and Verapamil 80 mg 3 times a day. I could not tolerate Ranolazine.
Anyone experience the same ?
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Purple098
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Hello,I am sorry to hear you are still experiencing chest pain following your heart attack.
A less common cause of angina, is when the coronary arteries go into transient constrictions causing a lack of blood supply to the heart, coronary vasospasms, vasospastic angina.
I live with this type of angina, Vasospastic angina oftens occurs at rest especially during the night waking you in the night and early morning.
Vasospastic angina is usually responsive to GTN spray.
I suggest you keep a log of your symptoms, see if you can spot any triggers. The common triggers are the cold, emotional, mental and physical stress.
The usual treatment is by medication in particular calcium channel blockers, Isosorbide mononitrate tablets. Verapamil is a calcium channel blocker.
Other options are GTN patches, nicorandil, statins and an antiplatelets.
Ranolazine tends to be more beneficial for people living with microvascular angina rather than vasospastic angina.
I couldn't tolerate Ranolazine either.
Beta blockers should be avoided as they can make vasospasms worse.
Perhaps ask your Cardiology team whether vasospastic angina is the cause of your symptoms?
It is possible to have both obstructive coronary artery disease and vasospastic angina at the same time.
It can take time to find the best combination of medication to help you best as an individual.
The BHF has this information about vasospastic angina.
Thank you so much for all your information, I am going to have a stress echo, do you think it would show on this test ? I will find out all the information on Vasospastic Angina.
A stress echo won't be able to show coronary vasospasms. It will however be able to show if there is a lack of blood supply to the heart by blockages or microvascular angina when heart is stressed by exercise.
Microvascular angina and vasospastic angina are types of ischaemia/ angina non obstructive coronary arteries.
Microvascular angina tends to lead to chest pain and breathlessness on exertion. It's more common in women.
Here's the BHF information about microvascular angina.
Hello, I've been diagnosed with microvascular angina recently and they prescribed me Amlodipine and Isosorbide mononitrate 50 mg slow release. They prescribed as well Ranolazine but I had severe side effects. I am so sorry to say but this ilness is a continuous fight with emotional stress, heat or high humidity when I need to use GTN spray because of breathlessness and tiredness. I do suffer as well with asthma and coronary artery disease, but they say coronary artery disease is not enough high to have a stent. I cannot exercise for more than 10 min at a time , but I can walk around 5000 steps 4 times a week. I am so sorry for your suffering but I really think that microvascular angina and vasospastic angina are not really researched because they are women illnesses. Referring Isosorbide mononitrate ,you need to get in contact with your doctor to ask maybe you need a higher dose and modified slow release . But you need a clear diagnosis first. I wish you good luck because the specialists can be very stubborn sometimes. They kept me one year with esophageal spasm diagnosis , and after 2 angiograms they recognised is microvascular angina . I had to go private for diagnosing. And I have to recognise that reading all the information about microvascular angina on British Heart Foundation and talking with their specialist nurses helped me to recognise the symptoms of microvascular angina in my symptoms. So you need to persevere with your doctors, to look for a second opinion in a private doctor and to look for any information on British Heart Foundation . They are very good.
Thank you Franchincense, I am beginning to understand, it's not going to be easy, I think I am on the maximum dose of Isosorbide Mononitrate 60 mg twice a day, but I am using the gtn daily seems to be at the same times, and waiting really for tests. I will definitely think about private testing. Have you been able to go back to work ? All the best .
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