Microvessel angina or vasospastic disease

[honeybabe54]

I had migraines for most of my adult life. They became a daily problem for me. In November of 2012 I started having heart pain which caused a heart attack and was misdiagnosed as having a classisc heart attack and was put on Beta blockers which exaserbated the problem. At the same time I was diagnosed with Renaud's and esophagial spasms. In 2015 I had another heart attack that was diagnosed as vasopspastic disease I was then put on new medication of Renolizine, amlodipine and Atorvastatin. As soon as I got these drugs working in my system the migraines, Renauds, Esophageal spasms and the angina stopped. However this year in October I had another heart attack and was hopitalized again two days ago with high cardiac enzymes. There doesn't seem to be any kind of rescue drug or therapy that helps when I have these attacks. I have been given pain medication that helps the pain, but also causes nausea. I would like to know if anyone in this community has any other ideas of how to handle this disease.

[Tos92]

I’m incredibly sorry to hear that these conditions have been the cause of 3 of your heart attacks. I had a MINOCA (myocardial infarction in non-obstructed arteries) in Jan 2022 after a severe spasm caused the heart attack.

I am currently being treated for similar conditions to yours which is vasospastic angina (VSA), MVA (microvascular angina) and oesophageal spasms.

Beta-blockers may make coronary artery spasms worse due to the mechanism of their action as they may interfere with the dilation of coronary arteries. I was trialled temporarily on a beta-blocker, namely Bisoprolol in 2022 however, could not tolerate the side effects.

In terms of pain medication causing nausea, I find I react this way to morphine. I have vomited a couple of times when having morphine administered via IV which is not pleasant. I was however, offered anti-sickness medication during my visits at the hospital to combat this. I wonder if you could ask for this?

I have only recently been diagnosed with MVA so it is helpful to read what treatments people have found do, and don’t work for them although it can be very varied depending on individual symptoms.

If it may be of some help to you and others in a similar position, I will be commenced on Nicorandil, GTN patches, isosorbide mononitrate, and maybe a statin. I am currently on Tildiem and a GTN spray. The other medications would be an addition.

I will be working with my cardiologist to perhaps reduce the nitrate side of things, as he has cautioned the possibility of becoming tolerant to both short-acting and long-acting nitrates. In addition to this, I have a congenital heart defect in the form of a bridge and therefore, I always like to be mindful of this when introducing the possibility of another nitrate.

There are other members who in fact have lived with MVA and VSA for many years who have had the opportunity to trial medications over the years to find a cocktail of meds that work for them. I hope they will offer their insights on this.

In the meantime, you may find the below link helpful which is supported by over 30 medical experts with experience in treating INOCA/ANOCA (ischaemia/angina in non-obstructed coronary arteries). I was actually able to locate my current cardiologist this way who is a leading expert in this field.

You may benefit from seeing an INOCA specialist as well if you are not already. It really does make the world of difference when you have a cardiologist that acknowledges your pain and treats your symptoms accordingly. I immediately felt a sense of instant relief after my recent meeting.

inocainternational.com

You do not mention if you were hospitalised during your recent hospital visit where your cardiac enzymes were found elevated. If you have been admitted, you could ask your cardiology team for a review of your treatment during your stay.

I wish you all the best in your recovery from your recent visit to hospital and I really hope you are able to get better control of your symptoms. I know the oesophageal spasms can be more excruciating than the coronary spasms themselves!

All the best and I hope others will be by to share their experiences.

Tos

[Milkfairy Heart Star]

Hello

I have lived with vasospastic angina for over 11 years.

I also have Raynauds Phenomenon and developed migraines when my vasospastic angina started.

I am on various medications to try and manage my coronary vasospasms.

I have been prescribed calcium channel blockers, nicorandil, Isosorbide mononitrate, GTN patches, clopidogrel and a statin.

I also use oxygen to help manage the pain of my angina and headaches.

I also use a Transcutaneous electrical nerve stimulation TENS machine, and find breathing and relaxation techniques helpful.

I make sure I keep warm and layer up.

This last week of cold weather has been challenging.

I, unfortunately despite the input of leading world experts in treating, ischaemia/ angina non obstructive coronary arteries INOCA/ANOCA (including the Cardiologist Tos is seeing now before he retired from the NHS), still experience frequent episodes of debilitating symptoms which means I need to be admitted to hospital, once or twice a year.

I have a supportive Cardiologist at my local hospital which is a heart attack centre. I have a careplan which was co designed by my Cardiologist, Pain Team, Clinical Psychologist and myself.

As patients we need compassionate and empathetic care from the staff who are involved in our care.

My present Cardiologist isn't an 'expert' however he listens to me and supports me.

When in hospital I am treated with IV GTN, I require very high doses of IV GTN for several days, which is then reduced very slowly otherwise I will experience worse rebound coronary vasospasms.

I have a patient controlled analgesia system of morphine and regular doses of IV or oral anti sickness medication.

My migraines symptoms also improve with IV GTN.

I am also treated with botox which helps.

Triptans, beta blockers and other migraine treatments can make coronary vasospasms worse.

Vasospastic angina is not well understood by many Cardiologists.

Have you been offered any further testing to confirm your diagnosis?

Other good resources of information can be found on the BHF website and this website.

bhf.org.uk/informationsuppo...

internationalheartspasmsall...

[honeybabe54 in reply to Milkfairy]

Thanks for sharing your story and medical history.