Well after 3 years and one aortic aneurysm fixed as a bonus, a consultant at an and e last night said ‘ you had better be tested for vasospastic coronary arteries ( well he said Prinzvariant actually) . From milk fairy’s and others brilliant posts that I have read at least I was aware of it. We are still going down the gastro route as well and maybe it isn’t vasospasticism ( if that’s a word) but at least it’s another attempt to find out what’s really happening. I have posted a number of times about my GERD but I am mindful that my symptoms aren’t classic especially the pulsating pain. However mine is just as often in the day than night and isn’t as bad as I understand many find it when they write. Mine is more a weird bunch / cluster of pulses if you will . And not always in a cluster but sometimes isolated. And while often in the sternum they can radiate across the chest as well. My espisodes can be short or long eg hours. I would give it a low pain score and doesn’t radiate and no other symptoms.
I have had ( I think) nearly every other test which in order are exercise stress test, numberous echos, CT , MRI stress, angiogram, CT then open heart surgery for aneurysm. Interestingly the only lengthy period of relief ( nearly two months exactly) was after the OHS ( for the aneurysm).
So off to the GP this morning to follow up referal from hospital. As an aside , is the angiogram with the accelerant ( forgot the name beginning with a … that they inject) done in most hospitals or only major cardiac centres.
many thanks for taking the time to read and any thoughts?
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Robfromwales
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Not sure if you have been referred to a hospital already but NHS Choices gives you the opportunity to decide where to go and that may include private medical hospitals too if they are under contract to the NHS. It not something they want you to know about, but nevertheless it exists and it is something to discuss with the GP should you choose to do so. But once you have been referred you lose the opportunity to choose.
Yes indeed Milkfairy. So update from GP is had ECG when getting this pain this morning and showed no ST elevation. Not referred at the moment to cardiology but given gaviscon (which I take anyway) and given GTN spray. Come back in two weeks or go to A and E if after spray there is no improvement.. Does one specific and recognizable pulse/spasm of pain/discomfort in sternum every minute or so in same place during the day sound familiar to those who suffer with it or something completely different in terms of symptoms.
I thought this might help. I have recently been diagnosed with microvascular angina (MVA) on top of vasospastic angina (VSA). I am under the care of a leading specialist in this condition and I queried with him why I did not always present with ECG changes when having chest pain. He responded with this maybe more consistent with MVA, and MVA does not always cause ECG changes.
It’s also difficult to catch a coronary artery spasm. I have had many isolated events at home, and when the ambulance have arrived or I have presented to A&E, no ECG changes are found which is really frustrating.
I can see that you seem somewhat informed on VSA already. I have attached a link on MVA in case you find that these symptoms are similar to what you’re experiencing at the moment and perhaps, you can query this with the GP in addition to the VSA.
There is also a specialist based in Wales listed on the INOCA site above in case you find this useful too, which is how I originally found my current specialist.
I have also had a CMR with perfusion in the past with adenosine however, my cardiologist at the time was not looking for MVA and therefore, it was not diagnosed. A specialised technology is used to look at the smaller blood vessels. If you were referred for this test for the purposes of ruling in/out MVA, and it was negative, then perhaps MVA is not the cause. You could ask your cardiologist or GP for clarification regarding your stress MRI.
That sounds like positive news Rob. From my experience, you definitely don’t want both! Having neither would be much better as I’m sure others with these conditions would agree. It can be debilitating some days.
Robfromwales my spasms from my VSA are more intense and stronger. They can typically start in the centre of my chest or under my left breast and radiate to my upper back and arm. Lately, I’ve started feeling a deep pressure in my throat and ears. Changes in my heart rate also fluctuate during these episodes of VSA. The duration of these can vary. It can go from a couple of seconds, to coming back in clusters over the course of an hour or more despite using my GTN spray.
When I had my MINOCA in 2022, it felt like a squeezing, tight gripping pain in the middle of my chest. This went straight into my jaw and to the right side of my chest and arm. This spasm lasted around 30 minutes and was strong enough to trigger the heart attack. This was also accompanied by abdominal pain, vomiting, and sweating.
My MVA on the other hand, is a constant daily pain in my chest which varies in severity. It is present pretty much throughout the day regardless of what I am doing such as household chores, going for a walk, doing errands etc. This pain is also felt in my chest, both right and left side, my arms, and upper back. There is no duration or frequency of this as it is there in the background all the time. The pain manifests itself differently. It can feel like a squeeze, pressure, dull ache, or a stabbing sensation.
As Tos has said it can be difficult to catch a coronary vasospasm in action.I have a confirmed diagnosis of vasospastic angina with spasms in my large and small vessels, so technically microvascular angina as well as coronary artery vasospasms, according to the same Cardiologist that Tos is now seeing.
My understanding is that a vasospasm may not last long enough to cause ECG changes that can be recorded.
I am unfortunately severely effected. I am admitted to hospital at least once or twice a year. I have frequent episodes of chestpain so it is slightly easier to catch my coronary vasospasms in action.
The episodes of my chestpain come in clusters of pain lasting for longer and longer. These crescending episodes last about an hour stop then will start again later.
It feels like being in labour to me, my heart feels as though it is being squeezed and strongly twisted like water being rung out of a damp cloth.
I can't breathe in.
I feel my angina pain to the left of my sternum, between my shoulder blades and stomach. The pain radiates into my left shoulder, upper back, arm and neck.
I had a wonderful, experienced nurse on the ward once, who said she was going to go hunting for my vasospasms.
She performed consecutive ECGs during an episode of chest pain.
I had a normal ECG, then T wave inversions followed by ST depressions, then T wave inversions and then normal ECG as my pain settled.
You don't necessarily have ST elevations if you have vasospastic angina.
If you just have one ECG you can easily miss the moment.
There are actually more Cardiologists around who are sympathetic and knowledgeable about caring for patients living with microvascular and vasospastic angina than are listed on various support group websites.
Many thanks for as ever a thoughtful and helpful reply. My symptoms (if thast what I have) are quite different in intensity and type but I fully understand we are all different and experience things in different ways. I am not great with pain for example and get very anxious.
I think this is going to go down a dual route although at present i have only been referred again back to gastro ( i know I have oesophagatsis as have had an endoscopy) while the GP hasnt yet referred me back to cardiology but wants to see how ppis/gaviscon go and if GTN spray relieves. I have presented to A and E 5 times in last 2/3 years so know to go when necessary but other than one syncope - its never resulted in anything blood supply to heart related
You're right everyone has their own individual version or experience of their heart condition. I found it helpful to learn how to manage my anxiety and stress otherwise I'd live in A&E.
This is work in progress even after over 11 years of living with vasospastic angina.
I practice Tai Chi, yoga, breathing and relaxation techniques.
I pace my activities.
I have been to yoga this morning. I am now tired, I have chest pain which I expected.
So I am off for a rest, I'll listen to some music, podcasts and dip into the Insight Timer app which has loads of techniques to help me remain calm.
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