I had a terrible day yesterday. Woke up with pressure in the left side of my chest, feeling like my body was covered in lead weights, exhausted despite having slept for a solid 10 hours, easily getting shortness of breath and having lightheaded spells that a few times caused me to grab hold of something to stop me stumbling over.
Then the chest pain started in ernest. The worst level pain I've had yet with my angina. Alongside the pressure that I'm used to getting, this severe pain would come in waves and a few times the pain sort of fluttered too just before fading away. It was just awful. I had three separate episodes like that yesterday.
GTN spray helped it for a while but it kept coming back.
Obviously, I didn't go to A&E but when I fessed up to family this morning they whisked me straight there. I've not had that severe pain today, just the pressure and I feel generally much better.
Luckily, no raised troponin and my ECG hasn't changed from it's normal weird but the doctor said they were worried about the symptoms I'm having. So I'm to go as an outpatient on a suspended admission, instead of blocking a bed for the night. Which is a huge relief and a really sensible system. Not sure what to expect though.
Really hope it's the start of getting to the bottom of all these debilitating symptoms I'm getting since my heart attack.
I've been diagnosed with Microvascular Angina, CAD and possibly CAS. I get angina at rest, at sleep, half hour or so after exertion and on exertion if I push it over 120bpm for too long.
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bee_bear
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can't really give any medical advice. but listen to your body and try to do the most sensible thing.and try and keep calm do your deep breathing excersise ,really sorry about your situation hoe you get some improvement asap 🙏
I have frequent episodes of chest pain especially at rest in particular during the night between midnight and 6am.
I also have a delayed response to exercise, so I have to try not to have a high heart rate for too long.
I ended up in A&E after my cardiac MRI as the adenosine raised my heartrate and triggered my coronary vasospasms.
I experience chest pain at exertion when I am going through an unstable period of my vasospastic angina.
During a ' hot phase' I have episodes of chest pain that get longer and stronger and exertional chestpain. It feels like being in labour.
When this happens I go to hospital I have an agreed careplan and I am admitted to the Cardiology ward for treatment with IV GTN to calm my unruly coronary vasospasms.
In 11 years I have been admitted nearly 20 times.
It's good that your symptoms are not being dismissed, which can sadly still happen as microvascular and vasospastic angina are not well recognised or understood by A&E doctors or Cardiologists.
How was your microvascular angina diagnosed?
Have you been offered any furher tests to confirm your diagnosis of coronary vasospasms?
The treatment options for microvascular and vasospastic angina are different.
Beta blockers can help manage microvascular angina however beta blockers can make coronary vasospasms worse.
It can take time to find the best combination of medication that will work best for you as an individual.
The BHF has this information about microvascular and vasospastic angina on their website.
5 cardiologists have diagnosed the MVA. A few recent spells have had them say there's vasospasms involved too.
The cardiologist that did my angiogram and stents was the first one to diagnose me with MVA when I started getting angina a month or so after my MI & stents. He said his diagnosis was based mainly on symptoms, risk factors & where the blockage was that he stented it's likely my micro vessels may also have disease.
The only tests since the angio & echo when I had the MI, has been a cardiac CT which didn't show anything different to the angio and I have a stress MRI at some point on the horizon.
I'll find out next week, hopefully, what the plan is for next steps but I'm going in with the intention to push hard for a referral for tests to confirm the MVA & CAS.
I'm on beta blockers for 12 months to protect my stents, so if I am having vasospasms then it would be good to know so that we can see if there's another drug to use instead.
I hope you are able to get a confirmed diagnosis. The symptoms of Microvascular and vasospastic angina can overlap.
I was originally presumed to have microvascular dysfunction before I had my angiogram with acetylcholine confirming my diagnosis of vasospastic angina.
I was prescribed beta blockers and landed up in hospital with unstable angina as a result.
I now have written all over my medical records that I must not be given beta blockers.
The classic signs of vasospastic angina are chest pain at rest, especially between midnight and 6am, a delayed response to exercise with chest pain at rest later.
Thank you. I'm trying to get prepared for my assessment with the cardiologist tomorrow and going through my records.
I'm confused by this diagnosis from my cardiologist because the majority of my pain wakes me up or kicks in from 30mins after exertion to the next day. I have experienced angina on exertion but I really have to be pushing it.
Last month I was fed up at not being able to walk up our farm track and I walked up there. Ended up getting horrible squeezing pain on the way back down. Not been quite right since to be honest but the majority of my chest pain has been at rest/sleep and cardiologist knows that.
How can they be confident enough in their diagnosis of MVA to write it in my notes without a provocative angio and based on the majority of my symptoms being mostly at rest?
My tests so far have been an emergency angiogram, echocardiogram when I had the NSTEMI and then in response to the ongoing angina a Cardiac CT.
Cardiologist diagnosis says positive for Microvascular Angina
"How can they be confident enough in their diagnosis of MVA to write it in my notes without a provocative angio and based on the majority of my symptoms being mostly at rest?"
You are asking a very important question.
A Cardiologist can diagnose a condition by symptoms a presumed or suspected diagnosis or by following the appropriate testing, a confirmed diagnosis.
Microvascular and vasospastic angina are types of angina/ ischaemia non obstructive coronary arteries.
The problem I have found is that Cardiologists just diagnose everyone with microvascular angina without the proper testing.
Most of the tests offered are to diagnose obstructive coronary artery disease rather than the functional disorder of the blood vessels that lead to microvascular dysfunction or coronary vasospasms.
Some people do have both microvascular and vasospastic angina at the sametime or you can have vasospasms in your small vessels.
The gold standard test is a functional angiogram when adenosine and guide wires are used to make measurements of the blood through the small blood vessels.
Then acetylcholine used to see if coronary vasospasms occur.
Only a few centres offer an angiogram with acetylcholine at the moment
Ask has your coronary flow reserve CFR and index microcirculatory resistance have been measured.
A CFR under 2.5 a IMR over 25 indicates microvascular dysfunction, microvascular angina can be diagnosed.
This is a link to an article produced by the European Association of Percutaneous Cardiovascular Interventions.
Ask your Cardiologist if they are aware of this article?
Perhaps ask your Cardiologist if you could be weaned off your beta blockers to see if that improves your symptoms as beta blockers can make coronary vasospasms worse.
Non invasive tests for Microvascular and vasospastic angina
Hi, bee_bear, I am sorry to hear about your pain issues, and I know how worrying it can be. You have offered help and advice to me previously which I welcomed. I try to hide my pain from my family, but at times I get found out, they worry more than I do. You and others advised me to go to A&E when the pain got worse, so I am returning that advice, please seek help. Last Monday I spoke to one of our GPs about left sided chest pain that lasted 3 days and brought on two sessions of Panick Attacks. The result was a 12 1/4 hour wait in A&E for an ECG and Blood tests. We came away very tired, but happy that nothing serious was found. So please follow your advice and get checked out
Thanks Bludnut. I actually thought about what I'd written to you when I was deciding to go or not! I did go in the end and because my bloods came back ok but they were worried about my symptoms, instead of admitting me and keeping me in for the weekend, they've got me coming back in on Monday, so it should be interesting to see what happens.
Going to prepare for it, so I'm well armed with questions & requests!
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