I am very new to this forum so I would first like to say thank you for accepting me and to say how much I have picked up from reading some of the topics raised in my short time
I have been pondering a question to the side that even my cardiologist can’t get to the bottom of but i hope someone in this forum will understand my current symptoms and possibly suggestions?
I had a HA in 2018 and had a stent fitted ( LAD) however I developed angina in 2021 and had a angiogram which showed calcification of small arteries so increased medication.
Moving forward to Nov 2023 and I developed angina again but this time during resting and sleep. Taking GTN spray several times a day I finally got admitted to hospital on 20 Jan 2024 and had a further angiogram which once again showed more severe calcification of the small arteries and was sent home with revised medication even though I was still getting the pains and advised by the cardiologist that the pains would ease once the medication kicked in. Fast forward to today and the angina pains are getting more frequent however on speaking to my GP he was taken back that I was having angina pain whilst resting and this was uncommon???? I was even asked if I suffered with stomach reflux???
I am at a loss as what to do next as my pains are getting worse and the medical staff don’t seem to understand that I am having angina whilst resting , I am fine when walking or pottering about. Therefore I am reaching out to see if anyone has had any similar angina symptoms whilst resting and what action was taken.
Thank you in advance for any help you can provide
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Toffodog
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I’m sorry to hear you are still experiencing issues.
It is possible to have angina at rest. I have something called Vasospastic angina (VSA), which is commonly experienced at rest. This can be late evening, through the night and early hours of the morning. This is when one of my arteries constricts, which feels like a squeezing and tightening pain, limiting blood flow to my heart. GTN can help relieve the pain, along with other types of treatment, such as calcium channel blockers.
I also have MVA (microvascular angina) which are spasms in the smaller blood vessels of the heart. This is however, a constant/daily pain and I feel it in my chest, upper back, arms, and as of late, in my jaw too.
These are both under diagnosed types of angina and although research is improving, there are still a lot of doctors and cardiologists that know little about the conditions which is probably why your GP was taken aback a bit.
There is also unstable angina, which can be experienced at rest too and something which your GP or cardiologist may want to consider along with the above.
It would be a good idea to keep a diary of your triggers. Stress is a very big one for me which includes emotional, physical, and mental. The cold is also a trigger, including hot weather.
There are others who also experience angina at rest. I hope they will offer their insights too.
Thank you so much for your very informative message and for the website suggestions which I will be viewing. It sounds like you have experienced similar episodes of angina attacks at rest and what you describe does resonate with the symptoms I am experiencing. I am due to see the cardio rehabilitation team next week and hopefully get a chance to speak with a cardiologist .
I have lived with vasospastic angina for over 11 years. I experience most of my chest pain at rest especially in the evening or during the night at rest.
If I do too much I will experience a delayed response of more chest pain to later.
I experience chest pain on exertion when I am going through an unstable phase of my vasospastic angina.
As well as the information you have already been sent, I suggest you ask your Cardiology team to look at this newly published paper, I have linked it below.
My Cardiologist has uploaded this onto my careplan, as he was so impressed by it's contents.
It describes vasospastic angina in this way.
"Vasospastic angina (VSA) refers to chest pain experienced as a consequence of a sudden narrowing of the epicardial coronary arteries. VSA can occur in patients with non-obstructive coronary arteries and obstructive coronary artery disease, with transient spasm causing chest pain and persistent spasm potentially leading to acute myocardial infarction. Reduced blood and oxygen supply in patients with non-obstructive coronary arteries is not a benign condition, as patients are at elevated risk of adverse cardiovascular events."
My vasospastic angina was confirmed by an angiogram with acetylcholine 10 years ago.
I have transient constrictions of my large and small vessels.
Microvascular angina is more typically caused by the inability of the small blood vessels being able to dilate or stay dilated in response to extra demands like exercise, this is known as microvascular dysfunction.
Microvascular angina tends to be more common in middle aged women and more often causes chest pain when exercising.
The definitions and terminology are ever evolving. The European Society of Cardiology's 2023 Management of Acute Coronary Syndromes brought vasospastic angina and unstable angina under the same umbrella term of acute coronary syndrome which is a new change.
As the underlying causes of microvascular dysfunction and coronary vasospasms are different the treatment options offered are different.
Many patients are offered beta blockers following a heart attack or stent being inserted.
Beta blockers can make coronary vasospasms worse. I ended up in hospital with unstable angina when I was presumed to have microvascular dysfunction rather than vasospastic angina, after being prescribed beta blockers.
This maybe something to discuss with your Cardiologist too.
Unfortunately the knowledge of microvascular and vasospastic angina is still lacking amongst many Cardiologists, cardiac nurses and GPs.
Though it is slowly improving.
There are other sources of information about the condition on other websites created by patients working with clinicians in partnership.
Thankyou so much for your response and very informative description of possible things that I may be experiencing and I certainly will raise them with my cardiologist.Following my discharge from hospital on 24 Jan I was not happy being discharged still having pains so I reached out to BHF and the nurse put me in touch with this forum and I was informed that you had a vast amount of knowledge relating to the small ateries and you certainly do so I thank you for your feedback.
But could you please tell me if the pains are something you live with or can medication or even surgery control the pain?
Thank you for your kind words regarding my knowledge about microvascular and vasospastic angina. Unfortunately my vasospastic angina is resistant to treatment so by necessity I have had to gain lots of knowledge!
It is important to have an accurate diagnosis so you can be offered the appropriate treatment. Avoidance of beta blockers is important when coronary vasospasms are present, yet beta blockers can improve microvascular dysfunction.
There is growing recognition that coronary vasospasms can be a possible cause of ongoing chest pain following the insertion of a stent.
This is mentioned in the VSA management paper I linked in my previous reply.
The only treatment option for microvascular and vasospastic angina at present is by medication and lifestyle changes.
I attended a Pain Management Programme which helped me to respond emotionally to my pain differently.
It can take time to find the best combination of medication that will work best for you as an individual.
The other really important management strategies are the usual heart healthy diet, exercise stopping smoking, identifying your triggers and managing stress.
Episodes of coronary vasospasms can be unpredictable so learning to live with uncertainty is required.
It's a bizarre condition.
I managed to climb Great Gable in the Lake District in September, yet I was admitted to hospital for 10 dats with unstable angina in November
I found Cardiac rehab staff don't always understand vasospastic angina and our unique needs as patients.
I need a very long warm up and cool down. I keep my heartrate at a certain rate, too high and I'll experience chestpain later.
Many people do well on medication, some stay the same and a few continue with debilitating symptoms.
I suggest you ask your Cardiology team to consider whether coronary vasospasms or microvascular dysfunction are the possible cause of your ongoing symptoms.
I have just returned from seeing my GP who asked to see me because I have registered the angina issues several times during the last 7 days. His concern was that the cardiologist mention that there had been no change in my angiogram on 24 Jan and the one carried out in 2021 yet the letter states moderate to severe calcification in the smaller arteries which is a new feature from my previous angiogram however in the opinion of my GP this had been overlooked therefore he is putting in an urgent request to the cardiologist to investigate both microvascular and Vasospastic angina both of which he has previously referred other patients for so has prior knowledge of both . If it hadn’t t been for your response and raising both these symptoms I would have had no idea what he was on about so your timely message has already helped me a great deal so hopefully I will get a proper diagnosis of what is going off , so thank you so very much for sharing your knowledge.
Hi, I am also new to the forum. I am so glad your GP is referring you and seems to have knowledge of both. Good luck to you. I have found this forum has helped me so much. I thought I was the only person who was going through this. I am so thankful the BHF cardiac nurse suggested I join. Please keep us updated.
Hi I have pains when resting and have microvascular angina. Cardiologist put me on isosobide and Ranolazine I still get It even wake up with it. Hope this helps my cardiologist called it lazy blood which sounds nicer I think
I have angina at rest and it can wake me up. I didn't think it was unusual although people do assume it comes on after physical activity! 'Touch wood' mine is reasonable at the moment. I am on 60mg isosorbide mononitrate daily and was put on nicorandil as well 5 months ago as it became worse. I'm also on the other usual drugs. If its happening so regularly even with additional meds then I would ask to be referred back to cardiologist.
Thank you for your response reading the responses I have had it seems that angina attacks at rest are more common but yet there is very little research into the reasons why this is but I feel more assured that my attacks resonate with other people on this forum.
Hello, I had angina at rest after my stents and angina pain in my jaw before stents...anything can happen. My consultant didn't seem worried by pain on rest. Now I'm ok, no pains. I'm just saying find someone who really knows & chat to them...GPS don't have all the answers. Hope you get sorted ASAP. Take care.
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Any others with microvascular angina?
Angina in small arteries
Vasospastic angina (Coronary artery spasms)
