My symptoms have got better but is this placebo, I’m on extended release 120mg Diltiazem.
Cool I feel ok but now it’s worrying me that the reason it’s making me feel ok is that I actually have a problem with my heart going on and that my arteries are blocked. This is just messed up. Could that be what it means?
You can have ischaemia (narrowing of the arteries) without non-obstructed arteries. Therefore, if you feel the Diltiazem is working, that does not necessarily mean your arteries are blocked. As mentioned in a previous post by myself and others, vasospastic angina and microvascular angina can be present without any obstruction to your arteries - INOCA/ANOCA (ischaemia and or/angina in non-obstructed arteries). This means there is a restriction to blood flow to your heart without fatty plaque build up for instance.
bhf.org.uk/informationsuppo...
I had a MINOCA (myocardial infarction in non-obstructed arteries) as a result of a severe spasm. All of my arteries were clear.
Two days is probably not enough time to determine the effects of the medication regarding a decrease in your symptoms. 2-4 weeks is usually a good time line. If you have severe side effects however, or are worried about a new symptom, then you should contact your GP.
How are you getting on with managing the anxiety?
Tos
I’ve been better with my anxiety just therapy obviously only being once a week can be stressful to wait until next.
Obviously with MINOCA, if it may be it’s helped with the pain when I’m walking around too unless it’s not the diltiazem and it’s my head. Like why no pain unless it’s expanding my artery because there is a 70% blockage.
A MINOCA is a heart attack and needs immediate medical attention.
You are being treated for suspected vasospasms, which is a condition that falls under INOCA/ANOCA as well. Calcium channel blockers can help with these conditions. That doesn’t necessarily mean you will have a heart attack if your diagnosis is confirmed.
You may be having spontaneous spasms where your arteries go into transient constrictions without a blockage. There are a number of us on here who have INOCA/ANOCA conditions without blockages. Unless you have had an angiogram to confirm a blockage, you should not assume you have one as this can increase your anxiety. If you feel the medication is working, then this is a good step as it means the doctors are working towards a diagnosis for you to improve your health and quality of life.
How are you finding the therapy sessions? Do you feel like it is helping?
Yeah therapy is helping me process things differently. I’m trying to use the methods given and like prove my belief wrong. I guess it’s the point of by rerouting the parts in your brain.
So a MINOCA is a heart attack without blocked arteries, alright.
Yeah of course a few days ago I was experiencing them episodes which have stopped now but so has the chest pain when walking around. Which I would assume stable angina but the doctor said it would take decades to get to that sort of blockage and they wouldn’t test for me as my age anyways.
So do I just stay stuck in the belief that I have big blockages in which one day I’ll just die. Or does vasospasic angina also occur during activity, I don’t know. I’m trying to think logical like yh I might have like a 10% blockage somewhere but surely nothing obstructive.
Vasospastic angina is typically felt at rest during late hours of the night and early hours of the morning. MVA is more often associated with spasms or chest pain upon exertion. However, that doesn’t mean you cannot have VSA with exertion. I have and still do have vasospasms on exertion. This is because my spasms have been poorly managed and a definitive diagnosis was delayed therefore, my treatment plan is being adjusted to address these symptoms.
I would carry on taking the Diltiazem as instructed, and if you continue to find relief with it, then this will no doubt require further cardiac investigations which I’m sure your local cardiology team will do.
I’ve been taking Tildiem (another brand name for Diltiazem) and I have not been finding any relief on it so far. I really hope you have better luck with it.
I would carry on taking the Diltiazem as instructed, and if you continue to find relief with it, then this will no doubt require further cardiac investigations which I’m sure your local cardiology team will do.
But like how will this happen it wouldn’t prove anything if it helps as it could just be a placebo effect and also they won’t run tests I don’t have a cardio team I don’t have anything as you know tos being 22 it doesn’t happen,
It’s shit.
"What is ischemia? Ischemia is a condition in which blood flow (and thus oxygen) is restricted or reduced in a part of the body. Cardiac ischemia is decreased blood flow and oxygen to the heart muscle."
A lack of blood supply to the heart ischaemia can be caused by a permanent blockage in the coronary arteries or a when the blood vessels don't work properly eg Microvascular dysfunction or coronary vasospasms.
Transient constrictions causing ischaemia leads to vasospastic angina.
Prolonged episodes of ischaemia can lead to permanent damage , a heart attack.
This recently published article explains vasospastic angina more fully.
journals.sagepub.com/doi/10...
I have been taking Diltiazem for many years and have just increased by dose over the weekend to 360mgs twice a day.
I am keeping a log of my symptoms as it's too early to say if this higher dosage is helping.
I manage my stress by mindfulness meditation, yoga and Tai Chi.
I find this free app helpful. This morning I have attended an online yoga class, done a short meditation and now I am off to walk my dog.
Thank you, but could my vasospastic angina be happening when I’m walking about too then? But like they’ve never seen ischemic changes on ECGs to support it so it’s really difficult for me.
When I am in an unstable phase of vasospastic angina I experience chest on exertion.
Microvascular angina which a more common type of angina/ ischaemia no obstructive coronary arteries ANOCA/INOCA typically occurs on exertion rather than at rest.
The risk factors for vasospastic and microvascular angina are different.
Microvascular angina tends to have the same risk factors as obstructive coronary artery disease, however it tends to effect women more than men.
It can be difficult to catch a coronary vasospasm in action on an ECG. The vasospasm may not last long enough to cause ECG changes.
Sometimes I have changes on my ECGs, ST elevations, ST depressions or T wave inversions sometimes I don't.
The ECG changes are usually seen when I have consecutive ECGs done during an episode of chest pain.
What I have learned over the many years I have lived with vasospastic angina is that stress and anxiety makes my symptoms worse and more severe.
Reducing and managing stress is incredibly important.
I hope you are able to find a way to bring some calm in your life.
Thank you for this I’m trying to relax like I’m happy something maybe helping the pain but then it’s making me believe it’s actually obstructive disease in which they won’t prove because they won’t order any sort of test for me being 22. They just know I have no calcification of my conoraries and my stress test was fine.
It’s just a lot. I hope things get better. And that I can move forward to live properly whether or not this is the problem.
I need calm, meditation, just relaxation.
I have just edited my previous response to you.
When my coronary vasospasms are really bad they feel like being in labour to me.
I don't have any blockages.
I don't worry about having any obstructions. I am on statins, I eat a heart healthy diet, exercise, keep my weight down, my BM1 is 21, take my medication and manage my stress.
The severity of your angina doesn't necessarily relate to the amount of ischaemia you are feeling.
Be kind and compassionate to yourself and hopefully you'll find the calm that you need to live as well as you can with your symptoms.
thank you, I’m glad you’ve got no blockages but I don’t about myself and never will due to this system. I can’t know.
I just sit here afraid that my arteries are so clogged.
I am sorry you are feeling so anxious. I hope you have some support to help you with your health anxiety.
What if it’s real though you know and everyone is gaslighting me
I am afraid I can't answer that for you.I do hope you can find the support you need to live as well as possible with your pain.
Perhaps try to talk with one of the cardiac nurses on the BHF helpline?
If you feel unable to talk on the phone you can email them instead.
hearthelpline@bhf.org.uk
yeah I spoke with one yesterday they were nice and told me not to worry. I just think they only seem to care for older people like 45+ and don’t even recognise me due to my age.
It’s ok I just sit to die is how I feel sometimes
Hi, I've been on diltiazam for a few years now. It is a calcium chanel blocker. I have a couple of heart issues. I take the chanel blocker because I have left bundle branch block. Micro vascular blockage that can't be stented. Originally I had 340mg. Now I take 120 morn. 120 at night. I have coronary spasms. It don't think it means you have blocked arteries I'm no cardiologist but I was under the impression it was to help prevent blocked arteries. Your arteries may just be narrow not calcified Your blood may have some kind of restriction like me you may have spasms could be many reasons. Do you have high blood pressure.
Nah my BP is 115/75, like maybe they’re narrower my doctor mentioned that due to be sedentary for quite a while my arteries aren’t as strong hence the pain and inbounding obese.
It’s a lot to handle at 22 like I try to think it takes decades for plaque so how would I have a big blockage so young.
I’ll have a bigger chat with doctors about it all since they won’t check my arteries and if it helps I guess it’s ok. I just know from August 2023 I had no calcification of my conorary arteries so my good sign.
I assume you had ECGs and Echo and x-rays done before your treatment started.If these were normal and showed no blockages this is a positive thing.
Although there are various reasons that blood flow can be an issue even temporarily, many of those reasons when you are young are managed really well with medications , and often people can get to the point of being medication free if changes in their lifestyle , activity and self care including learning ways to reduce your stress and anxiety made at the same time improve the strength of their heart , arteries , circulation and blood flow.
The medication will be doing it's job, and in your case it seems it's begun to help quickly. A slow release medication can give you confidence that there is always some medication in your system doing the job of improving your blood flow in the way that you need it while you are doing physical activities. This should give you confidence in the fact that you are safe as you slowly build up your physical activities letting your body get stronger and fitter and helping your heart get stronger and fitter too,
A balanced and relaxed lifestyle, including physical activity and a sensible diet is the best investment you can make in yourself and positive way to prevent your arteries from becoming blocked in the distant future too.
It may be an idea once you have got used to the positive effect the medication is having on your symptoms self referring, or getting a GP referral to physiotherapy for advice on the best exercises for you and the free exercise referral scheme. You may also find it a positive step to get some pointers about a good diet for your heart and mind from a referral to an NHS Dietitian. Getting referred to talking and CBT therapies to learn strategies to cope with Health Anxiety rather than just Mental Health Therapy that you may already get is also really helpful in giving you reassurance, confidence and trust in your cardiac treatment.
If you haven't got blocked arteries, at your age the prognosis of making a good recovery after getting the right help and lifestyle changes and reversing cardiac symptoms are very high. Take care , Bee
Everything I agree with like the testing but obviously I haven’t had definitive proof of no big blockages. Like is echo, stress test, 7 day monitor, ecgs (like 40) and a CTPA enough.
Is my mental state just causing this.
The tests that you have had are enough to give the proof that you have no big or small blockages. Obviously, having some heart symptoms or issues when you are younger will have given you a scare , especially if you currently need some medication to help manage any ongoing symptoms. This fear and the shock of having any health scare can make many of us feel more anxious at first , especially when we are trying to get back to living a normal healthy lifestyle, but the normal tests results and what advice you have been given should be what you put your faith in rather than the negative thoughts that work to hold you back.
It's why CBT and Distraction and Talking therapy may be a great option for you in getting back the quality of life you deserve.
Take care , stay positive , Bee
You have extreme anxiety, I've now read some of the other responses and the one thing we have in common. Is spasms not calcium blockages. You are worrying over something that may not be there. You've mentioned your thyroid, being over weight could cause spasms. If your cardiologist has not prescribed you statins then I very much doubt he thinks its a possible blockage. Be kind to yourself and not worry. I know its easier said than done.
Calcium channel blockers
Channel blockers
Switch from Bisaprolol to Calcium Blockers
2 days on from Angiogram
