Is Isosorbide Monosorbate necessary?

[Thisishappening]

It's all come as a horrible shock. Last week received cc'd letter from Cardiology to my GP saying I'd got Triple Vessel Disease with severe coronary calcification, lots of scary medical jargon, urgent increase in medication and an appointment with the intervention team in two weeks. No sugaring the pill there! Given I had no inkling that I had any serious problems, am fit and healthy, swim two miles a week, don't smoke or drink, and have ok BMI, this diagnosis has knocked me off my feet. Also, I'm just left floundering with a thousand questions and no guidance as to exercise and rest guidelines. So I'm quite annoyed, as well as worried and depressed. I know I emotionally overreact (being ADHD) but just left to muddle on, not knowing what to do or what the prognosis is, seems really brutal (and stressful!!).

Things were picked up because I told the GP in passing that I had very slight pain around my heart when I got agitated. I was asking her if this was to do with the heart murmur she'd identified (now diagnosed as a mild aortic regurgitation). GP said no this was angina and needed urgently checking out. Weeks later, slightly offhand and sceptical telephone conv with local cardio nurse who eventually sent me for a CT tomography scan. Months later, appointment came through, scan done, another six weeks go by. Then the letter, now in panic stations mode.

What I've got is very mild angina symptoms brought on by emotional stress. I'm 63, male. It's like a slight stitch, almost trivial. They've doubled my atorvastatin to 80mg pd. And "added in" Isosorbide Mononitrate 60mg pd to "alleviate symptoms". I'm happy with the statin, but the nitrate tablets seem way over the top. I'm concerned that I'm being over-medicated and very unhappy about the side-effects. The GTN spray I have already gives me a splitting headache on the rare occasions I use it.

Question: is the (quite high dose) mononitrate medication simply to relieve the (slight) angina symptoms, or does it have a therapeutic effect on the heart which might prevent a serious cardiac event in future? If the latter, I'll give it a go. But if simply to quell symptoms which don't bother me, is there any good reason to put myself through the inevitable headaches and nausea that nitrates give me (provoking further mental ill-being)?

Any advice really appreciated. I feel like I'm going out of my mind without any clear guidance, much less reassurance from the medics.

ps "severe coronary calcification": does this imply arterial graft surgery (triple bypass) or might stents be an option?

[Tos92]

Hi Thisishappening,

I’m sorry to hear of your recent diagnosis that has taken you by surprise.

I don’t have all the answers. Isosorbide Mononitrate aims to relax the blood vessels and increase oxygen and blood supply to the heart. Nitrates are effective in reducing angina as they help expand the blood vessels and therefore, can reduce the possibility of a serious cardiac event. Your GTN spray works in a similar way, in that it dilates your blood vessels so that more blood and oxygen can get to the heart muscle, reducing the angina that you feel.

Isosorbide Mononitrate is a long-acting nitrate, so the idea is that it stays in your system for longer to manage and/or prevent the number of angina attacks you have whereas the GTN spray is a short-acting nitrate and wears off quicker.

nhs.uk/medicines/isosorbide...

I also have awful side effects to the GTN, with headaches, tachycardia, and a drop in my BP. You may find that your body adjusts to the GTN as more time goes by.

I hope you will give the Isosorbide Mononitrate a go. I have linked the number to the BHF cardiac nurses below incase you had more questions.

0808 802 1234

Hopefully, others in a similar position will see this.

All the best.

Tos

[Thisishappening in reply to Tos92]

Thanks so much Tos, it's good to hear from people in similar situations. Really appreciate your taking time to reply. Cheers for the suggestions. 🙂

[Tos92 in reply to Thisishappening]

No worries. I’ve just noticed that you referred to it as Isosorbide Monosorbate, but I’m sure you meant Isosorbide Mononitrate :).

[Thisishappening in reply to Tos92]

Duh. lol... brain not functioning fully!!

[benjijen]

I'm on 60mg and they reduced it. I was then back to having to have ambulance to a&e again. Dose was put back up. Since then have been put onto Nicoandil as well. I still have to use GTN sometimes. The side effects soon go so worth persevering.

[dlowell]

Need to get a top consultant’s opinion on stents and rotational atherectomy (RA) to deal with calcified lesions. See link below

ncbi.nlm.nih.gov/pmc/articl....

This consultant specialises in RA:

imperial.nhs.uk/consultant-...

[Badger1966]

keep strong , stay positive, I know it’s hard but it can be done , think of the worst thing that can happen to you , there is always somebody who would change places with us .

Regards Rick