heart attack caused by stress, (no blockages)has this happened to anyone else

[Schnoodlefan]

had a minor heart attack at Christmas; during angiogram they did a stress test which started closing down my arteries fast; has anyone else had this, if so have you had any support on how to deal with stress; was just given loads of medication and sent home; Drs have not been helpful 🙃

[Milkfairy Heart Star]

Hello,

Welcome to the forum.

About 10 % of heart attacks occur without any permanent blockages of the coronary arteries.

A Myocardial Infarction non obstructive coronary arteries MINOCA, this is a description of the cardiac event not a diagnosis as such.

MINOCAs disproportionately effect women. Unfortunately the awareness of MINOCAs is often lacking in the Cardiology world as the underlying causes can be difficult to diagnose and often also go unrecognised.

The possible causes are microvascular dysfunction, coronary vasospasms, spontaneous coronary artery dissection, SCAD, arrthymias causing a supply demand mismatch of the blood supply of the heart, a small piece of plaque or a blood clot blocking a coronary artery.

You say

'during angiogram they did a stress test which started closing down my arteries fast;'

Do you mean that you had a transient constriction of your coronary arteries, a coronary vasospasm?

Coronary vasospasms cause vasospastic angina a rarer type of angina.

I have lived with vasospastic angina for over a decade. I was admitted to hospital in 2012 with a suspected heart attack and told incorrectly that I couldn't have angina or a heart attack as I have unobstructed coronary arteries.

The cold, emotional, mental and physical stress are the main triggers for my coronary vasospasms.

I use various strategies to help me.

Yoga, Tai Chi, Mindfulness Meditation, breathing and relaxation techniques and walking my dog everyday.

I use this free app, Insight Timer which has loads of different techniques to help manage stress.

insighttimer.com/en-gb

Have you been offered any further testing to determine the cause of your MINOCA?

Are you still experiencing ongong symptoms.

Have you been offered a cardiac MRI?

This test is advised to look at the heart muscle itself to rule out other conditions such as Myocarditis or Takostubo syndrome that can mimic a MINOCA.

Knowing why I have my symptoms helps me psychologically manage my angina. It also means I have the appropriate treatment to help to prevent any further cardiac events and other complications.

I am still under the care of a Cardiologist. I am prescribed lots of different medications.

Have you been offered cardiac rehab?

This is often a valuable source of support.

The BHF has this information about microvascular and vasospastic angina, both types of angina/ ischaemia non obstructive coronary arteries INOCA/ANOCA

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

You may find some more information on this website, created by four patients with over 60 years of living with microvascular or vasospastic angina. Several of the founders have also experienced heart attacks without blocked coronary arteries.

internationalheartspasmsall...

Perhaps also give the BHF helpline a call and speak with one of the cardiac nurses?

bhf.org.uk/informationsuppo...

[Sljp0000 in reply to Milkfairy]

Hi Milkfairy,Quick question, do you know if vasospastic angina/heart artacks would show in any blood work, troponin levels etc?

I don't know if you remember me. I had failed bypass surgery followed by 4 stents but I still get random pains which feel like angina to me but are different from before. Pressure in chest and mouth, occasionally left arm. Most the time they are transient, sometimes they wake me at night. By the time I decide to get my GTN out they've mostly gone.

The Cardiologist has agreed another invasive Angiogram. Would they see this sort of angina on that if there are no obvious narrowing? I'm praying there's nothing wrong and it's all psychological but it could be vasospastic angina as I do get very stressed. I'm living with an unhealed sternum and a paralysed diaphragm cos they severed my phrenic nerve during surgery.

Hope you're doing OK, life will never quite be the same will it?

Susie x

[Milkfairy Heart Star in reply to Sljp0000]

Hi Susie,

I am sorry you are still having problems. You have been through so much already.

You're right life is never quite the same when we are bowled unwelcomed challenges.

The triggers for my coronary vasospasms are the cold, emotional, mental and physical stress. I experience most of my symptoms at rest. I can usually exercise but if I do too much I'll experience a delayed response of more chest pain later.

A severe coronary vasospasm can cause a rise in troponin blood levels as well as ECG changes.

Vasospastic and microvascular angina are types of ischaemia/ angina non obstructive coronary arteries INOCA/ANOCA .

These types of angina are due to the small blood vessels not working properly, microvascular dysfunction or transient constrictions of the coronary arteries, coronary vasospasms.

It's possible to have microvascular and vasospastic angina as well as obstructed coronary arteries.

A routine angiogram checking for blockages will not be able to detect whether the coronary arteries are not working as they should.

This requires a functional angiogram when adenosine and guide wires are used to measure the way blood flows through the small vessels then another chemical acetylcholine is used. Normal functioning coronary arteries should dilate in response to acetylcholine if the coronary arteries constrict then vasospastic angina is diagnosed.

Unfortunately only a few centres in the UK carryout this type of testing. Also many Cardiologists have limited knowledge about microvascular and vasospastic angina.

Have you discussed whether microvascular or vasospastic angina could be a cause of your ongoing symptoms with your Cardiologist?

I am still recovering from my latest hospital stay to bring my unruly vasospasms under control.

Otherwise I am looking forward to the warmer weather.

I hope you find the answers to why you are having your symptoms soon.

[Sljp0000 in reply to Milkfairy]

Thank you for your reply Milkfiary. Always full of great knowledge and wisdom.I only had a phone appointment when the Cardiologist agreed the angiogram so not discussed these types of Angina. I guess I'll wait and see what they find first. Of course, i could have another blockage or restenosis but its just the pains are so different and at rest. It sounds like they wouldn't be to test for this in Derby anyway.

Thank you for your support as always. I do hope you recover quickly and that you get some quality time without pain.

Love Susie x

[Tos92]

Hi Schnoodlefan,

Sorry to hear about your heart attack.

You have already been given some information so I won’t repeat it but I will share my experience with you in case it helps.

I had a heart attack, also known as a MINOCA (myocardial infarction non-obstructed arteries) in January 2022. I had no obstructions and stress was considered the main factor at the time. I was under a lot of stress 1.5 years prior to the MINOCA and I exhibited signs of angina consistently but it was never diagnosed.

I had a coronary artery spasm which triggered the MINOCA. There are other reasons for a MINOCA or a heart attack without non-obstructed arteries so it is important that the cause is ruled in/out.

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

I have since been diagnosed with vasospastic and microvascular angina which are rarer forms of angina. Stress triggers spasms for me. This is mental, emotional and physical stress.

My angiogram found a congenital heart defect in the form of a bridge and this was seen spasming at the time of the heart attack. I am one of a minority of people that are affected by the bridge. I have the angiographic evidence and I can see my artery narrow/constrict almost completely, before opening back up again. I would probably ask for clarification on what “closing your arteries down fast” as a result of the stress test means. This could be an indication of vasospastic angina.

It is difficult to get doctors and cardiologists to acknowledge and understand the seriousness of this type of heart attack. I was not offered cardiac rehab and I had to push to get an appointment with my local cardiologist 9 months after my MINOCA. As my MINOCA happened abroad, it did make my case a bit complex however, could you ask to be referred to cardiac rehab by your GP or cardiologist perhaps?

I was recently able to see a specialist in INOCA/ANOCA (ischaemia/angina in non obstructed arteries) where I was able to get confirmation of my diagnoses. You might find the below website helpful as well.

inocainternational.com

I find walking, meditation, breathing exercises and spending time with my nieces as good ways of managing my stress. Therapy may also be something that you want to consider at some point.

What medications were you released on?

I hope you are able to find some answers soon.

All the best.

Tos

[fishonabike]

I fully support what Milkfairy ry and Tos92 have said - please push for answers and further investigations - it is important that the underlying ause of this issue is clarified so that steps can be taken to reduce and avoid further consequences

you can request copies of your records from the hospital under Freedom of Information rules - their website should give details of how to do this - also you can request to be copied in on all communications about you to others, starting with the hopsital and your GP

[Mommasheart75]

hey there friend.. i too had a heart attack brought on by high levels of stress,known as TAKOSUBO syndrome basically a broken heart syndrome. All caused by stress. I am currently fighting trying to get disability since any exertion hurts me and strains my heart more. Please find you time to try and destress. It’s so hard these days with folks having things going on in daily lives. Sorry I can’t give exact things for you to do except slow down watch your diet and make time for yourself. Go get a massage. Usually helps me… I wish you all the luck