Hello everyone l had a appointment with my cardiologist on Monday 11 March with reference to the increased frequency of angina attacks I have daily and was told that he suspects that I have vasospastic angina which is affecting my small arteries. The step taken was to increase my Ranazoline medication from 1000mg to 1500mg per day and Isosorbide from 60mg to 120mg per day as a means to improving my symptoms.
Yesterday was my first full day of taking the increased medication and my angina attacks was almost constant all day and through the night ( every 30 -60 mins) which has just drained me. It continues today but I’m not sure if it’s due to medication changes and I have to wait for things to settle or what if there is anything else happening.
With this in mind could anyone who has had similar experiences please let me know if it is possibly due to medication.
Thankyou
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Toffodog
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You mention that you have vasospastic angina affecting the small arteries. Do you mean microvascular angina? Vasospastic angina tends to affect the larger blood vessels or arteries whereas microvascular affects the smaller blood vessels.
A confirmed diagnosis of vasospastic angina is achieved via a functional angiogram using acetylcholine most of the time. My situation was slightly different as one of my arteries was seen spasming on an angiogram during the time of my MINOCA therefore, specialised testing has not been performed or considered necessary at this time.
A diagnosis for microvascular angina can be obtained via a stress MRI using adenosine.
My experience with Ranolazine was not very pleasant. I felt like it was making my heart pound, almost like very intense palpitations. It was quite uncomfortable. I was only on a small dosage and for a shorter time than yourself so I don't recall experiencing an increase in my angina.
I would suggest you get back into contact with your cardiologist to review your medication dosages again. Usually, a specialist in vasospastic and microvascular angina can suggest different medications to try to help alleviate your symptoms. I have found that a specialist is more helpful than a general cardiologist when it comes to treating these rarer types of angina.
There are other users with similar conditions and also the same medications. I hope they will offer their experiences.
Thank you for your response, I had a angiogram in January and was informed I had unstable angina and given medication to control this however due to the increase frequency of angina I was given a urgent consultation in March and the consultant said it was probably a spasm in my smaller arteries and suggested vasospastic angina and adjusted my medication but as I say the angina continues so I’m waiting for another appointment now once my case has been discussed with the medical team.
Hello,Have you been offered any testing to confirm your diagnosis?
Coronary vasospasms, transient constrictions of the blood vessels of the heart can effect both the large and small blood vessels.
I have a confirmed diagnosis of coronary vasospasms following an angiogram with acetylcholine, 10 years ago.
I have vasospasms in my coronary arteries and microvascular vessels, technically both vasospastic and microvascular angina.
The treatment for coronary vasospasms whether they occur in the small or large vessels is the same.
My ' official ' diagnosis is Vasospastic angina.
Microvascular angina is more often caused by the inability of the small blood vessels to dilate or stay dilated in response to exercise, microvascular dysfunction.
Microvascular dysfunction in some cases be diagnosed by a perfusion MRI or during a functional angiogram when adenosine and guide wires are used to measure how the blood flows through the small vessels.
The treatment offered to treat microvascular dysfunction is different to coronary vasospasms.
Beta blockers for example can help treat microvascular angina but can make coronary vasospasms worse.
Ranolazine is a marmite medication you either tend to love it or hate it!
The evidence suggests that Ranolazine tends to help patients living with microvascular dysfunction rather than coronary vasospasms.
Like Tos, I didn't get on with Ranolazine, I ended up with palpitations and worse angina symptoms.
I was prescribed beta blockers before my diagnosis of vasospastic angina was confirmed and I landed up in hospital with unstable angina as a result.
Since my diagnosis over 10 years ago, I have seen an increase in the awareness and understanding of microvascular and vasospastic angina by Cardiologists.
Whilst, in the past I have been seen by specialist Cardiologists who researched these rarer types of angina, I now see an Interventional Cardiologist at my local hospital who listens and is willing to work with me to help support me to manage my refractory vasospastic angina.
He is very proactive in looking up the latest research into vasospastic angina.
He uploaded this recently published paper onto to my care plan and electronic medical records.
I suggest you keep a log of your symptoms, how you respond to your medication and discuss this with your Cardiologist at your next appointment.
I take staggered doses of Isosorbide mononitrate, 60mgs at 6pm and 11pm along with GTN patches.
When making changes to my medication, I do it one medication at a time, so I can tell which one is causing any side effects.
I am prescribed Tildiem retard a calcium channel blocker. Calcium channel blockers are the usually offered to treat coronary vasospasms and microvascular angina.
If you continue to have more angina as you describe I suggest you call 111 for further advice.
We all respond to medication differently, it can take trial and error to find the best combination of medication that will work best for you as an individual.
Perhaps also ask if it is possible to be offered further testing to confirm your diagnosis.
Thank you so much for your response which is extremely interesting and now being armed with the information you provide it will be useful when I next see my consultant. I have had no further investigation into why this is happening and been told it is unusual to have so many attacks and my consultant is due to meet with the rest of the cardiologist next week to discuss my case I will then be given a further appointment but not sure when this will be. I will be contacting the secretary tomorrow as I was told to call if symptoms still existed , so if I get through to the cardiologist I can use some of the information you have provided as a guide to try and get to the bottom of things, all I want is to have a proper diagnosis and understand what treatment I will receive to control the illness, once again thank you for your response,
Yes for me, ranolazine, isosorbide and diltiazem all made my angina worse along with side effects including constant headaches. I don’t have what you have but these meds increased the intensity of my angina.
But we are all different, the problem is it can take a couple of weeks at least for meds to kick in / side effects to settle.
But as your having quite a distinct and immediate response to the increased meds, like Milkfairy said a call to 111 or your GP if you can’t get through to cardiologist quickly, make them aware of what is happening.
I was relieved to not have to take them once doctor said I could stop but now I have no meds that reduce my angina.
Good luck and hope you find the right mix of meds.
Sorry for my late response the messages went into spam and I don’t usually look but anyway I’ve retrieved them. Thank you for your response which is very helpful. I managed to get through to the consultant via his secretary and was told that the increase in angina attacks is unusual so was told to continue with the medication and use the sprays and if the pains lasted longer than 30 minutes to go to A&E. After 2 weeks im still getting the high frequency of angina and taking the GTN and waiting for my next appointment so I’ll update this group once I have seen the consultant.
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