Unstable Angina - Carotid ultrasound scan?

[ootihat]

Hello, I'm here because in the last month I've had mild unstable angina symptoms - discomfort in shoulders and upper chest spreading to both or left arm and outside lower jaw. I went to A&E and had standard same day tests including electrocardiogram, chest Xray, bloods (troponin etc). Everything was negative but they're treating it as angina, have prescribed aspirin and GTN and are referring me for a MIBI scan. That may be as soon as a month but no appointment date yet.

In the meantime I'm in the waiting limbo. I have some questions.

My symptoms are of unstable angina, i.e. happen at rest/night or after very slight exertion, never during strenuous work. But standard unstable angina is a symptom of atherosclerosis. I can't find the answer, but wouldn't any angina due to atherosclerosis show up during hard exercise first?

So I'd like to know the state of my arteries, which I don't think the tests I've had would definitely show. I'm looking at more affordable same-day tests. The gold standard nowadays seems to be a CT calcium score but I'm sure that would be pricey. Echocardiograms and Carotid ultrasound are more affordable. Would either of these tell me anything valuable? Even if it wouldn't change my treatment I'd like to know. If my arteries are clear then that surely rules out a lot and maybe even point to a non-heart cause. Should I go for either a Carotid ultrasound or an echocardiogram?

Lastly, will the MIBI show arterial plaques?

[Milkfairy Heart Star]

The BHF has this information about angina.They list four types, stable, unstable, microvascular and vasospastic angina.

bhf.org.uk/informationsuppo...

A stress echocardiogram or a treadmill exercise test can usually help detect angina.

A CT angiogram is usual offered to see if there are any permanent blockages, however you can have angina without blocked coronary arteries, microvascular or vasospastic angina.

The BHF has this information about microvascular and vasospastic angina.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

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

bhf.org.uk/informationsuppo...

[ootihat in reply to Milkfairy]

Thanks Milkfairy , I think I can rule out stable angina. No sources are clear about whether unstable angina (non- microvascular and non-vasospastic) would give symptoms on strenuous exertion as well as slight or no exertion. Vasospastic might fit the bill. So might costochondritis and other things but many of their symptoms aren't present.

I will ring a BHF cardiac nurse, thanks! They may say different, but at present I still feel that an idea of the state of my arteries would narrow the possibilities greatly.

[Milkfairy Heart Star in reply to ootihat]

Unstable angina and vasospastic angina classic symptom is chest pain at rest.Unstable angina usually leads to chest pain on exertion and happens at rest which is unrelieved by 3 sprays of GTN 5 minutes apart.

It can be difficult to tell unstable angina apart from vasospastic angina.

Most people living with vasospastic angina can exercise.

I have lived with vasospastic angina for over 11 years.

I had no problems completing my stress echo, but then I experienced chest pain at rest later.

I do have chestpain on exertion when I am in an unstable phase of vasospastic angina.

I am then usually admitted to hospital for treatment with IV GTN and morphine. I have dynamic ECG changes such as ST depressions, severe crescending episodes of chest pain, which feels like being in labour to me.

I hope the BHF nurses are able to clarify things for you.

[ootihat in reply to Milkfairy]

 Milkfairy you say that unstable angina usually leads to chest pain on exertion. Do you mean that chest pain on exertion is a later symptom, or that anyone with unstable angina will also normally have pain on exertion? That's something I can't find a clear answer to.

Oh and I rang the BHF helpline but today was a training day. Will try again tomorrow.

[Milkfairy Heart Star]

Unstable angina is when you have chest pain on exertion and rest.

BHF website says:

"Unstable angina can feel different to your normal angina symptoms. It can happen even when you’re resting. Unstable angina feels more severe and lasts longer. Your symptoms might not improve when you rest or take medication.

If your symptoms don’t improve when you rest or take medication, you should call 999 immediately. "

bhf.org.uk/informationsuppo....

[ootihat in reply to Milkfairy]

Yes that does suggest that unstable is a later development after stable angina. In which case, having suddenly got mild unstable symptoms, it isn't unstable angina. It could be vasospastic angina but it's just as likely to be something else not necessarily even heart related.

[ootihat]

Just an update. I had a private carotid sonogram, I just wanted to know if my arteries are OK to rule out a lot of things. The good news, my carotid (and therefore probably coronary etc) arteries are clear. But it picked up an arrhythmia (missed beats). These didn't show on the ECG when I went to A&E but I had no symptoms at that time.