Hello , does anyone else get Angina at rest when anxious/stressed, but not when exercising? If so , was there any medication/therapy that helped you?
I have confirmed myocardial ischemia during a mycocardial perfusion scan , and unobstructed arteries , confirmed by an angiogram , I do have narrowing in one section but nothing worth stenting .
I am on
Statin 80mg
Diltiazem 180
Lorsortan 100mg
Asprin 75mg
GTN Spray
Blood Pressure good ( Unless stressed)
Cholesterol Good
I am fine exercising and always have been, I do get Angina attacks when anxious or stressed . The Diltiazem has helped,but the attacks still continue. I have an appointment with my Cardiologist in June , but before that , I was wondering if anyone has experienced the same symptoms as me , and if they can offer any advice.
Thank you
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Justdoit2015
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I read from your previous posts you have asked about microvascular and vasospastic angina.
I have lived with vasospastic angina for over 11 years.
Vasospastic angina is thought to be due to the inner lining of the blood vessels not working properly and hyperactivity of the smooth muscle in the artery walls.
I experience most of my chest pain at rest especially during the night.
The main triggers for my angina are the cold, mental, emotional and physical stress.
I tend to experience my chest pain after my stressor so I rarely experience chest pain when I exercise.
I will have more symptoms later if I've done too much or done something stressful.
Unfortunately after over 11 years of living with vasospastic angina and seeing world experts in the condition, I live with refractory vasospastic angina, I don't respond well to my medication.
I am on 360mgs Diltiazem twice a day, nicorandil, Isosorbide mononitrate, nitrate patches, clopidogrel and statin.
I anticipate that I will have more symptoms if I have done something stressful.
I spoke at my local hospital's research open day this week about my involvement in research.
I also met someone that I didn't really want to see.
The result was that I had more chest pain in the evening and through the night.
Thank you Milk Fairy . I am still on a list to be diagnosed with Vasospatic/Microvascular Angina . I will read through the article you posted. Thank you . Like you it is stress , such as dealing with someone I don’t like that can bring on tightness and chest tightness that lasts hours not the 15 minutes normal angina brings .
Hi Justdoit2015 I am going through something similar at the moment I get no real pain when exercising but have a really heavy chest feels sometimes as though something is pressing down, i always take my spray when any pain involved all my discomfort and pain is at rest not when exercising.
The consultant phoned me this week and has prescribed Isosorbite Mononitrate I took my first one this morning and now my head is spinning I don’t know what is worse !!
He is going to phone me again on Wednesday / Thursday next week, I had a HA in 2022 no pain at all just a heavy feeling in the chest ended up having a bypass
It can take a while to get used to taking Isosorbide mononitrate. You can have the ' nitrate head' a really bad headache for about two weeks. Drinking lots of water and taking paracetamol helped me get through this.
I am now on 120mgs of Isosorbide mononitrate which I take in divided doses at 6pm and 11pm.
You might find this information from the BHF website helpful.
Some people have angina due to either the small or large blood vessels not working properly, microvascular dysfunction or coronary vasospasms.
My hubby was diagnosed with angina, not because of his large arteries but the small ones. He gets tightness and heaviness but no pain, mostly when walking and recently at rest but not regularly. He finds it odd that he can go to the gym and pull weights with no symptoms but can’t walk or jog without having to use his nitrate spray,
Hello,Microvascular angina and vasospastic angina are strange!
Research is only just beginning to understand these types of angina. There is a growing awareness that how the blood vessels function is very important not just how blocked the coronary arteries are.
The small blood vessels need to dilate and then stay dilated in response to extra demands like exercise. If they don't then a person is said to have microvascular dysfunction.
After exercise the blood vessels should return to their normal diameter, in some people their blood vessels over react and the blood vessels go into transient constrictions.
These vasospasms can happen in the microvessels or coronary arteries. This is vasospastic angina.
I can exercise, but afterwards I will get chest pain as my coronary arteries constrict as I have vasospastic angina.
I suggest your husband keeps a log of his symptoms and discusses his findings with his Cardiologist, it maybe necessary to review his medication.
Thank you for your reply . Is Isosorbite Mononitrate a nitrate? I was prescribed a nitrate at one stage but decided against it as it interfered with other medication I am taking .
Anxiety is like a form of exercise to your body as well as your mind . Exercising and Anxiety , Pain or Panic all cause the body to experience something called Sympathetic Vasoconstriction.
Sympathetic Vasoconstriction sounds scary but it's actually just your nervous system responding to the need to react to a change that requires action , and telling the blood vessels to tighten causing the heart rate to increase to try to keep your blood pressure stable while increasing blood flow to the muscles, the blood needs to pump harder to get around to the places it needs to go.
But this can also trigger microvascular angina as the reaction can cause more stress in the smaller coronary blood vessels which are more sensitive to change or weaker in someone with Angina.
People with Angina are sensitive to any form of Stress, and Stress isn't just a bad thing either.
Stress is any form of physical or mental activity, either physical or mental , good and fun, or bad and sad, that is just too much for your body or brain to cope with at it's current health level.
Anxiety is just one type of Negative Stress.
Exercise is another type of Stress which can be positive or negative.
Which is why both can cause an Angina attack , even if you may be sitting for one and being very active with the other, they both cause the same internal body responses in your Autonomic Nervous System and your Cardiovascular System.
Angina can also be caused by the way your breathing changes under physical or mental stress .
During exercise or an extreme mental effort ,like fear or excitement, your breath can become shorter and you take in smaller amounts of air that can be too quick or shallow.
Often you don't notice you are breathing too shallowly until it's already become more urgent then you begin gasping.
This is called Hyperventilation.
Hyperventilation can reduce the amount of oxygen you consume and cause the need for sympathetic vasoconstriction to improve oxygen supplies to your essential body parts and this can trigger Angina.
A panic attack is an example of when these two physical changes collide and can cause cardiac symptoms.
One way to help reduce Angina or other cardiac health flares is to learn ways to control your Stress.
Whether you are exercising or having an emotional reaction learn the signs that your body reaction is overreacting and respond to it.
Sit or Rest until the symptoms improve.
Drink some cool water which helps improve temperature and blood flow , but also distracts your nervous system to take the foot off the " fight or flight " pedal and respond to the change in temperature and digestion instead.
Do some deep breathing exercises with eyes closed if possible in a supported or comfortable position , or safe area if you are outdoors.
Distract your mind as well if Mental Stress or Anxiety is causing the symptoms.
You can do this by trying some mental distraction exercises like actively making your mind blank or thinking of a calming thing or place , start with a colour, water or something soft or an easy thing which makes you feel relaxed.
Another useful distraction tool is to counting to 100 as you slowly breath in and out at a rate of five numbers or seconds per breath .
Still using the slow breathing method breathing in through the nose and out through a slightly open mouth distract you mind with other mental activities.
Look around your room or outside space , spot three things if a certain colour , three round things , three pointy things , three soft things etc.etc. until the feeling of anxiety passes.
Finally , get help in the long term with your Anxiety.
Speak to your doctor and get some medication , even for the short term until your situation is more manageable.
Ask to be referred for talking therapy and a local or online CBT course.
Speak to friends , family discuss your feelings with them honestly and explain simply and positively how others can help you control them.
Write a list of things that are causing the Anxiety and try to avoid them or find practical ways to make them easier.
Join a local or online support group to speak to people whom understand what you experience and can help you with tips or a friend to call when you feel a crisis coming on.
Pace your life with some more balance. It's not a weakness to do less when you need to and delegate jobs to others that you usually do and rest , that's what strong , confident and successful people do.
Don't try to fit too many things in to a day because you feel you have to do things or should be doing something. Cross all those "have to's" or " should do's" off the list.
Only included things on your " To do" list that you really "need to do" or "want to do".
Believe me about 50% of your daily activity is habit or routine and can usually be thrown off your list or only done when you feel up to it and that's often the stuff that causes you the most unnecessary pressure too.
Don't just keep battling on or pushing your mental health to one side because as you have seen yourself your physical health suffers because of it.
You will get there in the end and get things under control in a way that controls your angina too, have patience with yourself , you deserve to give yourself a break.
Do you have a lived experience of microvascular or vasospastic angina?
Understanding how your autonomic nervous systems, two components, the parasympathetic and sympathetic nervous systems is an important strategy in trying to turn down the 'volume' of stress and pain that can trigger an episode of angina.
However great care is required not to give the impression that if a person ' just chilled' they would somehow have no angina.
50% of women have their heart attacks misdiagnosed at first, often being told they are anxious or having a panic attack.
I did not suggest in any way that "just chilling" was all that was required in my reply or that Angina can be cured by Self Care alone. This is something that I feel you may have misread into my comments. If you read my reply again I think that you will see that my suggestions are not written to create the impression that it's easy to cope with these issues .I suggested some practised techniques of CBT to help to reduce the immediate autonomic effects on the body of an Anxiety episode to help reduce the risk of it causing the physical responses that can trigger an Angina event either whilst waiting for further diagnosis and as Self Care afterwards.
And some vasovagal breathing which is recommended to help to control the heart rate when under stress and prevent the risk of various autonomic symptoms increasing and leading to an Angina attack.
Plus, some strategies to help reduce and avoid the stress triggers that the original poster stated they were experiencing which are a key risk factor in cardiac events that combine cardiovascular and autonomic issues.
As well as , the suggestion about getting more support both medical and within their friends circle because I know how helpful that can be to people with. Anxiety .
I'm fully aware of the difficulty for women to get a diagnosis of a heart attack , especially younger women , as my youngest daughter had two heart attacks at the age of 20 ( which were not picked up until she was tested in AandE after attempting to take her life last year because of the level of chest pain and disability she was suffering from whilst waiting to be seen by a Specialist) and was then diagnosed with vasospastic angina as well as POTs but only after a terrible follow up Cardiology appointment with a person whom didn't have her AandE notes and flatly stated young women like her don't get heart attacks . I asked him to turn his computer and see the real facts.
Among other conditions my Mother had vasospastic angina and I had to care for her and advocate on her behalf. It can run through families of people with EDS.
As a person whom suffers from vasomotor disorders myself , along with my daughter , I'm also fully aware of the fact that their are many different external and internal stimuli that can trigger our symptoms and the severity of the health issues they cause, like you, I have suffered many Emergency events over the years and despite having Dysautonomia for decades had great difficulty in getting myself taken seriously and diagnosed.
I unfortunately have a number of vasomotor conditions myself because I have Chronic Dysautonomia and EDS.
I've had Ehlers Danlos Syndrome from birth and it effects all of the connective tissue in the body and caused the vascular and nerve instability that triggered the CD as well as triggered a genetic flaw in the macro electrical system of my heart causing Sinus Node Reentrant Tachycardia to develop.
I also have autonomic and vasomotor variants of POTs, Arrhythmias including aFib, and have intermittent episodes of coronary and cerebral vasospasm.
I have a wide spectrum of subtypes as part of Chronic Migraine Syndrome , including Cluster Headaches and Vestibular Migraines these cause me loss of motor skills , stroke like speech impairment, temporary amnesia , sudden fainting , extreme vertigo, convulsions , and Parkinsonism triggered once again by my autonomic dysfunction and vascular instability and made worse by a functional B12 Deficiency.
I also have Raynaud's Syndrome , Pseudo Bowel Obstruction Syndrome , Central Nervous System Sensitivity Syndrome, Chronic Pain Syndrome , Fibromyalgia and Small Fibre Neuropathy. There is sadly a lot more but these are the main autonomic and vasomotor related conditions I experience.
So you can believe me when I say I'm the very last person whom would ever take anybody's symptoms lightly , and especially not the impact that Mental Health has on a person's health conditions.
I'm painfully aware of the complexity of living a life with autonomic and cardiac dysfunction and that the triggers are varied , commonly include sudden changes in temperature , air pressure and other external stimuli and sadly feel like a full time job to keep under control so that you don't increase the frequency of cardiac or neurological events. That's why I think all these tips learned from our experiences count so much when replying to people whom a new or very nervous to these health issues.
I'm just hoping that our interaction hasn't caused any additional discomfort for the OP, but I felt the need to respond on this occasion. If you would like to continue the conversation please feel free to PM me as I don't want our discussion to take over the post.
Thank you for your detailed reply. I am still consuming a lot of the information. I will probably send you a PM tomorrow, when I have more time , as I note we share some diagnoses . I too have been diagnosed with Raynauds, Fibromyalgia and Hypermobile EDS , IBS amongst a few others . I have always suspected vasospatic angina , as when I was first given beta blockers , my chest pain doubled in intensity and frequency and I suddenly became allergic to everything, and had life threatening angiodema of the throat and was prescribed EpiPens. Apparently beta blockers are contradicted with these forms of Angina . I will hopefully send a message tomorrow. Thank you . Benjamin
Feel free to PM me, I'm happy to help if I can , or just be an understanding ear if you need a good rant.I've had similar experience with beta blockers as well but I was originally given them before my cardiac diagnosis for other health issues with rather alarming heart rate increasing / blood pressure lowering effects , I have other medications specific to my conditions now.
I've also had a few allergic and severe intolerance reactions to other medications for other conditions , so it's taught me to double check everything before I make the decision to start a new medication.
Carbamezipine caused me waking convulsions after one dose . Unfortunately as I was walking through the narrow alcove to my sitting room , so my head banged every wall and the door as I went. Valium sent me to sleep for two days , so that was two hospital events.
Beta blockers and Amitriptyline did the opposite severe hypotension dips increased my Tachycardia instead of reducing it and caused palpitations and insomnia.
Topiramate , instant migraine and palpitations and I didn't sleep for three days , again after one dose. The irony was that I'd been given it to treat my migraines and improve my sleep!
And as a nurse once learned to her cost , don't give me Codeine when I say I can't take it , within twenty minutes my face swells and I do a really good impression of the vomiting girl in, 'The Exorcist', she was standing in the way at the time !😆😆😆
Recently I was trialled on the Ajovy injection for Migraine , it lasts a month , it triggered aFib , Tachycardia events and Vasospasms. Of course , you can't take it out once it's in , so that was a rather unpleasant, nervous Christmas season for me last year.
I know it sounds terrible , but as you know from your own experience with our collection of conditions hypersensitivity to medications can be very common and sometimes severe. It doesn't mean these drugs are bad , just that we have a bad reaction to them. They work wonders for others but unfortunately "one size does not fit all" .
What's a " Cure " for one person can be a " Curse" for another.
But with care , and double checking, it is still worth going through the trial and error to find what treatment , dose or timing works in your case with all the different conditions you need treatment for. I never give up hope .
It's not a cure but getting to the point you can manage your conditions as well as you can and help reduce your risks of new or severe attacks is always worth trying in my opinion.
I knew of a muscular fellow who worked a very physically demanding job without symptoms. He had coronary artery disease and the only time he had angina was when he got upset at his children,especially at the dinner table. This demonstrates a difference in his sympathetic nervous system and how it reacts to emotional stress compared to physical exertion his body was accustomed to.
I mostly get my Angina pains at night . They waken me up or I get them whe I am sitting reading or watch television rarely get them when moving around .
I was told this is not good when you get angina pains at rest, that is unstable angina and can lead to heart attack, I would mention this to cardiologist asap
Yes, I had unstable Angina, I had blockages on my left Coronary LAD of 90%. And 70% blockage on my right. Angina would manifest during the night when sleeping. I regularly had back pain which was the Angina.
After my CABG x2 all is resolved with no further Angina eposides.
Hi,I have Angina too, sometimes out of the blue, for no reason, other times when stressed and anxious. I don't do any strenuous exercise, because I know it will bring on my Angina.
I do take Ranolazine for Angina,which I notice you don't take, I don't know if it's appropriate for you though.
My gtn is a life saver though, it's just a thought, ask your cardi or doc are you allowed to use your gtn when you first feel anxious or stressed, to see if you can catch it before you have an angina attack. When I first had angina I didn't know I was going to have one at all really,but, as time passed I can sometimes feel it coming, then I take my gtn and ride it out, sometimes short, sometimes long, then I want to sleep as my chest sore and take co codamol, I have other body sensations too. Hope you get it some answers
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Exercising with Angina
palpitations when exercising - 200bpm 
How do people balance exercise and rest?
More angina when walking
Short Angina. Advice please
