All normal

[Alfiesmum6]

Anyone been admitted with chest pain and elevated tropinin. Angio clear , echo clear and now MRI clear . Discharged back to Gp and can come off meds.Still get achy arm or back after doing too much. What do I do now just go back to normal ?

[Tos92]

Hi Alfiesmum6,

I have had elevated troponin which turned out to be a MINOCA as I think I’ve mentioned on one of your previous posts. All tests have been clear, including my echo, angio and MRI which only showed a very small area of ischeamia that has now resolved. Did you manage to speak to your cardiologist or GP about vasospastic or microvascular angina?

What medication were you commenced on and did it provide you any relief?

Might be worthwhile considering seeing a specialist in INOCA/ANOCA conditions if you’re having ongoing symptoms. Alternatively, you can seek a second opinion on the NHS. The below website has some good, up-to-date information on these conditions.

inocainternational.com

Have you noticed if anything makes it worse or better, such as triggers that set it off? Mine are stress, emotion, cold weather, really hot climate and exertion.

I hope you can get some answers soon.

Tos

[Alfiesmum6 in reply to Tos92]

Thanks , I haven't actually seen my cardiologist and gp only for sick note.

I haven't noticed anything specific but think I will start keeping a note so I can discuss with Gp.

I was out on aspirin, bisoprolol, statin but have been told I can now stop these. Was also given GTN spray but not convinced it worked.

[Tos92 in reply to Alfiesmum6]

Could you call the cardiology department and ask for an appointment if you’re still under their care at the hospital so you can discuss the potential reasons for your symptoms?

The GTN spray does not work for everyone with INOCA/ANOCA conditions. It is a hit and miss for me. Some days it takes the edge off of the pain, and some days it does nothing.

Have other causes for your pain been ruled out that are non-cardiac?

[Boharford]

Had angio in January following chest pain at rest . During procedure surgeon said artery's clear but thought he saw a blockage but it was a vasospasm which then opened up. Now on meds to control spasms

[Ensouleiado]

This happened to me 6 years ago. Discharged and told to stop all meds. Leaves you feeling bewildered!I then saw cardiologist as outpatient who said with tropinin rising to 300 something must have occured and diagnosed cardiac x syndrome which is the old term for ANOCA/MINOCA as mentioned by others. He tried various meds to try and relax my vessels inc ranolazine,diltiazem,monamil but non I could tolerate due to exacerbation of my migraines. So all I have is propranolol for migraine prevention and GTN spray. I belive an angiogram using acetacholine is the test we need to show spasm in the small vessels but I haven't been offered one so far.

So I just try and keep as active as as I can and use gtn if the pain is bad which for me is rare.

[Tos92 in reply to Ensouleiado]

Hi Ensouleiado,

Cardiac X Syndrome is what we know as microvascular angina today. A MINOCA is a type of heart attack also known as a myocardial infarction in non-obstructed arteries. Microvascular angina is considered a diagnosis whereas a MINOCA is a description of the events or incident that has occurred.

I also remember the experience I had on some of the medications that you mention. Migraines seem to be a common side effect. I had the same with Diltiazem, including horrible auras prior to the migraines. Took a month to settle. I also experience very unpleasant headaches on GTN or nitrates.

It’s good to hear you don’t have to use your GTN very much.

I wish you well on your journey.

Tos

[Milkfairy Heart Star in reply to Tos92]

The BHF removed their information on the website about cardiac syndrome X at the request of a patient advisor in 2017, who then helped develop the information about microvascular and vasospastic angina on the website. This patient continues to work with various researchers including being a co author of this paper about vasospastic angina which you may find of interest.

journals.sagepub.com/doi/10...

Often people quote from the work of this patient advisor without acknowledgement.

[Ensouleiado in reply to Tos92]

Yes I know thanks.it was just too long winded for me to write all that lol

[Milkfairy Heart Star]

Hello,

Many years ago I was admitted to hospital with a suspected heart attack.

This was before there was much understanding of angina/ ischaemia non obstructive coronary arteries ANOCA/INOCA.

Microvascular and vasospastic angina are types of ANOCA.

I was incorrectly told my symptoms were not heart related. A doctor abruptly stopped my infusion of GTN which had stopped my chestpain.

The doctor got the shock of his life when he watched me have a very painful coronary vasospasm as a result.

I ended up staying in hospital for 10 days until I had had a cardiac MRI.

I had a functional angiogram using acetylcholine in 2014 which shows I have coronary vasospasms in my small blood vessels and coronary arteries, vasospastic angina.

I suggest you keep a diary of your symptoms. It may help to reduce each medication one by one gradually and record if your symptoms change.

If your symptoms don’t improve or get worse go back to your GP.

Microvascular angina tends to lead to chest pain on exertion and breathlessness while vasospastic angina classic symptom is chest pain at rest especially during the night.

Beta blockers can make coronary vasospasms worse which is why they are not recommended for people living with vasospastic angina.

There is growing evidence that nitrates including GTN spray may not work for many patients living with microvascular angina.

If you have any severe symptoms ring 111 or 999 and go back to A&E.

I suggest you ask your GP to refer you back to a Cardiologist who understands microvascular and vasospastic angina. It's important to have the rise in your troponin blood level investigated further.

It is possible to have angina without obstructed coronary arteries.

It may help to refer your GP to the information on the BHF website about microvascular and vasospastic angina.

In my experience healthcare professionals will take notice of information from the BHF.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

I now have a supportive Cardiologist, I am seen in clinic 3 times a year, I have a careplan to guide the staff how to care for me when I am admitted.

However I had to be persistent to get my diagnosis.