Angina stable or unstable

[Kettl]

My 81 year old mothers suffers from what I assume is angina. It seems to happen at rest but when she is talking about something she feels stress regarding eg. moving house. It also happens during short bursts of exercise. It settles after a few minutes. She is not on a spray for this but is on lots of blood pressure and cardiac meds. She mentions it to her G.P but they fob her off. In saying that she usually goes in with 5 different complaints. She is extremely exhausted and sleeping a lot. She does have low iron and boarderline diabeties. Should I try and speak to the G.P? Mum refuses to let me go to appointments.

[sandandkev]

Unfortunately I don't think you can do anything with her gp without her permission, it must be difficult for you

[Kettl in reply to sandandkev]

Thanks, yes it’s frustrating.

[Sambobs17]

hi Ketti - this might help or not, I worked in general practice and relatives to our patients would ring prior to there relative’s appointments with there concerns, we would always pass onto the GP they were seeing just to give them heads up, the doctors I worked for were of the mindset the more information about the patient the better as I say that might just depend on the workings of your mums practice but you know it’s worth a shot just explain she wants to be independent therefore, does not want me with her on appointments but she’s probably not explaining the whole story hope this helps a little 😊

[Kettl in reply to Sambobs17]

Thank you, I will try this. I k ow she is going back next week.

[Sambobs17 in reply to Kettl]

Honestly they should listen to your concerns that’s what they are there for - it’s your mum’s generation fiercely independent which is great but doesn’t help in situations like this please let us know how you go on hope you get sorted 😊x

[Kettl in reply to Sambobs17]

Very true.

[Qualipop in reply to Sambobs17]

Yes I've done that about my husband who would never dream of asking a doctor any questions and certainly wouldn't tell them what they needed to know. I've also phoned one hospital department with concerns when he hadn't seen them for about 4 years and wouldn't do anything about it. . They were brilliant and wrote with an appointment making out it was simply a check up.

[Sambobs17 in reply to Qualipop]

I’m laughing to myself as I’m married to one that’s exactly the same - takes everything as read doesn’t ask too many questions example I knew some years ago now, we had arrived at A&E tests later they were ready to discharge him which I was baffled about, luckily I caught sight of his ecg I know enough to know there was a change on it didn’t know what exactly but a significant blockage asked the doctor who was about to discharge him ‘can I ask about this on my husbands ecg’ aaah yes next thing he was being admitted to heart care moral of the story ask, ask and ask again especially when it comes to men😂

[valeriep in reply to Sambobs17]

Yes, my sister was worried about her mother-in-law not eating and losing a lot of weight. She refused to let even her husband go into the surgery with her when she saw her GP and always wore a coat, so he couldn't see how thin she was getting, so who knows what she was telling him? My sister wrote to m-i-l's GP to explain the situation, and he found an excuse to drop in and see her in her home unannounced 'for a routine visit' and immediately sent her to hospital for tests. So they do listen. However, they cannot discuss the case with you directly without the patient's permission, due to patient confidentiality regulations.

[Kettl in reply to valeriep]

Good to know. This makes me hopeful.

[Qualipop in reply to valeriep]

We had a similar problem with my mother in law. It turned out , being deaf, she'd lip read a nurse mentioning cancer (in a different patient). She'd assumed the nurse meant her so, not wanting horrible treatments, she just decided to not eat- an easy way to end it all. If I hadn't told the doctor she wouldn't have lived to be 93. My husband, also deaf was put on omeprazole which he refused to take because he "Didn't have any stomach problem". He'd simply not heard the doctor tell him that symptomless acid reflux was destroying his voice box. He refused to wear his hearing aids along with a mask and glasses. I had to get him an appointment for the doctor to explain it to him. Unfortunately he left it too long and now 10 years later, I can barely understand what my husband is saying. The tablets did slow it down but he should still be taking them and won't because he still doesn't really understand it. There's a limit to what you can do.

[Gigi70]

hi

Thus would not be the case if this were your father!

Women get poor treatment for heart disease. It’s clear she needs and immediate angiogram. She should be referred to a cardiac consultant.

Suggest she change GP. This is a very serious dereliction of her current GP’s duty of care!

Michèle

[Kettl in reply to Gigi70]

I agree and in saying that. My mum is just as likely to be lying to me about telling the doctor. She wants to continue travelling and has been very reluctant to mention her heart as it would affect her insurance. Don’t get me started. She makes me very angry.

[RailRover in reply to Gigi70]

I don't believe this at all. There is difficulty getting the system moving, for sure, and the older you become the harder it gets, but I don't believe it is based on sex discrimination. Why should this be?

[Gigi70 in reply to RailRover]

A BHF-funded study has shown that even with improved diagnosis of heart attacks for women using a sex-specific blood test, women were half as likely as men to receive recommended heart attack treatments.

[RailRover in reply to Gigi70]

Interesting, but it doesn't make sense. Are we to believe that the cardiology branch of medicine is sexist? Cardiologists are human, and some of them are female, including the wonderful young woman who operated on me. Those that aren't female have mothers sisters and daughters who they presumably would wish to receive the best of care.

[Milkfairy Heart Star in reply to RailRover]

There is plenty of research evidence that demonstrates that women do not have equal access to cardiology care, they are less likely to be offered early interventions, less likely to be prescribed the appropriate medication or invited to cardiac rehab. Women have poorer outcomes.

The BHF published their Bias and Biology: The Heart Attack Gender Attack in 2019.

bhf.org.uk/what-we-do/in-yo...

The Lancet Women and Cardiovascular Disease Commission report was published in 2021. Again highlighting the inequalities in care for women heart patients.

thelancet.com/commissions/w...

This is a quote from the article below.

"Women are subject to gender inequality and inequity when it comes to their cardiovascular health. There are numerous reasons why this may be the case"

academic.oup.com/eurheartj/...

[RailRover in reply to Milkfairy]

Again, an interesting read. I note that one of the factors cited is later presentation in women, so of course this is more a matter of education among patients than a failing of the care system itself. Another is a greater tendency to obesity. Maybe a campaign of greater awareness of risk among women would be worthwhile. It's well known among patients that time is of the essence in achieving better outcomes.

I still struggle with the implication that there is some subtle malign force depriving women of the same standard of care afforded to men. It also seems counterintuitive to claim, as does the linked article, that women consume less fruit and veg, and are less likely to maintain prescribed medication than men. I'd have thought it the other way round, and that women are more diligent in these matters.

[Milkfairy Heart Star in reply to RailRover]

There is an acknowledged bias that women do not have the same access to heart care.

It maybe an uncomfortable thought that there are any instituitional biases within healthcare, however they sadly exist.

Not believing or listening to women or denying there are problems is part of the problem.

I agree that women, society as a whole and healthcare professionals need to understand the difference between men and women.

Women often seek help later as their symptoms can be different, they don't want bother anybody or they have had such poor experiences of care they decide not to seek help.

Another factor is that women are often initially misdiagnosed by medical staff which compounds the issue.

Many are told they are experiencing anxiety or a panic attack rather than angina or a heart attack.

Women have a different pattern of heart disease.

10% of heart attacks occur without pernamently blocked coronary arteries, a myocardial infarction non obstructive coronary arteries MINOCA. MINOCAs disproportionately affect women.

The common causes of these types of heart attacks are microvascular dysfunction, coronary vasospasms, spontaneous coronary artery dissection, a small piece of plaque or a blood clot blocking the artery.

These conditions effect women more than men.

Perhaps ask whether women heart patients feel there is an issue?

We're the ones with the lived experience of bias and prejudice.

The Global Heart Hub recently produced this report.

globalhearthub.org/women-an...

[Kettl in reply to Milkfairy]

Thank you for this information

[davidthegolfer]

hi, I’m a little concerned that it hasn’t been properly diagnosed. If it is angina the episodes won’t get better but there is a chance they could increase in frequency in my personal experience. Over the years mine became worse and I eventually had surgery. There are solutions. Stents for example. Sometimes when they are checking blood flow etc. they can pop a stent in and for most that is sorted. I am not suggesting that will be the route but I know only too well what causes it and it won’t just go away. If you can, you need to be diplomatically persuasive and have her insist that the Doctor has her properly checked. So she is 81 but these days that’s nothing. She has plenty of good years in her to come and getting this sorted could improve that quality. My life became a misery until the wonderful people at Liverpool Heart and Chest Hospital sorted me out.

[Kettl in reply to davidthegolfer]

Agree, as I’ve said above it may not be the G.P’s fault. It’s just as likely that she is not telling me the truth. Think I’ll just call the G.P office and ask the best way for me to pass on some information. It just makes me feel like a naughty child going behind her back.

[Tigger1969]

Hi KettI I would try and speak to your mothers GP. if that's at all possible.I've had unstable angina for many years but have found certain things in life set it off.

Worry and Anxiety are the worst culprits,but even if I'm feeling relaxed it can occur. I always keep my GTN spray handy

when I have a bad episode. It might even be a good idea to speak to a pharmacy, you can actually purchase the spray over the counter. The spray does help with the pain.

Good luck, hope your mother can get some help with her condition.

[Kettl in reply to Tigger1969]

Thanks, it does seem to be worry/anxiety driven.

[devonian186]

It sounds classic angina but we are not clinicians and only have a part of the story.

If you can prewarn the GP and describe the symptoms then it seems it would then be up to your mother to make the appointment, but I do think she needs to be seen.

[Kettl in reply to devonian186]

Thanks

[Lowerfield_no_more]

Unfortunately if your mother refuses to let you go to appointments then there is not a great deal you can do for her directly with her own GP, unless you persuade her otherwise. However couldn't she see another GP at the same practice, on the basis that there are usually several to choose from. I haven't seen or dealt with the GP I am registered with for years, that's just how it works out. Or she could ring 111 and see if they can diagnose although there is a possibility that they will send her back to her own GP. She or you could talk to the BHF heart helpline nurse for a professional opinion on her symptoms although the nurse will not be able to offer direct action. Or you or she could write to the practice and complain about the lack of understanding she is getting, and deserves better. I often find that works in resolving issues. Finally if it is stable angina then a consultation with the local pharmacist might be beneficial since they can provide an over the counter GTN spray which is used by angina sufferers, and if this an outcome that works it is 'ammunition' to take back to the GP to get them to give your mother the attention she deserves.

[Kettl in reply to Lowerfield_no_more]

It’s just as likely that mum didn’t tell her G.P and told me she did so I can’t get all angry at them. I think it’s time I forced the issue though. It’s worrying and so unnecessary. Mum doesn’t really believe doctors know what they are doing which doesn’t help.

[fishonabike]

I am not a doctor but (as an ex nurse and longish-term member of another forum about a specific heart issue mostly experienced by women) to me it sounds as though your mother had an undiagnosed condition now referred to as ANOCA or INOCA, this used to be classified as unstable angina and has not been treated very effectively in the past - it is now better understood - I hope that Milkfairy sees this and offers info and advice

with the right investigations your mother's condition could now be better identified and treated - but only she can ask for this, unless you have the appropriate power of attorney so that you can also speak to her doctors

I can understand that it is hard for her to deal with doctors who don't seem to respond to her needs - GPs work ing different ways now and, sadly, expect us to prioritise our conditions rather than treating us as whole people - but it is hard for some of us to help our older relatives deal with this approach

[scentedgardener]

I have, more than once, written a note to a family member's GP, marking on the envelope for his/her attention before appointment on whatever day and time. They cannot discuss the patient with you unless they have the patients permission but they can, and do, listen.The first time was for my adult niece, and I was actually accompanying her, but I knew she wouldn't be totally forthright, and didn't want to give the appearance of putting words in her mouth. I told the GP that I was giving him this information so he knew what questions, etc, to ask her, then he could decide the best course of action.

Very much worth doing.

[Happyrosie]

I worry that she’s going on holiday and. It telling her insurers about her medical condition. If she travels abroad with , effectively, no insurance - because she hasn’t correctly completed the application form - they how would she be able to afford treatment and repatriation?

[Kettl in reply to Happyrosie]

Believe me. I worry about this also. Last time she had to come home early with wheel chair transfers. She is a live life while you can and if I die doing what I like then so be it kind of lady. I just keep saying, it’s hard to enjoy life if you die from a preventable heart attack. She doesn’t listen to me because she thinks I’m a worrier. In her defence I do feel she has some signs of dementia which is another thing I’m trying to get her to seek help with.

[theonethatgotaway1]

Sounds very much like Angina. A GTN spray or nitrate medicines may well be the solution to relieve the symptoms of pain. There are options of other treatments too. Probably best to push to get this checked out.