I was diagnosed with Coronary Artery Spasm by a cardiologist in August 2018 after seven years of symptoms and having to fight for a referral. This was my second attempt at a referral. The first had ended in discharge following a clear myocardial perfusion scan and the advice that there was nothing wrong with me. The second ended in a diagnosis of exclusion with no further testing and discharge back to the care of my GP. I was assured by the cardiologist that this condition could be well managed in primary care.
The hospital had previously given me a GTN spray and the GP continued this and has done to date. This works well and generally symptoms are well controlled.
In May 2019, a locum GP prescribed triptans for migraine. Discrepancies between the doctor's instructions and those on the box sent me to the BNF and the information that these tablets were absolutely contraindicated! A phone call to the surgery revealed that my diagnosis had never been added to my record. I was told this would be rectified.
In March 2020, I was on high dose steroids and having episodes on a daily basis so asked for a referral back to the hospital. There I was assured that the escalation in my symptoms was nothing to do with the steroids. I was also told I needed to be on Diltiazem, which would have the added benefit of lowering my BP. As my BP is generally around 110/60, and often lower, I queried this and was advised to ask my GP for 24 hour BP monitoring so we could see how low it actually goes. The GP refused.
Since then there has been no interaction with the GP surgery at all other than my annual thyroid test and medication review.
I have recently discovered from their revamped website that the surgery runs a separate clinic for people with heart conditions. The website actually says that people who don't attend cannot be looked after safely and must find another doctor. As I have never been invited, I raised this with the pharmacist who was doing my recent medication review and she told me that I am not on 'the cardiac register'. She said she would speak to one of the doctors to see if I could be added, but I have heard no more. I cannot find out what this cardiac register is and what the criteria are for inclusion.
I'm now trying to get my ducks in a row before I try to speak to the Practice Manager. I have looked online, but can't see anything that defines what their obligations to me are, what they should be doing and whether there is anything I can quote when I speak to him.
Can anyone help please?
Written by
AngelRain
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If I was in your situation I would ask your practice what heart conditions qualify you for inclusion in the heart clinic.You could also contact PALS to see if they can track down the letter your cardiologist would have written to your GP.
In my area there is a PALS for hospital matters, and another one for GP matters, but they would be a good starting point.
Your local Healthwatch could also offer some advice.
Thanks. That's helpful. I have the letter, which is unequivocal in terms of diagnosis, so if Healthwatch could tell me what obligations the surgery has not met, that would be ideal.
If you look up the contact details for your local PALS they should be able to give the details for the GP PALS. They used to be the same here, but tgen split. They are very useful.It might be worth having a look at the NICE guidelines for GPs, but if the local practice have decided to run a specific clinic I would assume they can make up their own rules about what heart conditions are appropriate.
I personally would be inclined to contact the practice in a friendly, casually enquiring way, asking them what hesrt conditions involve being included in the heart group. If they are a bit woolly just say you were concerned because of what is says on their website, and wanted to ensure you were doing all in your power to optimise your health.
I wouldn't be surprised to find the heart group concentrate on encouraging people to get their weight in a good range, exercise, follow a healthy diet, etc. All very good advice, wish someone had told me more when I first had a diagnosis of AF.
Two weeks on, I have contacted Healthwatch, who have no idea what this cardiac register is, and have referred my query to the ICB.I have heard nothing from the surgery and the blood test form I am waiting for is still not available.
In fact I decided it was better to have things documented, just in case. I have sent an email this afternoon, but they only check the inbox once a day and they don't reply by e mail, so your guess is as good as mine.
The response to my e mail to the practice manager was an e mail from the pharmacist saying that I would need to see a GP about my cardiac symptoms. I'm not sure need to as my symptoms are well controlled, but I have booked myself in anyway and will ask about this cardiac register.
So, I have now seen a GP. She tells me that the Heart Clinic run by the surgery is really for people with heart failure, but she has offered to make some inquiries for me. I don't quite understand why she did not know my diagnosis or why she did not at any point in the consultation ask me how I was, given that I have not seen a GP face to face for over four years.
I have now had a call back from the doctor. She has reviewed my notes and informs me that my type of angina doesn't tick the box and "doesn't come under cardiovascular risk because it is not ischaemic." So the end result of this is that they can check my cholesterol yearly, but that is all.
Pretty poor service I would say. Not sure what to do next as if this is a box ticking exercise, presumably all surgeries will say the same.
Vasospastic angina is a type of ischaemic heart disease due a functional disorder of the blood vessels, causing transient constrictions of the coronary arteries.
I live with vasospastic angina, I am on my GPs register of high risk heart patients.
The World Health Organization (WHO) is responsible for the International Classification of Diseases (ICD), which is a system of codes used to classify diseases, injuries, and causes of death.
The NHS uses WHO ICD codes to classify and record health conditions.
I suggest you ask the GP and Practice Manager to check the WHO ICD code 120.1 which lists angina pectoris with documented spasm as a type of ischaemic heart disease.
Also request them to update their knowledge by reading the European Society of Cardiology's 2024, Management of chronic coronary syndromes.
See section 5.2.
Vasospastic and microvascular angina are types of ischaemia/ angina non obstructive coronary arteries INOCA/ANOCA.
When I've had random tests before I've not had the full results, just total cholesterol, HDL and ratio. It feels like they are just paying lip service to something, but I'm no longer sure what.
My random cholesterol tests show: Total Cholesterol, HDL cholesterol, non-HDL cholesterol, LDL cholesterol, Total Cholesterol/ HDL ratio and triglycerides
Symptoms? I get a lot of low level chest pain not connected with exertion, some shortness of breath and then the totally unpredictable episodes of acute chest pain, which seem to come in clusters. The last of those hit me when I was sitting on a bus about ten days ago.
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