eventful week

[Anginalady]

Had my invasive angiogram 10 days ago.

Good news is that I have no microvascular disease. Other news is that I do have a myocardial bridge which is actually quite small and not what causes my angina. This is caused by a tortuous artery next to the bridge.

Under acetylcholine, the tortuous artery releases chemicals that bring on a spasm. So it’s not your typical vasospastic angina as it is brought on by exertion.

I’ve been told my heart is strong and there is no disease in the tortuous artery, so all good news there.

I was on Bisoprolol which actually worked with no side effects, they stopped this and put me on Diltizium… oh my goodness! First night I had pounding head ache and my heart was bursting out of my chest. Ended up in A&E next day.

They switched me to Isosobide mononitrate, same horrendous headaches but milder pounding of the heart. Almost a week now, I have a 12 hour window of headache, dizzyness and pounding heart. I can walk but the chest pain gets to about 70% but stops there and doesn’t develop further. I know it can take time for the meds to bed in but I did expect them to stop the chest pain as the Bisoprolol did.

I don’t understand why they would take me off the meds that work completely and gave me no side effects.

I’d really like a good nights sleep…..

[Milkfairy Heart Star]

Hello,

Myocardial bridges and tortuous arteries are rare and there is very little research about how to treat this type of angina non obstructive coronary arteries ANOCA.

I had spontaneous and acetylcholine induced coronary vasospasms when I had my functional angiogram.

Acetylcholine should cause normal functioning coronary arteries to dilate, if the blood vessels constrict then coronary vasospasms are diagnosed.

Beta blockers can make coronary vasospasms worse which is probably why your medication was changed to Diltiazem, a calcium channel blocker, the usual treatment for coronary vasospasms.

Isosorbide mononitrate can give you a headache for a couple of weeks. Drinking plenty of water and taking paracetamol cann help.

I share your frustration of living with a rare heart condition that has few treatment options that Cardiologists have limited knowledge about.

I have over the years had to work with my Cardiologist to find the best combination of medication that will work best for me as an individual. After 12 years we're still trying!

I suggest you contact your Cardiologist and ask for an earlier appointment to review of your medication.

Fanfab1 Fanfab1 has mire experience of living with a myocardial bridge and hopefully she will share her experience with you.

[Anginalady in reply to Milkfairy]

Hello,

Luckily they brought my appointment with the cardiologist forward after my trip to A&E, and we saw him today. Apparently older beta blockers were used to treat different types of -something I can’t quite remember, but Bisoprolol is different, so they’ve agreed that I can go back to Bisoprolol safely. I am so pleased.

He said that only 7% of people have this combination, so yes it is quite rare. I had such a bad night last night and the walk from the car park to outpatients brought on a spasm. I will be so pleased to stop the Isosobide.

Apparently my bridge itself isn’t causing any major problems and they’re hoping that in around 5 years time, hormonal changes may mean that my spasms will clear. I suppose it could go either way, improve or decline. Only time will tell.

Hope you’re keeping well.

[Milkfairy Heart Star in reply to Anginalady]

It's good to hear you were able to see your Cardiologist so quickly and have your medication reviewed.

There is some evidence that beta blockers and Amlodipine (a different type of calcium channel blocker ) may help people with myocardial bridges.

jscai.org/article/S2772-930...

I have a careplan to guide the A&E staff, how to manage my escalating unstable vasospastic angina.

Only my Cardiologist makes any changes to my medication.

It may help to ask your Cardiologist to write a plan of care for you too?

I am not so sure about the belief that coronary vasospasms improve after the menopause.

A woman's risk of cardiovascular disease increases after the menopause.

I hope your symptoms become better managed soon.

[Anginalady in reply to Milkfairy]

Thank you..

Apparently they do have a care plan in place for me as my case was deliberated amongst the cardiologists and external help was sought as this is a rare case for them. I now actually have a cardiologist that I can contact which I never had before.

I must admit I double checked on the 5 year improvement theory with them as I found that hard to believe, but they still say it’s possible.

I think being a rare case for them it will be a case of ‘wait and see’ what the outcomes are.

They mentioned L-arginine as a supplement if I needed it, but I need to read up on it first.

[Milkfairy Heart Star in reply to Anginalady]

L-arginine is recommended in the US to improve the function of the inner lining of the blood vessels.

I do other things to improve my endothelial function, such as eating a heart healthy diet, exercising and stress management.

I am prescribed a statin which helps to improve endothelial function too.

I have a great Cardiologist, whom I email when I need to be admitted.

[Anginalady in reply to Milkfairy]

I’ve just had my first good nights sleep since my angiogram, so just hoping everything will settle down now I’m back on the Bisoprolol.

I also had raised troponine levels when in A&E, would this be due to the angiogram and the stress caused by the Diltizium do you think? They assured me it wasn’t a heart attack.

[Milkfairy Heart Star in reply to Anginalady]

There is nothing like a good night's sleep!Troponin is released into the blood stream when the heart muscle is damaged.

A lack of blood supply to the heart can cause myocardial ischaemia.

The more myocardial ischaemia usually the higher the troponin blood levels.

The tests are very sensitive, I have raised troponin blood levels and ECG changes with my coronary vasospasms.