I had a heart attack in October and I am still off work. I am getting chest pains roughly 3/4 times a day, this can be from the start of feeling stressed or if I walk up the stairs or exert myself ( like walking or hoovering) but I’ve been back to the docs and they say it’s just anxiety, how can it be that after a heart attack??! I feel easily tired and my mental health has taken a battering, just wondering if this is normal and how long it takes to feel normal again. I am trying to eat healthier, 5 portions of fruit and veg a day, less sugar less processed meat but I miss my sugary treats. I just want to feel strong again. I am due to go back to work next week but I keep putting it off as just don’t feel 💯. Thank you
chest pain after a heart attack? Is t... - British Heart Fou...
chest pain after a heart attack? Is this normal? GP says it’s anxiety
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47yrsold2cats
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Sorry to hear that you are feeling so poorly and that you are anxious about your GP's diagnosis amongst other things.
It's difficult to say what is normal regarding your situation without knowing a lot of things like the type of heart attack you had, the treatment you are on for it, your general health - the type of things your GP knows.
Perhaps you should keep a diary for 2-3 days in which you note down what you doing when the chest comes on. Make a note about 2 things (1) the type of pain - is sharp stabbing or a bruise-like pain or mild. Where is it on your chest - towards the centre, on the right/left, above or below or on/under the breast? (2) What you are doing/feeling when the pain comes on: sitting down or walking on flat ground/going up a slope or stairs, hoovering ... and add a note about how you were feeling at the time: anxious/tired/calm.
After say 3 days, drop the note off at your GP's surgery - or send in an email - asking to discuss the issues if you are still worried.
It's good that you're taking steps to have a healthier diet. Hope you'll feel better and that your GP will help clarify your concerns.
Thank you for your kind words and advice. Not sure what type but it was a heart attack and they found from the angio that I had a narrowed RC artery but no need for stent. I am now on aspirin statin and tigrelgor I think and I am awaiting a heart MRI as they are not sure what caused it but my diet, family history of heart attacks and problems and that I smoke probably didn’t help. And the stress. So I’m just wondering what is normal after a heart attack, are these aches just normal now and to be expected? Will my energy improve… The pains seem to be achy and muscular and vary from left to right side of my chest, under boob area, but I just get on with what I’m doing most of the time( cleaning, walking etc.). I am awaiting cardiac rehab after the MRi. Ive also cut down on smoking as know that’s a bad one.
Many thanks for your time x
I am on Ranolazine, Isosorbide mononitrate and a beta blocker for angina post NSTEMI. I have been on these three meds for 5 years. I still get break through angina so I have nitroglycerin tablets for those time.
We women (some men too) can also have MINOCA - non obstructive heart disease that causes debilitating angina. I get spasms once in a while…it feels like a heart attack...and is not nor should be treated any differently from a HA.
Keep due diligence and get educated on heart disease. Anxiety and stress will cause angina, but there are medications that help. I am on almost all of them. Here is a link to a good support group. Their website seems to be corrupted, so Facebook is the second best. facebook.com/groups/minoca/...
Also, Dr. Gupta is a great resource. He has a YouTube channel and practices in York. Wonderful man. youtu.be/_EXq4Lj8eN0?si=h7g...
Hugs to you, Thea
Ah thank you Thea for your response and advice. I will join the support group x
Has your GP or anyone else mentioned angina? From the webpages below.
"stable angina (more common) – attacks have a trigger (such as stress or exercise) and stop within a few minutes of resting"
And have you been invited to a cardio rehab course offered by your hospital? If not contact the cardio unit to find out where you stand. This is the sort of issue that you could raise whilst you are on the course.
Thank you for your response, my GP touched on angina and said if they go again quite quickly then it’s angina but sometimes the aches last a few hours whether relaxing or active, I’ll check out the link tho. My cardio rehab isn’t till after the MRI which apparently won’t be for a few months so seems everything is on hold until then. But yes I will do thank you
Have you been given nitroglycerin spray to try when you have one of these episodes? If the pain goes away that could be a good indicator
Not sure, I’ve got GTN whatever that stands for x
Same thing. (It stands for glycerin trinitrate, FWIW.)
Ah I see, yes I’ve used it 3 times on one occasion and it didn’t do anything
I have the same issue with chest pain during exercise . GTN and beta blocker don’t get rid of the symptoms . I am now being investigated for possible Microvascular angina
That’s it
That’s interesting, thank you for your response. I was looking up on angina and mine does sound similar to micro vascular.
, My pain started in. Dec. 2019 , and began by journey . Over the next four years I had repeats of nuclearCT’s and nuclear stress tests . After the second set in March of this year, it was discovered that I had a blockage so the angiogram was done to detect the extent. It was revealed that I had a 90% blockage in my LAD, which was then stented. I fully expected that when I left the hospital I would feel much better and the pain would gone, but that was not the case. The day after I left the hospital and went for a walk, the pain resumed. I got a new cardiologist and was put on a beta blocker with the thinking that it would help . It did not . I am on a minute dose, but it makes me very tired. Two weeks ago they repeated the angiogram to see if there were any other issues that have come up or had been missed, and there was nothing. I will see the cardiologist in January to discuss next steps .
Good luck to you, I hope the cardiologist can help and thank you for your response x
Thank you
Hi, my heart attack was in April, angiogram showed no need for stents, discharged with bag full of meds. I was so tired during the summer (but no chest pain) and blamed it on bisoprolol (beta blocker). Was looking to reduce dosage but early September went to GP with onset of chest pain , she listened to my heart and detected irregular heartbeat (atrial fibrillation) , referred to cardialogy and seeing them next week. My anxiety is through the roof , I am so incredibly tired (64 year old man) , get occasional chest pain and I'm sure it is anxiety bringing that on. So just wondering have they done an ECG and are you on a beta blocker ? AF and bisoprolol have between them rendered me physically and mentally exhausted. Hope you feel better soon, meds may need a tweak , maybe get ECG as my rhythm was fine after HA but then just went irregular sometime late summer. And if you find a way to relax let me know as anxiety is a b****r..
So sorry to hear you’re not well also with similar symptoms. Anxiety can also make you feel so tired eh? They did an ecg whilst I was in hospital but not since I’ve been discharged. I have been put on a piddly dose of propanalol( if that’s a beta blocker) but I find it doesn’t really do anything. My GP has upped these slightly today but I suppose am just trying to work through the aches and try and lead a semi normal life. Thank you for your advice, I will ask for an ECG when I next speak to the GP, they don’t seem to know much about what to expect etc after a HA, just say everything is anxiety now. I hope you feel better soon also, I’ve been referred to talking therapies also so maybe that’ll help me to relax a bit, I’ll let you know if it works! X
MilkfairyHeart Star
Hello,
You can have angina even a heart attack without blocked coronary arteries.
A Myocardial Infarction non obstructive coronary arteries MINOCA is more common in younger women.
Some of the possible causes which again effect women more than men, are when the blood vessels don't work properly.
Either the smallest blood vessels in the heart have problems dilating, microvascular angina.
Or the large blood vessels, the coronary arteries go into transient constrictions, vasospasms, vasospastic angina.
The BHF in their ' Understanding Angina' booklet explains the different types of angina.
bhf.org.uk/informationsuppo...
I suggest you keep a diary of your symptoms and see if you can spot any triggers.
My triggers for angina are the cold, emotional, mental and physical stress.
I live with vasospastic angina which can be associated with small narrowings of the coronary arteries.
Smoking and beta blockers can make coronary vasospasms worse.
If your symptoms persist I suggest you discuss this with your GP, Cardiac Rehab team or Cardiologist.
Ah thank you, yes they’re calling it a MINOCA at the moment. I will look at that, sounds familiar to what you’re going through, I will keep a diary
I had a Minoca 3 years ago, and went back to the hospital 3 times with chest pains. I saw a really good cardiologist who knows about this type of heart attack, and I'm now on Isosorbide mononitrate 10mg a very low dose, and it helps with the chest pains, as does a gtn spray under the tongue. I have to take a different statin now as the one they give you after your heart attack made all of my limbs ache. I felt like I was having after pains from the heart attack. I am now more or less stable, but I still get chest pains that can drop me to my knees at times. I hope you get answers and treatment. Good luck
Thank you, I will keep an eye on the meds and maybe suggest a change of them, thank you for your advice and sorry to hear you’re still suffering x
I feel your pain - literally
What you’re describing is exactly how I feel. I had a heart attack in September and had a drug coated balloon inserted. I have exactly the chest ache you describe and have spoken to my cardiac rehab nurse several times who said that it doesn’t sound cardiac related. I wasn’t an anxious person before but it does seem to happen now when I feel more anxious. Being back at work hadn’t helped so take it easy and don’t rush things.
Ah thank you and sorry to hear you’re in the same boat! Yes I can’t imagine work would help atm although they are being supportive at least x
I haven't had an HA but I've plenty of experience of anxiety induced pain and you sound like a perfect candidate for it! You say it comes on with stress, your MH has taken a battering... I agree with your GP! Sorry, I know it's not easy to get your head around, but it just means you need to switch some of your attention from physical to MH and above all learn to relax! You might be one of those for whom meditation is still a weird idea but believe me it can work wonders! But patience is necessary, it does take time...
Thank you for your advice I shall try to relax and am hoping cbt counselling will help x
I had same and eventually got off a lot of the meds because of the way I was feeling . It's very early days. You heart is still recovering!
You will be strong again. Last Xmas I couldn't lift the Xmas tree and large boxes out of the loft .This year I'm back to normal doing it myself.
I had 5 months off work so give yourself time to recover. Are you taking lansoprozole or omezparaole to protect your stomach ?
I had the worst pains and acid reflux/ GERD even on theses drugs because of the ticagalor and aspirin.
I’m on omeprazole. Thank you for your response and kind words, I shall try and be patient x
It is so hard to be sure what the exact cause of chest pain after a heart attack is.
Mine was in July and my right coronary artery was found to be blocked - to 94% at one point! A stent was put in. Things are slightly complicated by the fact that I also have atrial fibrillation (AF).
For several months afterwards I was getting chest pains and I had 3 trips to A&E and one admission. They ran lots of tests but came to no form conclusions. Possible causes were:
- small vessel disease - in other words some of the tiny blood vessels in/to the heart are blocked - small enough to cause pains, but too small to detect.
- the AF
- anxiety/coronary artery spasm
Have you been given a GTN spray for when the chest pains happen? Does it help?
Things have settled down a bit for me - I still get the pains, but they do not throw me into a panic or cause me to ring 999 - they are bound to cause worry to begin with as you have had a big shock to the system. I agree with the suggestion to keep a detailed record of the episodes including what had proceeded them.
My advice would be to try relaxation - there are apps like Insight Timer which take you through relaxation exercises. And very definitely ditch the ciggies!!!!!
It is early days for you and I too found it hard to begin with as every pain caused me huge worry - I am more relaxed about it now. It is so hard to tell what is trivial and what is serious, and after the fright of a heart attack our sense are on high alert.
Lots of good luck.
Coronary artery vasospasms are a cause of vasospastic angina which increases a person's risk of a heart attack, stroke, heart failure and further hospital admissions.
Have you been offered any further specialised testing?
During a functional angiogram, coronary vasospasms can be confirmed by using acetylcholine.
Another chemical adenosine and guidewires can then be used to assess whether the small vessels are working properly, microvascular angina.
It's important to be given a correct diagnosis as the treatment options are different.
Beta blockers can make coronary vasospasms worse.
While GTN seems not to work so well for people living with microvascular angina
Thank you for your response. I have GTN and tried it once, it didn’t do anything and eventually the pain subsided. It’s so hard to know whether to go to a&e with it as I can still usually do everything while it’s happening so I just wait for it to pass and at the moment take propranolol and tell myself it’s anxiety. The HA was a 9/10 and these pains are like 3 or 4/10. Have cut back the ciggies but they are the thing that I go to when I’m stressed but recognising now not to go to them when I am feeling like this so hopefully one day I’ll look at quitting. I will look at insight timer, thank you x
I was called to an elderly neighbour recently who was displaying signs of a HA, she had pains in chest and arms, rapid breathing and was in a panic. She was discharged from A and E later that day having been diagnosed with anxiety, for which she is receiving treatment.
That was the first time I had seen what anxiety can do.
50% of women have their heart attacks initially misdiagnosed often as anxiety. leeds.ac.uk/news-health/new...
The British Cardiovascular Society published a consensus document about women accessing cardiovascular care in September.
Women's heart disease is underdiagnosed, under researched and under treated.
Ah bless her, yes it’s so strange how something like anxiety can affect us this much physically x
2Years ago I had a heart attack, had to have 3 stents, They said my EF was 40 to 45 a few weeks later. I started to feel exactly like you and it took me an age to work things out.
My EF is 54 now and the consultant was rather pleased, but it takes work.
My advice is to believe your doctor's. Anxiety causes a multitude of effects including everything you describe. I had them and was almost at breaking point until I pulled myself together.
Diet wise - Treat it as a chance to explore new tastes and splash out on the finest of fruit, veg and new healthy foods, I was amazed at how I could replace the bad with the good. I have lost 3 stone and am the same weight I was in my early 20's (I'm 70 next year). If this is needed for you, it will make you feel great and you can get new clothes to fit.
Exercise - You only need to go for healthy walks, find pleasing spots to go and let your feet do the work , but only as far as you feel happy with, don't push it.
i was getting the pains and palpitations, It turned out to be the medication, I was on far too much. Push that with your doctor but only after the safe time has been reached.
Look for self help meditation take time out to relax, breath and contemplate good things.
Doing this will make you feel better but it take a positive attitude.
It's natural to worry, I do even now when thing seem to get worse, but every time I have found it is caused by another ailment. Consider this, your body is not always your friend and will occasionally try to fix something that is not really wrong.
I don't know what medications you are on, But I had to change and lower my Statins, remove one drug all together and adjust dosage. Do this gradually with your doctor's help. You may need to push the point but stick at him/her.
It takes time, a long time, but you will get better and better and come to understand your condition and you will find peace again.
My next treat is a Dr Who Tattoo, My first ever, yup I'm mad but but it is exciting lol.
Good luck. I know how you feel.
Ah wow bet your tattoo will look great! Thank you for your response. I’m buying more fruit but tbh finding it hard to think of what to eat for dinners, aiming for hardly any processed meat, fish at least twice a week and add veggies. I will continue to look for appetising recipes. I do love a good walk and am continuing that despite feeling ropey sometimes. Thank you for your advice x
You will be fine, you are doing the right things, I got into Salmon and diced veg, Bean soups, Chicken stews. Removing Saturated Fats was my big goal. I just created my own meals, No recipe's lol. I miss biscuits, cakes, chocolate, deserts and cheese, I was a cheese addict, now I can only have tiny pieces. No cheese on toast(sob)... Tattoo will be like this.
Tardis
Great tatt! Thank you x
From personal experience I would say chest pain is quite common after a heart related incident. Some of it probably caused by being more chest aware and noticing any niggles where we'd have ignored them in the past. That and the raised anxiety has led me to a few trips to A&E in an ambulance. I even spent Christmas Day 2022 in hospital (Christmas Eve through to Boxing Day). Each time I've felt a bit of a fraud and apologised to the staff only to be told, quite forcefully, that I should always be checked out, especially given I'd had a heart attack previously. My anxiety issues were worsened somewhat after an incident at Cardiac Rehab, of all places, that knocked me for six. My GP referred me to MIND and the rehab team mentioned Talking Therapies (free on the NHS but not available everywhere - you can self-refer I believe). Both were a great help and talked me through me fears and how to develop coping strategies. I still have the odd wobble but I'm loads better.
Wish you all the best, take care
Thank you for your response and advice. I have started talking therapies so maybe that will help me also x
I am sorry to hear that you seem to have been left with little understanding of what is happening to you by the medics, I hope that some of the info here has been helpful. Milkfairy is a wonderful source of info on ANOCA/INOC/MINOCA, which most GPs have little understanding of
I only wish to comment on your return to work : if you are not ready to return to work do not return - you could be a risk to yourself and to work colleagues if you are not 100% ready and still having uncontrolled chest pain - also I hope that you are not driving, a bout of chest pain while driving could have severe consequences for you and others. I don't know what the current rules are about medical certification for return to work so I suggest you check that and get your doctor's cooperation in delaying your return - later you might be able to arrange a phased return when you are ready
Thank you for your response and advice. My worry is that I was only at the job 5 weeks when I had the HA. I’ve had more than that off now and it would be such a shame to lose the job as I did like it and god knows what I’d do for work as I was off 2 years prior to starting with a long term back condition so feel like I’d never get another one! But it is what it is and I feel right for not going in, my family want me to go back to work so I don’t lose it and think it’s hard for them as they want me to be back to normal as much as I do, but these things take time. So will just have to see about the job. Occupational health are involved which js good. I don’t drive so there’s no risk there. X
I hope you find a solution for your dilemma which works out well for you - I tend to urge caution because of my own bad experience after repeatedly returning to work too soon - in my case it was not a cardiac condition but the pressure of return ing to work (too soon) led to me having to take early retirement on health grounds at 43 - that's something I would not wish on anyone, even though it worked out ok for me in the end
Jeez that’s early! So sorry to hear that but glad it worked out in the end x
Hi there, I am so sorry you are having the chest pains. What sort of treatment you had in hospital. What i can understand you were just monitored and sent home without any invasive procedure. I guess your G.P. has checked and has eliminated any serious cause of the pain. Apart from anxiety there are 2 things to be sorted out -firstly it could be angina which means the heart is crying because of insufficient blood supply and the second is musculoskeletal which means pains coming from chest wall. I suggest taking simple pain killers say 500 mg paracetamol up to one eight times a day and see how it helps. That can be reassuring. Regards.
Thank you. They did an angio and found a narrowed RCA but not enough to stent it. Waiting for a cardiac mri now. Thank you for your advice x
Are you taking your GTN spray?
I’ve only tried it once ( 3 times in that one incident) and it didn’t work. But I always carry it in case I need it for more severe pains
If your GTN spray is not working on you then it is more likely to be something else. See your GP.
Not necessarily so.
How a person does or doesn't respond to GTN spray isn't the best way to say whether someone has ischaemic heart disease.
People living with microvascular angina do not always respond to GTN spray or isosorbide mononitrate tablets.
I have a confirmed diagnosis of vasospastic angina following a specialised invasive functional angiogram.
I don't respond particularly well to GTN spray or any of my other medications.
So what medication do you use?
I am on very high doses of calcium channel blockers, nicorandil, nitrate patches, Isosorbide mononitrate, Ivabradine along with clopidogrel and a statin.
During crescending episodes of chest pain.
I use oxygen, hot water bottles, Transcutaneous electrical nerve stimulation TENS machine, listen to music, use breathing and relaxation techniques.
When I run out of resilience to manage the pain of my coronary vasospasms, which can feel like being in labour, I email my Cardiologist.
I am then admitted for 10 days or more for treatment with IV GTN and morphine to settle my unruly coronary vasospasms.
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