Told not angina after years of meds- help

[Robinface]

Hi informed yesterday husband heart & arteries are perfect!?These are results from angiogram in oct last year! On a variety of meds since blocked carotid & mild stroke over 10years ago! Told he can now stop taking meds & breathlessness & pain in shoulder blades on exertion are not heart related! No advice on which meds or how to reduce so will await letter to GP! However what does he do now? Any ideas? Insist on trials of inhalers?? Help

[AuntyEdna]

See a cardiologist! Ignore the doctor for now regarding stopping meds until you talk to someone who understands heart conditions- could be microvascular related. Had a stress test came out positive showed microvascular issues . So ask for more investigation would be my next step in your position .

Note Beta blockers are a no no with MVA I take calcium blockers- could it be that? Also my ECGs are ok and angiogram only showed 40% blockages.

Good luck and hope you get a proper investigation ☺️

[Robinface in reply to AuntyEdna]

Hi thank you it was a cardiologist that told him this!! We were so shocked couldnt think of questions! May email for more information! Awaiting letter to GP

[1a2b3 in reply to AuntyEdna]

Hi there ….after four years of chest tightness while outdoor walking , two nuclear CT’s, two dye contrast stress tests… first round done in March 2020 , showing no blockages . Carried on for the next three years, still having chest tightness only exercising and only for about five minutes each time. Each time I would have an appointment with my family doctor I would mention it, and she was very proactive in trying to figure out what was going on.. Back -and-forth to cardiologist who said it was likely muscular, I didn’t agree. I kept persisting and went for my first angiogram April 2024, at which time a 90% blockage in LAD was discovered . Stented was fitted. Fully expected to be feeling better without chest pain. This was not the case , everything stayed the same, no better no worse. Back to the cardiologist a couple more times with no satisfactory explanation . At this point, I requested a female cardiologist, which thankfully I was able to get. After reviewing my chart, she started me on a beta blocker to see if that would help as she suspected it may be microvascular.. after starting the beta blocker and being on the lowest possible dose, I felt terrible with no change in symptoms. She took me off beta blocker and did a repeat angiogram to make sure there were no new issues or any issues with previous angioplasty… ie restenosis. The repeat angiogram showed no issues. I asked again about the possibility of Microvascular and was told that in Canada, we do not have a special angiogram to detect microvascular. They do some sort of pressure test while doing the standard angiogram, which they did and it showed nothing irregular . I am beyond frustrated, still experiencing the same pain. Once again being told it could be muscular or possibly asthma, which I have never had and have had zero issues with breathing, never have. I understand in England that they have a special angiogram that does detect microvascular. Is this a relatively new test or is it just something that we are simply not using in Canada?

[Milkfairy Heart Star in reply to 1a2b3]

There are several centres in Canada that carry out functional angiograms to diagnose microvascular and vasospastic angina. Some in Ontario and British Columbia.

I suggest you contact this organisation.

cwhha.ca/cwhha

ottawaheart.ca/clinic/women...

[1a2b3 in reply to Milkfairy]

Thank you I will ask my doctor

[Milkfairy Heart Star in reply to AuntyEdna]

Actually beta blockers are contraindicated if you have coronary vasospasms rather than microvascular dysfunction

People living with coronary vasospasms are usually exercise tolerant and have no problems completing a stress echo, they may however get chest pain later.

[gasp1]

I had something similar and was struggling with breathlessness etc after being told I had and then hadn’t last due to my arteries showing no issues they then diagnosed me with micro vascular angina which basically is the smaller arteries that feed into main network of arteries being narrow apparently this doesn’t show on any of the rest that the did may be worth just asking for a second opinion. It would appear that micro vascular is not all that known about

[Hel52]

Hi Robinface

I was taken off all my angina medication it was after an angiogram all clear apart from a stiffening on the heart wall an some odd name It still states I don’t have enough oxygen going around in to my heart a cause of the stiffening so another blood test is needed and a lung function test I still have angina pains with the gnt spray nothing explained too me.

I wouldn’t stop your medication yet you need to see a cardiac consult to give you the answers as why they are stopping your medication to me it’s not professional to say stop medication they are putting you at risk especially as you had a mild stroke before the medication is to prevent it.

Good luck hope you get your answers soon.

Big hugs hel52

[Wingnutty]

The fact that hubby has had a blocked carotid 10 years ago should be a red flag to doctors and as others have said, it could be a micro-vascular problem. You have too bear in mind that doctors do make mistakes sometimes. I would be loathe to come off medication until they have evidence of something else causing the problems.

[Gibson01]

Just because the main arteries are clear it does not mean that your husband is not suffering angina. He could be suffering from Microvascular angina which results from blockage of the fine arteries which cannot be explored in a simple angiogram. Or vasospasm or a combination of the two.

Ask for a referral to a cardiologist with experience of treating these conditions. With the right medication these conditions can be kept under control.

[Milkfairy Heart Star]

Hello,

It is possible to have angina/ ischaemia without obstructed coronary arteries ANOCA/INOCA.

There are two types of ANOCA.

Microvascular dysfunction- microvascular angina, which is due to the small blood vessels of the heart not working properly. They either fail to dilate or stay dilated in response to extra demands like exercise.

Coronary vasospasms- vasospastic angina is caused by transient constrictions of the coronary arteries, some people have microvessel spasms.

Microvascular angina can in some cases be diagnosed by a cardiac perfusion MRI.

The symptoms usually occur with exercise and can include breathlessness.

Vasospastic angina is difficult to diagnose. It's hard to catch the ECG changes caused by a transient constriction of the coronary arteries.

The classic symptom of coronary vasospasms is chest pain at rest, especially during the night rather than on exercise.

My story started in 2012, when I was admitted to hospital with a suspected heart attack. I was given an infusion of GTN to treat my unstable angina.

My chest pain stopped, however I was told incorrectly, because my coronary arteries are clear that I couldn't have angina or a heart attack.

A doctor abruptly turned off my infusion of GTN.

I was hit by a wall of pain, it felt like I was in labour, I almost cried with pain.

I was found to have vasospastic angina following a functional angiogram. This type of angiogram is the only way to confirm a diagnosis of ANOCA/INOCA. First adenosine and guidewires, are used to measure how the blood flows through the small blood vessels. From these measurements microvascular dysfunction can be confirmed.

Then another chemical acetylcholine is injected into the coronary arteries. If the person has certain ECG changes, experiences chest pain and the coronary artery almost completely closes in a spasm, then vasospastic angina is confirmed.

The BHF has some information about microvascular and vasospastic angina.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

The BHF website, also lists this patient group's website as a resource for people living with microvascular and vasospastic angina in the BHF 'Understanding Angina' booklet.

internationalheartspasmsall...

I suggest you ask your GP to refer your husband to a Cardiologist who understands microvascular and vasospastic angina. You are entitled to ask for a second opinion.

It can help asking your GP or any Cardiologist you see to look through the BHF information about microvascular and vasospastic angina with you.

My Cardiologist uploaded this article onto my electronic patient records along with my careplan.

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

Unfortunately microvascular and vasospastic angina are still not well understood by many Cardiologists and you may have to help them update their knowledge!

[Statinlover]

Hi, I don't wish to concern you with the advice you have received as they are the professionals however I had a lucky escape following my advice. After months of chest pain during exercise I went to my GP who initially diagnosed angina and referred me to the cardio department in Jan 2024, where I underwent all the tests where I was informed that my heart was fine and the pain I was experiencing was not heart related and I was fine to continue with my exercise. This I did and continued to experience pain, however as I had been informed this was not heart related rather than take my GTN spray I took indigestion tablets !! In Sept the pain got worse and I had a heart attack at home where luckily my wife drove me to hospital (15mins) as the ambulance was 90mins away. within 10mins of getting to A&E I went into cardiac arrest and required cpr, defib and surgery for stents. I'm now on the road to recovery and have been told it was an accident waiting to happen ?

So, always question advice you have received as I should have done. Have you considered mentioning GTN spray to at least see if that alleviates the pain ?

[Robinface in reply to Statinlover]

Hi sorry to hear of your experience, hope you are on the mend! He has tried the GTN spray which floored him literally! Hard to know if it cured the pain as he was almost unconscious!! Also tried low dose tablet version which made no difference! It was mentioned a long time ago possible micro vascular issue- we assumed all the meds he was on would cover this too??? Thank you for responding much appreciated!

[bluemoon572]

We're warned that certain cardiovascular meds that may regulate or affect heart rhythm and heart rate as well as blood pressure should be tapered off and not stopped cold turkey for fear of dangerous rebound effects