Hello hello. Desperate for some advice about the diagnostic process for vasospastic or micro vascular angina. I was discharged from cardiology last year following a CT scan that showed insufficient blockage to cause symptoms. I fought hard to be seen again and to retain my isosorbide mononitrate, as I was still having symptoms and its effect had been *miraculous*. I didnt mind the headaches, I felt magically so much better, 10 years younger. Can that happen? Or rather, is that usual? GTN spray is also a godsend, meaning I could get some exercise again.
After a painful episode at rest they doubled my dose to 50mg Elantan per day and I've been symptom free since then (unless I'm running up a steep hill trying to catch a disappearing dog near a sheep field - or unless theres a bad family row). I've been able to start jogging a bit. Im lucky, I know. But when I went to have my ECH stress test I was told to take my meds as normal and the chest (shoulder and arm) pain didnt happen. I'm so scared of being discharged or not listened to again, and of being taken off my nitrate meds. Any advice about the diagnostic process or how to navigate a very very busy NHS would be gratefully received.
Thanks
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Dottiedaydream
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My vasospastic angina was diagnosed by a specialised angiogram using a chemical acetylcholine over 10 years ago.
I didn't stop taking my medication prior to any of my tests.
Most people with vasospastic angina can exercise and their stress echo may well be normal. My stress echo was normal, I got chest pain afterwards at rest.
The classic symptom of vasospastic angina is chest pain at rest or at night.
Microvascular angina tends to lead to exertional chest pain and breathlessness.
I suggest you keep a log of your symptoms, your activities, the weather and life events.
You maybe able to spot the triggers for your episodes of angina.
Mine are the cold, emotional, mental and physical stress.
I have had more symptoms during the recent cold weather. I also will be effected by sudden drop in air pressure during a storm.
Caffeine and artificial sweetners will trigger my coronary vasospasms too.
I suggest you ask to see a Cardiologist who understands microvascular and vasospastic angina. If necessary contact the Patient Advisory Liaison Service, PALS of your hospital.
You are entitled to ask for a second opinion.
The BHF has this information about microvascular and vasospastic angina.
Thank you Milkfairy, I can see that you help a lot of people in this sphere and I'm grateful for the advice.When symptoms first started they were more exercise related- walking uphill quickly, or, the very dramatic first time, running to catch a train to an important work meeting... since I've been on nitrates I think there is some influence of the cold, a little if I push physical exertion for longer and harder than I should, but the only real twist of pain through my chest and down my arm comes in very heightened conflict situations (or road rage lol), both of which are thankfully rare. I'll keep a diary going forward.
I used to be super fit but being menopausal stopped that. I think the cardiology people think I'm a complaining woman of a certain age who can't accept that my days of super fitness are over... but my dad had (normal) angina for 40 years so i know a bit... and as you say, I do know my body. Those pains are completely different to any sort of muscle strain, or whatever.
I am arming myself and preparing to be persistent!
Yes it is OK to do a stress test whilst on Nitrates, I have done several different sorts, eg: echo, nuclear perfusion, CT.
However if you suffer from Vasospastic and or MVA be prepared for the stress tests not to reveal anything. Mine did not, and each time the cardiologists inferred there was nothing wrong with me.
As Milkfairy says the only effective test seems to be an invasive angiogram in which Vasospasm is provoked by acetylcholine, and blood flows in the heart are measured to detect MVA.
After years of treatment I finally had this procedure last February. Once correctly diagnosed, a simple change of medication has made my life so much better.
Hi Gibson01, and thanks for your response. It's good to know that the stress test isn't the be all and end all and thanks to you guys I know what to request next time they try to discharge me.
My cardiology nurse was kind of accusatory when he pointed out that most of his patients can't comfortably walk across the room - i understand that I'm comparatively lucky, but I don't want to turn into one of them!
It seems that persistence is the name of the game.
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