Cold Weather Blues

[Richie34]

Hi my BHFs

I had balloon angioplasty on 8th Jan this year along with being started on DAPT (clopidogrel+aspirin) and a statin and nitrate tablets (all new).

I've had some lingering left sided chest discomfort since the procedure that could be heart related but I'm thinking also might be costochondritis or hernia related (I have a sliding hiatus one) the symptoms are worse when I think about it and when resting/thinking about it in the evening not on exertion/exercise.

However yesterday I felt I took an alarming several steps backwards. Walking to the shops and back to get my wife a valentines' card, when I got in the house to write it I noticed for the first time in my 58 years blueish tinges in both hands and fingers and a certain junction/joints they appeared almost black. It went away after about 10 minutes but I found it very concerning and didn't sleep well worrying about it. I'll concede it was bitterly cold yesterday and I wasn't wearing gloves but I've walked in weather this cold in recent weeks and not seen that before so I'm thinking/asking what could have changed suddenly?

Has anyone else experienced this new symptom after having angioplasty/starting clopidogrel+aspirin and did it go away in time or not.

Thanks in advance

Richie

[Blackknight57]

I’m on warfarin always get cold hands and feet. Occasional white fingers. Was told the cold and blood thinning agents can cause this.

[MountainGoat52]

It will most likely be the Aspirin and Clopidogrel that are affecting your hands. Are you generally feeling the cold more?

I suffered for the year that I was on Prasugrel (a similar anti-coagulant) after my HA and stents. Then I had an elective bypass op followed by twelve more months on Clopidogrel. I had to wear gloves when it was cold, anything below about 8C, or suffer the consequences.

In my case the situation was exacerbated by me suffering from Raynauds (hereditary) and my fingers would go completely white. When they warmed up and the circulation returned, the pain was excruciating. Once off the Clopidogrel my fingers were better and I now take Nifedipine to help with the Raynauds, but I still have cold hands. Thankfully no white fingers any more.

[Richie34 in reply to MountainGoat52]

Thanks for your reply, yes most definitely feeling the cold more since the PCI, this Winter has felt the coldest and longest I can remember and as I said my hands have never been discoloured before so have to put it down to the blood thinning (do their job) effects of the clopidogrel and aspirin but I shall be glad when the 12 month 'course' of clopidogrel is over next January. I guess age is a factor too. In the space of the 2 months since my suspected HA (although never confirmed bizarrely) I feel like father time has caught up with me suddenly,I'm more aware of changes to my body,anything from changes in skin colouration,odd unexplained twinges and spasms even a severe criked next 3 weeks ago that is reluctant to heal. I never wanted to turn into a snowflake (not a Gen X quality ) but here I am. I have a friend who is mid 60s with Raynauds who runs daily and is as fit as anything,takes the same precautions as you but hasn't been through what we have so no blood thinners needed. Thanks again.

[MountainGoat52 in reply to Richie34]

Oh age-related aches and pains. My advice is to embrace them as a natural process, not let them overrule your life and above all keep positive. I have actually made a physical improvement since my HA, stents and bypass and now aged 72 I am still climbing the hills.

Don't forget any medication needs a bedding in period for your body to adjust. It took several changes to get my mix right and now I am fiercely protective of it. My GP practice understands and reviews are generally just an enquiry as to whether everything is okay which suits me.

You may wish to consider taking Vitamin D to help your immune system, especially at this time of year when we don't see much sun. The recent cold and overcast weather has certainly not helped people. I used to suffer from SAD, so I know all about that. Thankfully it is nowhere near as bad nowadays as I spend the time planned hill walks. 😀

All the best for the future... keep positive!

Gerald

[Richie34 in reply to MountainGoat52]

Thanks Gerald, although based in the Midlands I used to love getting away for a bit of hill walking (usually Derbyshire or the Lakes) but after losing a friend 5 years ago who sadly died suddenly enjoying a not unfamiliar walk in the lakes on a Summer's day it has kind of put the fear of God in me to try and do anything like that again, especially as one is so far away from rescue should anything happen-it's sad,where 5 years ago I could practically sprint up a modest fell/mountain now I'm scared to do anything more than look at them. Vitamin D is a good idea I shall buy some. I don't suffer with depression especially but this newly found 'health anxiety' has practically consumed my life since I first found out I had a couple of coronary artery blockages 6 months ago,I've surprised and been disappointed in myself just how much of a daily controlling grip it has had on me. I'm hoping some upcoming cardiac rehab will install some much needed confidence (to do things like hill walking) again. At 58 and before all this i was starting to plan and look forward to retiring in about 5 or 6 years and do all the things in the natural outdoors I wanted to do IE now spent a few weeks in Scotland walking/climbing rather than a rushed few days/a week now again (annual leave ). Thinking that I might not be able to do any of that now is depressing but perhaps I just need to relax and give things more time?

[MountainGoat52 in reply to Richie34]

Hi Richie,

I think rehab will help you establish what you can manage. I found that I could achieve far far more than the set exercises and the rehab guys just let me get on with it. When I demonstrated at home what we did in rehab, my wife almost had a fit and she banned me from doing it at home. I did tone it down once the course had finished. I've never been one for gym exercise and much prefer walking in the countryside coupled with doing a bit at home.

I too live in the Midlands, in Northants, but I find the landscape around here a bit limiting. My preferred hill walking area is up in Scotland. At the moment I am walking on my own as my walking partner is currently unable to go with me. I fully appreciate your concerns about rescue as I have them as well, but with the proper preparation the risks can be minimised. I know my capabilities... the important thing is not to overstep the mark. I'm more concerned about twisting an ankle than having a cardiac event as I pace myself and take it steady. I can cope with doing a couple of Munros in a day, though sometimes the lower less frequently walked hills can be more of a challenge. A lot of research is done beforehand.

What I would suggest is that you start on the smaller simpler hills and build up slowly Derbyshire is ideal. If you have a friend that can walk with you, all to the good. In terms of your mental wellbeing, you will find there are lots of positives to getting out walking.

As I said before, keep positive.

Best wishes,

Gerald

[Milkfairy Heart Star]

Hello,

Are you on beta blockers?

I have 3 vasomotor disorders.

Raynaud's Phenomenon, migraines and vasospastic angina.

The cold is my enemy and the main trigger of my coronary vasospasms.

A side effect of beta blockers is developing secondary Raynaud's Phenomenon.

I ended up in hospital with unstable angina after being prescribed beta blockers before my diagnosis of vasospastic angina was confirmed.

I wear silver threaded lining gloves along with other multiple thermal layers, fleece liners in my boots, a hat and snood.

My Raynaud's Phenomenon has improved since I am on high doses of Diltiazem. I am on clopidogrel for life.

Do you know why you had your heart attack?

About 10% of heart attacks occur without any permanent blockages of the coronary arteries by plaque. Known as a myocardial infarction non obstructive coronary arteries MINOCA.

Some of the possible causes of these types of heart attacks are microvascular dysfunction or coronary vasospasms.

[Richie34 in reply to Milkfairy]

Yes,forgot to list that (Bisoprolol 5mg) daily, sometimes my pulse seems a little low to me, now regularly in the mid 50s/bpm. I know all these meds are meant to keep me well and from future events but there feels like there is a considerable daily pay off for their preventative/protective effects. I've never had headaches before (or very rarely) now there's a low dull sensation most days, I constantly feel faint when I stand up and need to now carefully consider that,my bowel habits have reduced significantly-I could go on. It's early days in having this cocktail prescribed so will give it time to hopefully settle down but part of me wants my old/younger 'well' self back again.

[Milkfairy Heart Star in reply to Richie34]

Coming to terms with any life changing diagnosis can take time.

We wistfully long for our former lives and grieve the loss of the life we thought we we're going to have.

I have for nearly 13 years had to take a ridiculous number of medications and I end up in hospital about once or twice a year.

I have had to learn to like eating prunes.

Maybe go and see your GP for a medicine review?

A heart attack is usually diagnosed if you have angina symptoms, certain ECG changes, a rise then fall in troponin blood levels.

Troponin is a protein which is released by the heart when it's damaged.

The way the wall of the heart moves can be altered too. This is detected by an echocardiogram.

Have you been offered cardiac rehabilitation?

Cardiac rehab can provide the psychological as well as physical support those new to heart disease need.

[Richie34 in reply to Milkfairy]

I have been offered cardiac rehab but not until end of March due to long waited lists/strapped resources but glad of it either way and I shall engage with it fully when it starts and like you say it will be more about the psychological side for me regaining my confidence (or at least that's what I'm hoping it will provide) rather than my fitness as I have been exercising since the procedure in early Jan but OMG been absolutely hideous doing my recommended walks in this miserable cold, dull weather, now up to 1 hour walks at a 3mile/hr pace which in and of itself has given me small amounts of confidence but alas I still find (annoyingly) I'm monitoring myself all the time whilst doing it rather than the old me of just enjoying the walk for what it was for example going up a slight incline,"oh is my hear beating faster? is that too fast? it didn't used to beat that fast before ,and on and on,I'm annoying myself. Going back to the tests my troponin levels were ok,ECG (I had loads of them) all of them a little different but again everytime I was told they are normal however the cardiac nurse presented me with one to keep (after my PCI) saying it all looked normal but when i got home after discharge i looked at it again and in the top left hand corner it said "abnormal report unconfirmed report, probable inferior myocardial infarction, probably old with posterior extension" so God only knows what lead her to summise there were no issues! That's the thing,I've not had great comms with cardiology,it's been like pulling teeth to a) get hold of anyone and b) to get the answers I need.

[Milkfairy Heart Star in reply to Richie34]

I have had many many ECGs. I am sadly a seasoned traveller.The computer generated comments on the reports are not always very accurate.

It doesn't help if you cannot get a healthcare professional to explain your ECGs to you.

I agree walkingin the wet and cold is miserable.

The psychological impact of heart disease is challenging!

[Richie34 in reply to Milkfairy]

In terms of a heart attack, it's kind of bonkers to say but no one ever told me I'd had one. I was experiencing odd chest pain and because dad died of a HA aged just 46 and I was 57 at the time they decided to do a precautionary CT where some coronary artery blockages were found (one in circumflex and one in the (and still don't know what this one is-listed as intermediate artery (?) and decided to go ahead and treat those (plus the cocktail of new drugs)