Hi, was diagnosed with angina back in 2013 and had 2 stents fitted. Not much pain since then but now have permanent Afib (asymptomatic) and on all usual meds, including Digoxin, which was added in June last year to bring heart rate down. In the past few months I have started having attacks of what I would describe as severe angina type pain - sudden chest pain causing me to double over. It doesn’t respond to gtn spray and can last for 20/30 minutes.
After the third such attack I went to gp. He insisted I should be dialling 999 in these instances and referred me back to cardiology.
I have just had my appointment with a Nurse Practitioner. Did an ecg which he said was “perfect”. I was amazed and questioned this - he then said , well it’s showing you’re still in afib but the rate is better, so not quite “perfect”. He assured me my pain is therefore not heart related and said you can’t have angina pain and be fine in between attacks, and that if it was angina, it would respond to the gtn spray.
He is arranging an ecg treadmill test . I mentioned the coincidence of these attacks starting after I was prescribed digoxin and his response was that digoxin does not cause heart problems and he will not be stopping it. So I have my gp insisting I dial 999 next time it happens, and a nurse practitioner insisting it is not heart related. Totally confused and would appreciate any comments.
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Chest pains don't have to be heart related. They can be caused by gastro issues, think simple 'indigestion'. When I presented at A&E with chest pains and subsequent admission I was misdiagnosed by a cardiologist to have angina even though I explained I had reflux disease. He had based his diagnosis on an earlier NSTEMI but then after an angiogram agreed it was more likely gastro rather than cardio.
Hi, thanks for replying. Yes I do appreciate there can be non heart causes and have other issues myself that can cause chest pain - hiatus hernia, bronchiectasis. It was just his immediate and total dismissal of heart causes and his incorrect assertions re angina. (See Jim’s post below). Also, being female, it is not uncommon for medics to automatically presume stress and anxiety, which I find condescending- he told me to stop googling !
HiSorry to hear this very upsetting for you. Just a thought has Oesophageal spasms been considered? Extremely painful and similar to heart pain. If I feel one coming on I glug down some Gaviscon before it takes hold. Seems to lessen and shorten the pain. As I say just a thought. Hope you get sorted soon.
Without a definitive diagnosis, your GP is being cautious and prudent Your NP is being both cavalier and incorrect.
Angina is often episodic, especially in chronic stable angina, and pain-free periods are common. Also, GTN (nitroglycerin) not relieving the pain doesn’t rule out cardiac ischemia, especially in cases of microvascular angina or severe disease.
Also Digoxin can occasionally worsen ischemia or trigger arrhythmias in some people, especially if levels are high or if underlying coronary disease is present.
Another thought is that the digoxin could have triggered GERD thus causing pain. Maybe your GP might suggest antacids and/or a PPI or a short trial off Digoxin.
Chest pain can have several causes and the diagnosis is not always clear cut often involving both a GI specialist as well as a cardiologist.
A nuclear stress test is a good start but a CT scan would be better.
Hi Jim, your reply is just what I needed to hear - thank you so much, I was beginning to doubt myself. The word “cavalier” is a very apt description of what I experienced. I am in agreement with your points re angina being episodic, and I too have read that in some people, digoxin can indeed have an effect on the heart - but he just told me to stop googling ! He may well prove to be correct in his assumptions that it is non heart related but I think he definitely needs to improve his bedside manner .
Take your GP's advice and ring at least 111 who will probably send paramedics who can do an ECG while it's happening. I would also mention to your GP that hurse's condescending and cavalier attitude
Thanks Qualipop - that’s good advice to call 111 in first instance , although no doubt as soon as I mention chest pain, they’ll just send me to A&E ! I do intend to speak to someone, possibly Pals, about the nurse’s manner - there was no discussion taking place, it was more or less what he says goes. I understand Nurse Practitioners do a 4 year (Masters) degree, rather than the standard 3 year nursing degree - this certainly doesn’t make them anywhere near as qualified as doctors.
If you have chest pain they will absolutely NOT tell you to go to A&E. That would be risking a heart attack on the way. On the few occasions I've had to ring 111 they have always sent an ambulance. Just once I rang 999 myself and that was a heart attack but only once have the paramedics taken me to hospital when the ECG showed problems
This one was puzzler for me too! Was it angina or was it stomach pain? So I was already taking Omezaparole for the stomach, was told to double it, no effect so I tried the GTN spray - Bingo, it worked. Continued using the spray daily until I got seen by my GP.
Quick referal to Hospital for short stay, tests then Cardiologist, put me onto Bisoprolol. Things have worked out ever since.
Thanks Jedi14, I’m on low maintenance doze omeprazole so may well need increased - I have a hiatus hernia. Totally accept could be stomach pain. Will await treadmill test then take it from there. (Also on Bisoprolol and various other meds)
Hi there, I just wanted to say I completely understand why you’re feeling confused and frustrated — and you’re right to question what you’ve been told. I was told I had chest infection the first time I went to A&E, second time an infection gallbladder and then I paid to see a cardiologist who sent me straight to hospital as he said there was a good chance I would have a heart attack very soon. 2days later I had a stent due to a 99% blocked artery.
A few things really stood out to me from your post.
Angina can absolutely be intermittent — The idea that you can’t have angina and feel fine in between attacks is simply not true. Many people with angina (even after stents) live symptom-free most of the time but can still get episodes, sometimes severe ones.
GTN spray doesn’t always work — While GTN can relieve typical angina, there are types of chest pain (such as coronary spasm, microvascular angina, or diffuse disease) where GTN doesn’t always help. So the fact that it doesn’t relieve your pain doesn’t rule out a heart cause.
Your GP is right to advise 999 — Any new, severe, or prolonged chest pain like you’ve described should be assessed urgently. It’s much safer to be checked during an attack — that’s when the ECG and blood tests may show what’s really going on.
Digoxin can sometimes worsen symptoms — While the nurse practitioner may have meant that digoxin doesn’t “cause” heart disease, it can definitely affect heart rhythm, blood flow, and oxygen demand, especially in people with underlying coronary artery disease. It’s valid to question whether starting digoxin coincides with your symptoms — you know your body.
A normal ECG doesn’t rule anything out — An ECG between attacks may well look fine (even in someone with coronary disease or angina). What matters is what’s happening during an episode.
You deserve a proper assessment — A treadmill ECG test may help, but it’s not the best tool in cases like yours. It might be worth asking for a stress echocardiogram, nuclear scan, or coronary review to rule out things like spasm, restenosis, or new narrowing elsewhere.
You’re not imagining this. Your symptoms deserve to be properly investigated, not brushed off. Don’t hesitate to dial 999 if you get another severe episode — even if someone tells you later it “wasn’t your heart,” it’s always better to be safe.
Do you have a lived experience of microvascular and vasospastic angina? I do, the forum requests that we speak from our own experiences.The strength of the forum is sharing our authentic lived experience of a condition.
The information you have given isn't entirely correct about microvascular and vasospastic angina perhaps because you don't have a lived experience of these types of angina?
A quick response to sublingual short acting GTN is the usual response for people living with vasospastic angina.
Other symptoms are chestpain at rest, especially during the night. Most people living with vasospastic angina can exercise, however they may experience a delayed response to exercise sometimes shortly afterwards, even a day later.
There is some evidence that short acting GTN may not be affective for people living with microvascular angina.
Whilst microvascular and vasospastic angina are types of angina/ ischaemia non obstructive coronary arteries ANOCA/INOCA the underlying causes and treatment are different.
This article was loaded by my Cardiologist into my electronic patient records, it gives full up-to-date information about vasospastic angina.
Thanks so much for your response Goonerboy - it’s heartening to read that others also have opposing views to that of the NP. I have no doubt myself that angina can indeed be intermittent and was shocked when the NP stated that it absolutely couldn’t- he was so certain of himself ! Similarly re Digoxin, he was totally adamant and actually said “I will not be changing it “
I thought the patient was supposed to be consulted during these appointments, and treatment was to be discussed, not dictated. This NP seems to believe he is a qualified doctor, or even a consultant, (although most of the Drs or consultants I have met have a much nicer attitude).
As said by 2 people above, it could be vasospactic angina. It can come on suddenly without exertion and it can last for upto 30 minutes. Apparently GTN usually helps but not always.
And heart nurses are not hitting the mark . I found fast AF would give ne a heavy feeling on my chest , it is wise to call 999 if your chest pain is lasting a long time . I found the best way was to search all the local cardiologist on private hospital website to see their specialist interests for one who was interested in women’s heart and unusual angina . Once found I saw him the best £200 I have ever spent and was diagnosed with coronary artery spasm , more frequently it can be micro vascular dysfunction in ladies post menopause,
Have a look at the Inoca international website it’s full of such helpful advice , they also have a facebook page .
Be a warrior woman go get good information that will help you .
There is also the International Heart Spasms Alliance a website created by four patients working with over 30 world expert Cardiologists. This group is listed in the BHF 'Understanding Angina ' booklet as a resource.
I am sorry you haven't had a positive experience and feel your symptoms are being brushed off.
I was admitted to hospital over 10 years ago with a suspected heart attack, incorrectly told I couldn't have angina or a heart attack because my coronary arteries are unblocked.
Women unfortunately do not always have their heart problems recognised by healthcare professionals.
I was later diagnosed with vasospastic angina following a specialised angiogram.
Angina is a symptom of a lack of blood supply to your heart.
The most common cause is due to a pernament blockage to the coronary arteries.
Angina can occur when the blood vessels do not work properly. Either failing to dilate or stay dilated in response to extra demands like exercise, microvascular angina.
Or the coronary blood vessels go into transient constrictions , vasospasms, vasospastic angina.
If there is a mismatch between the amount of blood needed by the heart and how much the heart can supply this can lead to angina too.
Atrial fibrillation, high or low heart rate, high or low blood pressure can lead to this supply demand mismatch. Some medications can also cause problems.
I suggest you keep a log of your symptoms to see if you can spot any pattern or triggers of your symptoms.
Also ask to see a Cardiologist who understands heart rhythm problems, an electrophysiologist.
Also ask whether microvascular or vasospastic angina maybe responsible for your symptoms.
Thank you Milkfairy for such a helpful reply, in layman’s terms which I can fully understand - I am not at all scientifically minded.
I like the idea of keeping a log of my symptoms and will certainly be doing that from now on. I am fully open to the idea that the pain I experience may not be heart related , but would certainly like the heart option to be fully explored first.
I come from a large family, and everyone of my siblings is affected in some way by heart disease. My father died at 41 from a heart attack and on my mother’s side, 2 of her siblings died in their 40s and 3 in their 60s, all from heart disease, so I have good reason to be concerned.
On the whole I would say I have received good care from the NHS, but this latest experience has to rank as one of the worst and I do intend to take it up with PALS or whoever deals with these issues.
I don't want to add to any confusion, but the first time I was diagnosed with angina (25 years ago) it was a misdiagnosis - what I actually had was costochondritis. nhs.uk/conditions/costochon... There is so much going on in the chest that it's always worth looking at all the possibilities.
Yes, thanks for your reply. Totally open to the idea that it may not be heart related, and I actually have other issues that could be causing it - hiatus hernia and bronchiectasis. It was just the attitude of the NP and his misinformation re angina that got to me.
I have heard of Costochondritis and understand that it is often confused with heart pain.
My surgery ecgs are sent onto the cardio dept. in local NHS hospital, not even the GPs thinks they are equipped to comment never mind a NP who is the ‘technician’!
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