Sudden Cardiac Arrest & Heart Attack
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Worrying heart tests

Hi all. 2 weeks ago, I had an ecg, which detected ectopic beats, which was the main reason I had one done, but it also questioned whether I’d had a recent cardiac event. I’ve had chest pain along with the palpitations, but nothing like I’d imagine a heart attack would feel like! 😐 Anyway an urgent 24hr ecg and echocardiogram were requested by my GP. The 24hr ecg I had done last week, and the echo this week. I had a cardiology appointment booked for 15th Dec to discuss results. However, I got a call on the afternoon of my echo, from my GP, asking me to go to the surgery straight away. When I got there, the GP said that my 24hr ecg showed abnormal beats and that I was to be seen urgently, the same day (although this was 4 days later!) The GP needed to check me over and ask how bad my chest pains were. I said they felt like a heavy crushing type pain, more of an ache really, so was told that was ok, but they needed me to see the cardiologist sooner. I got a call straight away for an appointment in a weeks time. Since then I purchased an oximeter. Tonight, and last night and throughout today, my pulse will be around 100-107, then suddenly drop down to 28. When this happens I feel faint, and my heart is pounding (I’d been getting those symptoms, but didn’t know why before the tests and oximeter. Anyway, I know I see the cardiologist now in just a few days, but am worried sick. Why could this be happening? Is it dangerous to be dropping that low? I’m a 45 year old female, and had always been very fit, up until 2 years ago, when I got arthritis in my spine, knees and ankles, and recently I’ve discovered I have high thyroglobulin antibodies, which I was told is Hashimoto’s. My other thyroid levels are middle normal range.

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Main thing now is not to panic. They are on it and will take care of you. When you go write a list of questions you have and remember to ask them so when you leave the appointment you are content. Get as much info from them as you can. Remember things happen in life and are not always predictable. Relax....yes i know how can you but try. And good luck.

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Thank you Andyman. I know worrying is probably the last thing I should be doing. It's so hard not to though isn't it. You're right, they are on it, so hopefully will have some answers and possibly a solution soon. I keep telling myself not to get stressed about it xx

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Hang in there

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Don’t stress too much you are on track to see the cardiologist who will tell you more

Just Hang in there and be positive

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Thank you both very much xx

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Hi, have you had a bad flue. The large differnece in your heart rate can be due to may things. There is a common disorder commonly missed called POTS. (Google it) There is a simple table tilt test to confirm THIS. POTS can occur after infection, when the autonomic nervous system become dysfunctional. Recovery in some can take a long time. Extra beats can have many origins, most benign. If they continue and are destroying your quality of life, ask for referral to a cardiologist. Worst case scenario,is that you can ask to have a simple little device called a loop inserted just under the skin at your shoulder (about the size of a small match box) these are in for about 2-3 years and almost definitely will catch anything sinister should that be the case. They do not detect symptoms of ischemia, but my detect a rhythm disturbance caused by it. Can also be very reassuring if nothing detected. GPS can aslo insert a cheaper version of the loop, but only a handful offer this marvelous little device. Good luck

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Hi, and thank you. I’ve had no flu, viruses or bad colds for a few years. Was referred to a cardiologist, who started me on bisoprolol, as he said such a heavy burden of ectopics could damage the heart. He also asked for me to have a heart MRI, but wanted to get the ectopics under control first, as they’d get a clearer picture then. Sadly, they have not controlled them, and I’m still having severe heart beat and blood pressure drops, which make me feel so giddy and faint, so the GP has reduced the bisoprolol again. Trouble is, I was having these drops before I started the meds. Anyway the MRI went ahead on Friday, and was told they were mainly looking for ARVC as the ecg and my symptoms pointed towards this. In the MRI paperwork it said results would be in 2 weeks. However, I was told afterwards, that the results would be much quicker, as they were speaking to my cardiologist whilst I was in the scanner, and that the report was being sent straight away. I don’t know whether they found anything, or whether it was because of my ectopic beats causing a problem (they did say during the scan that the mri didn’t like the extra beats). They wouldn’t tell me anything else. I suppose they can’t as it needs to be checked by the cardiologist. One thing, it surely couldn’t have been too bad as I’m sure they’d have sent me to a and e. That’s what I’m trying convince myself with anyway. Still haven’t heard so I’m guessing it wasn’t as urgent as they made it sound, and maybe it was just because of the ectopics. Hate playing the waiting game though x

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Hi, do you know if you are having sustained ectopic beats (sustained VT) or non sustained Ventricular tachycardia? ARVC was originally called ARVD the *D* meaning dysplasia, an ongoing disease process. I met the doctor who first described this disorder, a lovely kind French man called Guy Fontaine. He and a doctor called Frank Marcus. Thats a long story. Anyway your MRI. MRI has long acquisitions and cini imaging which is much slower than CT multislice, although both have there uses MRI is the better modality for structure and function, but ectopics or various arrhythmia can cause blurring and artifact. I also have a very good friend who was a consultant purely in CMRI who has recently retired. Im sure you have read about the criteria for ARVC and it'd normally easily spotted on good MRI imaging People do not know or understand how distressing and worrying ectopics can be. It important to find the reason if possible before anti arrhythmia drugs are prescribed. There are many good ones available, but as with any anti arrhythmia drug the can also cause arrhythmia. There is also ICD should the arrhythmia be deemed to be of a dangerious nature. I hope you get your results and especially some sort of explanation as to the underlying cause, as not knowing can also be as upsetting as the ectopics. Good luck 🤞

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Hi, it says as follows. A 12 lead demonstrated sinus rhythm at a rate of 86 beats pm, but frequent ventricular ectopic. During her normal beats, an RSR pattern was seen in V1-V3 with minor T-wave inversion. The ectopy was of a left bundle morphology and positive in leads 3 and aVF suggesting a potential right ventricular outflow origin. The echocardiogram demonstrated normal biventricular size and systolic function, with no obvious regional wall motion abnormalities but frequent ectopic throughout. Mild tricuspid regurtitation was noted with normal PA systolic pressures and only trivial mitral regurgitation was present. The 24hr Holter monitor showed a very high burden of ventricular ectopy, approaching almost 20%, with nearly 21,500 mostly unifocal VEs in 24 hours. There were 511 bigeminal and 112 trigeminal events. No episodes of venrcular tachycardia, triplets, couples or atrial fibrillation.

I would like to put her forward for a cardiac MRI scan given the ecg changes and morphology of her VE's to ensure she does not have an underlying cardiomyopathy, specifically ARVC. I think it would be worth suppressing the VE's, for the MRI to get good images, with a dose of beta blocker, as over a long period of time, such a high burden of ventricular ectopy can cause deterioration in LV function.

Every night I get awakened by what I can only describe a violent buzzing in my chest (normally I just feel fluttering, or thumping). Each time it does this I sweat, am extremely dizzy and light headed, and my heart rate goes from 104 (at it's highest) to 24 (at it's lowest). My beta blockers were reduced as they weren't suppressing the palpitations at all, but the funny turns at night continue. I was asked to check my blood pressure as well as my heart rate, and on Monday night, I took the bp monitor to bed, and am pleased I did. That night I fainted twice. I had a number of dizzy panicky spells that woke me, and I checked my bp and hr. Both dropped low. My hr to 24, albeit for brief periods each time, and my bp was 74/43. This happened around 4 times and on the 5th time, after sitting up in bed to get ready to take my bp, I fainted, hit my head and knees. When I got up, I checked my bp, and it was the same. I remembered once before that drinking helps bring it up, so poured a cup of water, then found myself on the floor again with a crushed water cup, and water everywhere. I checked my bp again and there was no change so I drank lots, which brought it up to 113/69, and I felt much better, although still a bit light headed. When I was running through all the bp checks, I noticed that the time between faints and subsequent bp checks was only 5 minutes, so I must have only been passed out for a few seconds. Scary though!

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Dear dear, I'm sorry to hear you are going through all this. Without doubt your doctor has ticked all the boxes. I would push for a quick MRI as this is the modality of choice for your ongoing heart issues. There are many good medications that may help in resolving many of the arrhythmia issues you are having. Also stabilising the associated hymodynamic problems you are having with BP etc etc. Good luck and I hope you get to the bottom of things ASAP.

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Thank you xxx

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Hi all. Had a GP letter asking me to attend the surgery to discuss the results of my recent cardiac test results. I had my MRI a month ago, and a second 24hr ecg two weeks ago, so wasn't if it was for both, or one. Anyway finally had time to attend today, but was not told anything about my second ecg, which he said to discuss with the cardiologist when I see him (still awaiting appointment planed for this month), and said from my MRI results, that my heart was basically ok, but there was right ventricular wall abnormalities, then said but need to discuss with cardiologist. So now I'm even more worried than ever. When I googled this (yes I know I shouldn't have), it mainly points to ARVC /D, which is what the cardiologist was checking for and that my ecg results pointed towards. Surely if it was ARCD, the cardiologist would have seen me sooner, wouldn't he? My palpitations are still very much here. The beta blockers have done nothing for that, although my heart rate and bp are lower. All the information I can find on right ventricular wall abnormalities is very medically written, and too clever for the likes of me. Has anyone got any information that might put my mind at rest. My father had a heart attack, and said he had abnormal heart beats, but he can't remember why :/ So not sure if I've inherited anything

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The oximeter is not capable of detecting exact real-time accurate heart rate. If you watch ECG machines they will do the same bob all-over the place. When it moves suddenly there has probably been a sudden normal rise or fall, sometimes the oximeter will take a while to correct itself with short durations of low or high readings, especially standing or sitting. This is common with all my heart equipment.

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Hi, sorry I missed part of your post. MRI is indeed the modality of choice for the conditions you describe and until you have the MRI carried out and reported on I would try and remain calm. Easy said I know. I would push to have the MRI as soon as possible. Royal Brompton has a world centre of excellence CMRI department. These disorders were first described by Guy Fontaine and Frank Markus. I have personally met Guy several times in France. MRI is almost 100% accurate at detecting ARVD/C as it's now called. Good luck

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HI. I have had the MRI. It was the MRI that showed the right ventricular wall abnormalities.

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Sorry, right ventricular wall motion abnormalities are indeed associated with these conditions. There is a set criterion set out to establish arvd/C. Are you doctors saying you have it fit the criteria? There are other conditions that present with right ventricular wall motion abnormalities. The radiologist will never make a diagnosis only report what they see and it's usual associations. You need to speak with a consultant cardiologist with experience in these conditions, he's the person that needs to make the call. Good luck

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Sorry, when MR was relatively new, what was abnormal or a variation of normal was a learning curve . in studies, some healthy individuals were found to have a right ventricular bulging and slight wall motion abnormalities now believed to be normal. There needs to be other signs and observations on MRI to make a diagnosis of ARVC. These are well established today, so if the radiologist did not report it, its highly unlikely that you have any of the other major criteria needed to make the diagnosis. If you are still unhappy, you should maybe seek a second opinion both in the MRI and your ongoing distressing symptoms. Good luck

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Hi James, I don't know if I fit the other criteria as all I've been told is the MRI showed I have right ventricular wall abnormalities, and that was by the GP. AT the time of the MRI, the radiologists had trouble getting a clear picture to start with due to the palpitations, but got there in the end. When I asked if I'd get the results in a couple of weeks, the radiologist said it should be much sooner than that, as they were speaking to the cardiologist on the phone, whilst I was in the scanner! That was a month ago! I was supposed to be seen this month by the cardiologist, but the appointment wasn't sent out, because I was supposed to phone up for an appointment, which they failed to tell me, so now I have to wait until 28th April. I'm worried sick, especially as I'm having awful blood pressure drops, and severe sweats at these times, dizziness, and even fainting. My 24 hour eggs, show RV origin, and have over21,500 ectopic beats, which I have been told would cause damage if left untreated. I am on bisoprolol for this, but it is making no difference. The palpitations are still very much at large. I'm worried because a friends husband had similar problems and died of a heart attack, before his appointment came through, because he'd been waiting too long for this appointment, so I know people are missed, even if the evidence shows they should be seen urgently. I'm not feeling very well, and have not been for some time, which is why, coupled with the palpitations, that I had my first base line ecg, which was abnormal.

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Hi, I take it that you reside in the UK? I can sympathise with you regarding your symptoms, anxiety and ambiguity thus far reference an explanation. I'm sorry but in the UK you need to be very proactive and pursue your GP and consultant via phone and appointment until you have a satisfactory answer. You are also entitled to a second opinion. You also have the other option of a one-off appointment to see a cardiologist of your choice privately ASAP. This may be worth it alone to put your mind at rest.

I wish you good luck

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Hi James, thank you. Yes sadly I am in the UK. It does seem as though you have to pester, but I do hate pestering and instead spend my time worrying :/ Hopefully it is ok, but just wished if they were going to tell me anything at all, they'd told me it was all fine, if that was the case, then I wouldn't need to worry so much. That being said, I'd like some answers as to why I have fainted, and why my blood pressure dops so low overnight to the point of either fainting, feeling like the room was spinning, sweating terribly, and even being sick. The latter of these symptoms may be all due to the bp drops, but wish I knew why it was dropping so low. At the time of my dizziness, and bp drops, which I have every night, my heart feels like it's actually vibrating, or buzzing. It's not like the palpitations I have 24/7, it's literally like I have a motor running in my chest, so it must be related to the bp drops, but can't find anything online that matches that. So I just don't know. I do know it's not anxiety, because it often occurs when I've gone to sleep and it wakes me up.

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The buzzing vibrating feeling in your chest may be A/F. Although you need a 24 hour tape in place to confirm or dispel this. There is also a permanent loop recording device. This is inserted just under the skin adjacent to your shoulder. Stays in for about 3 years. This will pick up any arrhythmia you feel may being overlooked Discuss with our cardiologist. Best J

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thank you James x

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Hi,I forgot to ask,you say you get these attacks during sleep. May I ask if you snore or have been diagnosed with obstructive sleep apnea ?

This may be also worth investigating as sleep apnea is well known to exacerbate blood pressure and arrythmia for a multitude of reasons. Hope this is of interest . j

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Hi James, the attacks are mainly just as I'm drifting off to sleep, or already asleep, so I was wondering about exactly the same thing, sleep apnea, as yes I do snore, terribly and often wake myself up struggling to breathe. I thought this right up to the day before yesterday, when I had a series of attacks before I fell asleep. I was however in bed, but not quite tired enough to go to sleep yet. I had been laying down for approx half hour when it started, and felt really faint again, so just didn't sit up, for fear of falling like I did before. It eventually passed, but went on and off for about 45 minutes to the point where I wondered if I needed to go to hospital. I had chest and arm pain too, but not excruciating pain, so didn't think it was a heart attack, but it was very unpleasant, alongside the dizziness, and feeling like I was about to faint again.

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I have a 48hr ecg on 6th April. It was to be this Friday, but the place that was to fit is was up two flights of stairs, which I cannot do, due to spinal problems and arthritis in many joints, so had to be changed to a different date and location. I've had two 24hr ones, which were both abnormal, but did't catch these episodes, because I wasn't having them every night then, just the palpitations. However the cardiologist phoned after I emailed my symptoms and said to call an ambulance if they occur again, and said he'd arrange another holter before the app with him. I don't like calling an ambulance unless it's really necessary, but was getting a bit nervous the other night. The cardiologist said there were some changes to the right side of my heart but he doesn't know why yet. He's hoping this 48hr holter will catch the vibrations, which he thinks may be another abnormal beat, and give him some more answers. Hate not knowing what's going on x

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Good morning, please see your GP and tell him that you snore. This is a well-known symptom of sleep apnea with a connection to angina, rhythm disturbances and cardiovascular pulmonary issues. Please see your Dr and explain that you snore and request an urgent referral to a sleep clinic for a sleep study, preferably a FULL study "Polysomnography". Good luck and hopefully this can address the sleep disturbance issues you are experiencing Best James

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Have asked now for a referral to a sleep clinic, so hopefully that will either be excluded as a problem, or treated 😊 x

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Great I am glad to hear this .OSA is now on death certificates in the state of Calafornia in association with other cardiac issues . Other states will follow soon with this autopsy finding Breath holding can seriously derange blood chemistry inc carbon dioxide and raised Catecholamines which play a major role in the induction of cardiac rhythm disorders. There for it is of the utmost importance that you get treatment for OSA should you have it. Many studies are on going around the world ref heart attack,stroke and cardia arrhthmia to mention but a few. Much more will be coming soon about heart attack, and multiple health issues related to this underestimated breathing disorder. Snoring is not evidence of OSA but can be closely associated with it.

Best J

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Yes, I had to complete a score chart, to be referred, and had enough points to be referred. Hopefully I do not have OSA, but I will at least know either way. Thank you once again for all your advice 😊 xx

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It would explain the poor sleep with possible supra arrhythmia. Very very common in OSA. Would be helpful if that was cause. Worth investigating. I have came across it many times. You really need to push for a full sleep study on the grounds that you you have structural abnomalaties and ECG changes. You will get there ! -:)

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Thank you James 😊 xx

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If your consultants are unsure, do not be frightened to ask for a referral to a centre of excellence that specialises in these rare disorders. Royal Brompton, Sydney Street is involved in specialised genetic testing for cardiac disorders that are not overtly obvious with tests .Just another avenue to pursue.

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hi, sorry to have joined late on but l have been in a similar situation and have gone via the Royal brompton route. It is a worrying time and theres nothing that can be done about it. I found solice in the suport others have given me. I have microvascular disease inc vascular spasms, meaning my arteries close shutting off blood to the next organ down stream. l will continue on the next post

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My MR Scans showed sub endocardial hypoperfusion damage (l have to be careful because the prof dont like me including the word damage) basically areas of narcosis in the endocardial, there was also some on the valves. my walls are a tiny bit thicker and the horizontal axis is a bit shoter, also my pumped valume is low. EF was spot on 67%. hey imstill here! continued next post

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my GP hadnt or hasnt got a clue so he leaves it to the consultants but in my case there are no cardiologists in the birmingham/wolverhampton area with a working knowledge of my disease. there are a few more that now know about my disease because l make sure l tell them. Ihave had to make sure l know asmuch as l can so l can educate them. more than one arguement has happened. Especially with wolverhampton heart and long who on principle dont reconise the disease. cont next post

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this app on a ipad is mank. what im trying to do is to show youthat you need to be your own advacate. learn as much as you can so that you canhold your own ground. Also find a cardiologist that has a working knowledge of your disease. forget the likes of the BHF because they are only interested in blow it up, put a spring in or bypass it! been to meetings withem and they said anything out side this and they will just give it lip service.

be lucky Kel

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Thank you, yes I will be more assertive x

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Hi,you can have good preserved systolic function ,but have diastolic heart failure . where you diagnosed by cardiac MRI Perfusion scan at the RBH Do you know the name of the consultant who reported on your MRI?

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Hi, the two names at the bottom of my first sheet reads Dr Brian Halliday CMR Unit Fellow and Dr John Baksi CMR Unit Consultant. Yes l do realise about dyastolic disfunction but at the moment the readings are all bottom limits. Themain one that hit me was the low LV volume at 47ml per m per m, age ajusted saysaprox 80mean

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MRI is not the modality of choice to measure LVEDP. Gold standard is angiogram with pigtail in left ventricle . You are one of the luckier patients If you have a low LVEDP in single figure ,with preserved systolic function. All the best

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I have no idea what my dyastolic pressure is? all l cansay is that my blood pressure is erratic and there can be a difference between arms, just incase l caused confusion my lvedv is 47, my lvesv is 15, lvmass index is 59. other is, wall thickness max 13mm and mildly reduced long axis. It points in the direction of dyastolic dysfunction but im not suposed to have actual heart attacks just the slow dimise of function so l dicided to have two NSTEMI's 18 months ago😅

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LVEDP, IS LEFT VENTRICULAR END DIASTOLIC PRESSURE. Not related directly to diastolic blood pressure. I used to have a very good friend at RBH CMRI, but he has retired now a few years. What was your diagnosis . have you been gene tested. There are many studies taking place in genetics. There is also the 100,000 genome project in the UK with 400 participants in Northern Ireland.

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(Coronary) Microvascular disease. (call by many names including, Syndrome X and Small Vessel Disease) this also includes (Coronary) Artery Spasms. Basically on a micro and macro level my arteries close up, a pinch or squeze in other words. I get this whole body and multiple times daily. see next post

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Anything down stream is then subject to hypoperfusion. Dependant upon how good the pinch is is proportional to the hypoperfusion or on a physical level the amount of pain. l have the start of an heart attack daily but not always strong enough to matter, I have had bettween 20 and 30 ones that did matter during the last 7 years, 2 which where given Heart Attack status. Grrr this app

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Which is why l laughed when you said l was a lucky one 😢 I am lucky because these spasms only stay on for a short time, hence if you read some of my posts my pet subject is vasoconstrictors and vasodilators.

What makes you interested in the heart?

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First, microvascular disease is not exclusive to the heart but is the holy grail of cardiology at present. You have had MRI perfusion with gadolinium? I apologise I did not mean to appear condescending about your condition as these conditions are extremely distressing as there is no cure, and won't is until the aetiology is better understood. There are some good antispasmodic drugs available ie diltiazem( slozem lorazepam, beta blockers. Hopefully, you will find one that will make your spasms more tolerable.

Good luck in the future.

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I did say earlier on that l get this whole body, well 4 main areas heart, brain, skin and abdamon, in that order. l think l get it in the intestings but its never been diagnosed

you never said your interest in the heart

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Didn't think I'd actually be pleased to have a funny turn again over night, but as I had my 48 ecg on, I was hoping to catch them, so I could hopefully get some answers. I had loads, last night, so hopefully they're all captured now. Now to wait for the results, and maybe, and hopefully, treatment of some kind, so I can start getting a decent nights sleep. xx

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