Is this microvascular angina or something else?
Posted , 5 users are following.
Hi All, I have been experiencing unexplained symptoms for over 2 years and wondered if there is anybody out there that can share similar experience or offer some guidance as to what my problem could be.
It started 2 yrs ago with episodes of a kind of vertigo feeling. Like a falling feeling. I also suffered with a discomfort just to the left of my spine near my shoulder blade that may or may not be related. I initially shrugged it off. It happened 5 or 6 times over a 6 week period then went away for a year. Then it returned with a vengence! the episodes now came with a horrible sense of doom along with pain in the tips of my shoulders, palpitations and chest pressure. I was sent to both cardiology and the musculoskeletal unit. Cardiology had me do an echo, ecg and stress test but found nothing. MSK did an MRI of my thoracic spine but found only moderate degenerative disc disease that they say is normal. MSK did an examination of my thoracic spine and found significant stiffness in the muscle that runs down the left of my thoracic spine. They gave me exersises to do and discharged me with a diagnosis of possible T4 syndrome.
By this time I began experiencing a deep aching in my back, chest, left neck, jaw and the left side of my face. This can come on at rest, last anything from 5 mins to 45 mins then go away as if nothing was wrong. i have experienced episodes of involuntary arm curling with the vertigo/doom episodes although this has only happened 3 or 4 times in 2 years and passed quite quickly. It had me feeling I was about to have a heart attack. I also began to experience a discomfort with my breathing. Feeling as though Im not getting a satisfying breath. This also comes and goes at random. I experience dizzy spells too. Over the last 12 months this has gotten worse. I was referred back to cardiology and fitted with a holter monitor (found nothing) They tested me for a pheochromocytoma (nothing) and finally a CT angiogram that showed no calcification and clear main arteries although they did say the smaller vessels could not be seen on the scan and that they couldnt rule out MVD or microvascular spasms. They discharged me with a note to my GP to try me on nitrates and calcium channel blockers to see if they improved my symptoms. My GP tried me on nitrates but they made me feel ill and I stopped them after a couple of weeks. My GP wont try me on CCBs because I am taking propanalol and says the two cannot be taken together. Since then Ive been left to suffer. No further investigations, no diagnosis and a worsening condition. In the last couple of weeks the weather has been really hot and I have noticed my symptoms are worse, difficulty getting a satisfying breath along with the usual angina type pain referal pattern. Now I also get a feeling of a knife between my shoulder blades that comes on, is really painful and then goes away in a couple of minutes.
I really dont know where to turn next. Ive also seen a Rhuematologist that said he could explain some of my symptoms but not all and questioned why I had never had a invasive angiogram. He also advised me to push for the CCBs. I have registered with a new GP but I havnt seen him yet. I have lost confidence in my old GP as I dont think she knows what to do.
My blood tests show a raised lipid profile. Combined HDL LDL ratio of 6.1 but my Tryglycerides are at a massive 5.7 and I have been offered nothing to help it except "change your diet"... I eat the odd take away like everyone else but i dont eat unhealthily at all. My Ferritin levels are at 700 but my C reactive proteins are normal indicating no inflammation and I am not anemic. My red blood cell count is slightly lower than it should be but apparently not enough to account for the breathing issue. I was also B12 deficient at 172. I am on injections for this but no mention of any further tests to get to the bottom of things.
I am 39 yrs old. Male.
Thanks for taking the time to read this. Any opinions and shared experiences much appreciated.
Thanks
0 likes, 18 replies
samuels dean30360
Posted
Yes I was originally diagnosed with this but the diagnosis changed over the years, none of your symptoms were the same as mine, well except for the breathlessness and in my case moderate to severe chest pain, nitrates worked for awhile, my body built up a tolerance to them, this is an incurable condition at the moment, they generally can be controlled, but rarely.
GTN (spray under the tongue) even though it made you feel sick it should of eased your discomfort as it opens up arteries and blood vessels and as a rule of thumb should stop the spasms.
Have you had an endoscopy to rule out Esophageal spasms ? this condition also gives off angina type pain.
dean30360 samuels
Posted
Thanks for your reply. No never had any investigations into my esophagus but then again my pain is rarely in the centre of my chest. It seems to be more back, left shoulder, neck, jaw and face. It has any doc ive seen stumped for answers. I spend a few weeks convinced its my heart, then a few weeks convinced it stems from my spine/ribs where the constant discomfort is. I just dont know. MSK think its my back and the palpitaions, dizziness and doom feelings are because my sympathetic nerves are being irritated. Cardiology wont commit either way and have left me in limbo..
I hope you have found relief from your symptoms and thankyou for taking the time to reply it is much appreciated.
samuels dean30360
Posted
Hi,
Yes those para sympathetic and sympathetic nerves can do some weird stuff to our bodies, although I don't think, and I could be wrong here, but I don't believe this part of the nervous system actually causes pain, it definitely causes uncomfortableness .
All the best and I hope you and the doctors find the answers you so need to recover
victor33304 dean30360
Posted
Any news ?
My symptoms were different, but I also struggled for about 2 years with all kinds of symptoms while all investigations were negative, including mri, echo, ecg, stress test. Blood tests were fine except high lipids.
Multiple cardiology doctors said I'm fine. Only when they finally did an invasive angiogram they found blocked arteries.
samuels victor33304
Posted
That's usually the way it goes when it comes to high cholesterol or a weird lipid profile.
dean30360 victor33304
Posted
I seen the new GP and he has referred me to the respiratory team to have my lungs checked as I have already had so many cardiac investigations. Im not convinced...
Symptoms are getting worse, I find myself getting short of breath trying to hold a decent conversation and then it takes me half an hour to get it back. Ive been having pains in my upper abdomen at the same time as the shortness of breath along with a feeling of nausea. I find myself taking deep breaths and exhaling through pursed lips to try and keep the nausea at bay. These are new symptoms. Does this sound like a lung problem? The whole thing makes no sense and is getting worrying. Had my bloods done again, ferritin and tryglycerides are still sky high which indicates inflammation, infection or disease according to my GP. They just cant find it! Id pay for an invasive angiogram if I had the 3 grand it costs but I dont have it. I feel like Im waiting for a heart attack before anything is done.
Weird thing is I feel more pain/discomfort in the back of my left rib cage than my chest. Im in two minds whether or not to pay for a ct of my lungs and thoracic cage to see if anything shows up. Current waiting list for respiritory team is 18 weeks... Good old NHS eh..
samuels dean30360
Posted
dean30360 samuels
Posted
I dont have swelling in my calf muscles but I have had pains down my left leg as well as my arms. Sorry to hear youve had such a rough time of it! I thought I had it bad.. Is this something that is ongoing for you or did they manage to get you sorted out?
Can I ask how long did you have symptoms before you got a diagnosis for either the angina or the pulmonary embolism? I seem to be going around in circles. Ive just had another trip to the doctor today and I have been referred for a liver ultrasound and to see a liver specialist due to the recent change in symptoms and the raised Lipids. Also given me a GTN spray to trial as he isnt convinced this isnt my heart now either despite the clear ct scan. Still have the respiritory appointment pending too...
samuels dean30360
Posted
Hi Dean,
The prinzmetal angina is an ongoing issue for me, although I have 2 cardiologists saying yes to the prinzmetal angina and one saying no, I was originally diagnosed about 15 + years ago with the small blood vessels going into spasms, very painful and told there was no cure, only medication that would either stop or prevent the spasms, I was warned that my body would build up a tolerance to the nitrate medications. As far as the pulmonary embolisms go, I have been given the all clear with them, clots all gone, on blood thinners for life. My calf muscle pain started after doing a days work of interior painting of my house, I thought I may of twisted the wrong way and strained a muscle, it didn't get any better after about a week so I mentioned it to my GP during one of my routine visits, he was of agreeance that it was just a strained muscle , another week went by without any relief and I was also getting breathless a lot more easily, making the bed and even showering puffed me out completely, I also had increased chest pain, I attended our emergency department due to my angina and breathlessness, the paramedics asked me why I was limping, I explained what I thought it was, they mentioned it to the triage nurse, she came out and had a chat and pulled up both my trouser legs, looked at both calf muscles, as I mentioned the left one was puffed up and it was slightly red and hot to the touch, triage nurse said to me that she was more concerned about my calf muscle than my chest pain this night, unfortunately I'm a regular visitor to our emergency department, I was taken straight through, had the ECG and the troponin test, the doctor walked in and also asked for a D-dimer blood test, after about 45 minutes the doctor came back and informed me that my troponins were slightly elevated and the D-dimer blood test was way off the charts so he then ordered a contrast CT scan, results came back as multiple blood clots in both lungs, I was admitted for a day or two, I think only a day because I felt a bit better after they gave me a type of clot busting medication the night before and the consultant put me on blood thinners, because I said I was feeling Ok he was confident enough to discharge me, it takes ages to recover from a pulmonary embolism(s) took me a good 12 months or so before I came completely right.
You mentioned your lipids, this is why my diagnosis was changed from small blood vessels within the heart going into spasms, I assume they called that MVD, I can't remember, any way that diagnosis was changed to prinzmetal angina (coronary artery spasms) the 2 cardiologists explained it very well to me into why they believe it is indeed PM angina, it was to do with my extremely weird lipid profile and what it can actually do the nitric oxide in the endothelium.
I had been going around in circles like you for years and still to this day some doctors do not believe or have even heard of PM angina. If the GTN works for your pain I think you can pretty well say you have some type of angina, if not that a condition they call esophageal spasms, which produces the same symptoms as angina, GTN also helps in that condition as well, and easy indictor for this condition is hard to swallow or hurts to swallow, nothing like that with me. They also tell me that gallstones give off angina chest like pain symptoms as well, for me all clear, your doctor is heading in the direction with a liver scan, problems with the liver can produce similar symptoms, conditions were never really explained to me as my liver came back reasonably clear, just a slight fatty liver but apparently just about everyone has a slightly fatty liver.
Hope they get to the bottom of it all for you in a speedy manner and all the best for your upcoming investigations, hope they find answer(s) to your concerns.
dean30360 samuels
Posted
Thanks for your reply, it sounds like you have had a rough time of it! Indeed it is very difficult to have anybody take you seriously when all the tests are coming back negative. If it wasnt for my blood results being up the wall I think I would have been brushed off by now. I had one Cardiologist write to my GP and advise that I was evaluated by a clinical psychiatrist... I was not impressed! That was quite a while ago and since then my symptoms have gotten worse and it is starting to show in my blood.
Thanks for your good wishes. Hopefully Ill be able to update this thread with a definitive diagnosis soon and it may help somebody else.
samuels dean30360
Posted
Hi,
It took a heart attack for emergency doctors and my own GP to stop putting my symptoms down to panic/anxiety. Vary rarely does my blood work come back normal, my kidney functions are nearly always all over the place, white blood cells the same, red cells and platelets nearly always out of whack, and to top that off I have extremely low iron. no one has any answers for me so I have been placed in the to hard basket by the specialists, emergency doctors can no longer say to me it's just anxiety, cardiologist has instructed that troponins to be taken on every presentation to emergency as I have had two NSTEMI's , spaced out a touch, two heart attacks with 18 months.
dean30360 samuels
Posted
So sorry to hear that. I know what you mean about the "too hard basket", I was naive enough to believe that when we get poorly we go to a hospital and they can do a magic scan, give you some magic meds and off you trot into the sunset ! Only now do I realise how primitive modern medicine is. There is so much we know very little about or how to solve. Its quite frightening!
I hope they get to the bottom of things for you Samuels
victor33304 dean30360
Posted
dean30360
I had the same symptoms, including the part where sometimes I felt like I'm struggling just to talk for longer than 30 minutes and strange pain in the back and burning in upper stomach.
It took a stronger pain in my back for several days and slightly elevated troponins for them to finally decide that maybe I should have an angiogram, where they found blocked arteries.
All other investigations to my heart and blood pressure were always in great shape, and they also considered I should consult a psychiatrist .
You should at least carry on you all the time some aspirin, 150 mg or 300mg, I'm not sure about the quantity. If you'll suspect a heart attack, you could at least chew that while the ambulance arrives.
Unfortunately the doctors are very reluctant to prescribe angiograms unless there's a very clear and strong suspicion you have blocked arteries.
randy797 dean30360
Posted
Looks like the last post in the section was 9 months ago and was just wondering how you were doing Dean?
I also have microvascular angina issues and was wondering if you have found any relief....also have you thought about going to somewhere like Cleveland Clinic or Mayo?
dean30360 randy797
Posted
Hi Randy
Since the last post I have been diagnosed with compound Haemachromotosis following a positive blood test. They think this could be responsible for my wide range of unexplained symptoms. I am on the waiting list for phlebotomy and a liver/spleen MRI to check how bad the iron deposition is. Apparently years of iron build up in your organs and tissues can cause lots of problems including heart, liver and even bones, skin etc. along with pain and discomfort. Its taken since my first symptoms presented in March 2015 to get a diagnosis but I think they may finally have an answer to my problems.
I have found that taking L Arginine has really helped me and it is recommended for heart issues. It relaxes the blood vessels and has made a big difference for me. I started taking it as an alternative to CCBs as I didn't like the sound of all the associated side affects. I take 4000mg per day of the Arginine, 2000 in the morning and 2000 at night. I read that you can safely take up to 9000mg a day. There is a microvascular angina specialist here in the UK that prescribes Cialis (impotence drug similar to viagra) for MVA and it gets good results apparently although I haven't tried it myself! Cialis works differently than viagra in that it lasts for a few days rather than a few hours and opens up the blood vessels for longer resulting in relief from angina.
Besides the Arginine i take a low dose aspirin, CoEnzyme Q10 and propanalol and statins due to my high tryglycerides. The CoEnzyme Q10 apparently helps muscles including the heart muscle to repair itself. It is also recommended for people that take statins as they deplete the body's natural supply resulting in muscle pain.
randy797 dean30360
Posted
WOW....glad you are finally on top of things.
You have given a bunch of great info here. I am going to look into some of the things you have mentioned here to see if they might be a help for me.
I have never heard of Iron-Overload before....can they do anything about reducing the amount of iron in your organs or do they just treat the symptoms?
Keep us updated on how you are doing....this is really fascinating to hear how these drugs are working for you.
dean30360 randy797
Posted
Iron overload is treated by phlebotomy which is basically removing blood from your system over a period of weeks until your ferritin levels return to normal. The normal range is between 30 and 300 for men. Mine are currently at 850.. Following the initial weekly blood letting you are then treated with removal once every few months to keep ferritin in check. This will prevent further damage and ease symptoms although some damage is irreversible. Iron can clog blood vessels and result in many disorders. It is hereditary and the doctors here are looking at the possibility of Haemachromatosis being responsible for my mothers osteoporosis, avascular necrosis and adrenal insufficiency. It is often overlooked and can fly under the radar, especially compound Haemachromatosis as it presents differently from classic Haemachromatosis. My brother is 6 years older than me and is being referred to a cancer specialist as they think he has lymphoma that has originated from his liver, also a complication of untreated Haemachromatosis. Sufferers are apparently up to 200 times more likely to develop intrahepatic cancer than the general population.
Regarding MVA please do look into the supplements that have helped me as they are a safer alternative to some of the drugs given by doctors. The side effects of CCBs and beta blockers are really bad for some people. I'm sorry I ever started on propanalol as I cant get off it now. I thought I would try Arginine after I read about the benefits before I started to take the calcium channel blockers I was prescribed. That was 6 months ago and I haven't looked back. The CCBs are still in the box in the cupboard and I have no intention of taking them as I'm doing OK without them. Please make sure you get Arginine from a reputable source as there are some duff ones out there that don't digest very well and so there will be no benefit. Aim to get capsules rather than tablets. I get mine from either Holland and Barrett or JustVitamins but I'm not sure if you have these in the US?
Good luck with your quest for alternative therapy. There are plenty of things to try that are less harmful than pharmaceutical remedies. A google search for natural angina treatment will provide some good options. WebMD provide limited information on the following treatments for angina but its a good starting point to start researching;
ASTRAGALUS
COENZYME Q10
DANSHEN
HAWTHORN
KUDZU
L-ARGININE
L-CARNITINE
N-ACETYL CYSTEINE
PANAX NOTOGINSENG
PROPIONYL-L-CARNITINE
TERMINALIA
If you have ruled out problems with the main arteries with testing then start experimenting and see what works for you. Google any that appeal to you and do some research. Only you know what works for you after you have tried. I did this and hit the nail on the head with Arginine. The Q10 is proven to help with the muscle pain associated with statin use and so I use it anyway but there are sites out there that recommend it for angina and heart failure as it helps rebuild damaged muscle. These are all vitamins and supplements and harmless if taken using the guidelines so you have nothing to lose. I hope you find relief from your symptoms.