Angina symptoms, but cardiac angiogram normal

[Teatray]

I am suffering with symptoms that appear to be angina on slight exertion - walking, climbing stairs, hoovering etc, and stress - watched Eden Lake recently and had a major attack after.  I am finding the quality of my life is going down the pan.  I have always exercised, and normally walk at an pretty aerobic pace, covering 3 miles within an hour with ease.  The last time I walked the dogs, it took me an hour to cover a mile.  

I am 48, have been asthmatic since 3, diabetic (type 1) since 7.  I control both conditions well and am on a low GI diet.  My bloods are good, with no sign of anemia.  To date, I have no complications or damage from the 41 years I have been diabetic and am accustomed to living an energetic and full life.  I had a hysterectomy 6 years ago, but kept an overy, and developed an under-active thyroid at this point in life, which I am on 100mg of Thyroxin for daily.  The symptoms I encounter when I do the slightest thing are prohibitive.  Also, my resting heart rate has climbed from the mid 60's to a range that encompasess the mid eighties to the high ninties in a matter of 3 months.  The hightest I have recorded is 106.  I am really struggling.

Yesterday, I had an cardiac angiogram which revealed my heart to be normal, with clear arteries and no damage.  The surgeon was pretty dismissive when I asked what else could be causing the symprtoms and stated bluntly that it was not the amount of Thyroxine I am on.

What is going on?  I need to follow this up with my GP as something is blatently wrong, but I don't know what to say.  I am concerned he will also be dismissive.

[Teatray]

Hello,

I've just received a preliminary diagnosis of microvascular cardiac disease and been given some meds to try and assist the now rather persistant angina style symptoms.  I've a stress test in roughly 2 months time, where my heart will think it's going for a jog. This may, or may not, show what is happening in the small arteries which feed the heart with oxygen.

If it hadn't been for your reply to my initial question, I would not have known to persist and then insist I was seen by an alternative cardiac specialist.  My GP did a range of general tests, all of which came back negative, and actually suggested I was 'doing it to myself'' i.e. it was in my head.  If I hadn't have taken Mum in the surgery with me (she gave him a verbal seeing to), he may have written me off.  The moral here is take someone, who knows how you are when you are well, in with you to assist with fighting your corner, when you know something is physically wrong.

However, your reply was invaluable - thank you.

[Teatray]

Thanks for the prompt reply.

I had an ECG treadmill test roughly 10 weeks ago where the results were on the boundary of abnormal/normal.  I nearly passed out as I got off the treadmill.  The consultant who ran this test told me that my base heart rate was too high, so I started to keep a regular note of my resting heart rate, which I took to the consultant who eventually did the angiogram.  Each entry was between 84 and 101.  My blood pressure remains on the low side of normal.

No other tests have been offered or carried out.  The information you've given me is useful as I can discuss these tests with my GP.  If my resting heart rate continues to rise at it's present rate I could be in serious trouble.

The symptoms I currently get when active or stressed are: shortness of breath, increased heart rate, sensation of pressure across chest, discomfort/pressure in throat, pain in left armpit going down left arm.  All these worsen if I try to keep moving, improve on resting.  At their worst, they take a good 10 mins to clear.  Occassionaly, I get pain in centre of my back where my bra strap does up.

Thanks once again

[fizzixgal]

There is really no excuse for a physician behaving in a dismissive manner toward anyone with real symptoms. Your GP shouldn't be dismissive, and if he is, you need a new doctor! But you will probably need to see another cardiologist anyway, in which case I wonder if you can find one who manages heart patients medically? It's possible that since there was nothing to be done surgically, no bypass or stenting indicated that the surgeon decided you weren't worth his while -- which is NOT making excuses for him, just that I've run into that type myself and I'm not surprised anymore to find vascular surgeons with that attitude.

Even though angiogram is the gold standard for diagnosing major artery disease, there is also the possibility of microvascular dysfunction that can cause angina through abnormal vascular tone or narrowing of the smaller arteries and capillaries that feed the myocardium. These smaller vessels cannot be seen on an angiogram. But in order to diagnose that they first have to establish that your symptoms are really angina. Have you had a stress thallium or stress echo? You don't mention results of either. Even a stress EKG might be able to establish that you are really experiencing ischaemic pain. I would also hope that you have been screened for pulmonary embolism (D-dimer and/or spiral chest CT), which can mimic cardiac symptoms and cause progressive disability.

I hope you can find answers soon.