h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Hiya Bri

I'm now using the under-tongue spray for chest pain 3 times a day but still it only takes the edge off doesn't get rid completely. It feels like someone has put a paving slab on my chest then got an elephant to stand on it. Have you got any tips for me, you've been at this business longer than meand thanks<--- it's allowed

Annie

Hi, have to say that doesn't sound too good.
Is the chest pain occuring 'at rest' or after minor exertion?
If thats the case then its a sign of the Angina becoming unstable and requires urgent medical intervention.
If the GTN spray is only taking the edge off the pain and not stopping it altogether then tbh, you need to get yourself off to the hospital pdq.
If there's no-one to drive you there then call an ambulance.
If my gtn hasn't stopped chest pain completely after use and within 30 minutes then I hit the lifeline alarm.
With all the different meds of varying doses I'm on, I tend to only need the gtn spray possibly 3/4 times a week. If I had to use it 3 or more times a day I'd be very concerned and be seeking further help/advice.

I was at my yesterday and they said "rest" and they are also chasing up my Nuclear Stress Test which hasn't come through.

I can't go to the hosp Bri, I have to see to my mother tomorrow and my daughter is away on holiday so I am seeing to her cats (she would see to Goldie for me if I had to go in). However she's back Saturday so if it's no better by then I will go get checked out.

I saw this conversation from the front page so have a quick question/ comment. I read that if there is a problem with the heart it tends to make its presence known through pain down the left arm or the left side of the thorax. If you have a more central pain that tends to be associated with muscular strains (intercostal) and digestion. I am prepared to be corrected from those that are more expert in this area.

I take it when you were at the s yesterday you did tell him/her that you have been using the gtn 2/3 times a day and it wasn't stopping the chest pain?
Did they do an ECG, blood pressure etc? If the advice was to rest rather than go to the hospital then fair enough, if they're confident of things not deteriorating.
Last time I said that to my the next thing I knew was an ambulance appeared, paramedics and I was gone, straight into hospital, hooked up to all manner stuff.
I had to arrange for my brother to collect my car from the surgery and look after the moggies.
You didn't say whether the chest pain was at rest or not. TBH if its at rest then my advice would still be, get off to the hospital.
You won't be helping your mum or anyone else if you have a heart attack. Sorry if thats blunt but its also fact.
Been there, done that, didn't want to let work or workmates down, result? 7 weeks in 2 hospitals, 2 wks on life support. Don't go down that route, it ain't nice.

Hi Stone Aart, chest pain from Angina can manifest itself in a multitude of ways, from central chest pain, to Left and Right side and also up into the jaw and neck. Angina can also cause numbness and pins/needles as well.
Unstable angine leads, if not treated immediately, to heart attack.
Heart attack gives central to left side severe pain travelling into left arm with numbness/pins+needles etc. You can also get pain from heart attack travelling again up into the jaw/neck. Also not all heart attacks are 'painful', I believe the term used is 'silent attacks' tho I daresay there's a full medical term for this.

I've done some checking http://www.bhf.org.uk/heart-health/conditions/women-and-heart-disease/recognising-the-symptoms.aspx and I have all those symptoms.

I didn't understand about rest/active Bri, I get the pain, I go lie down, it goes away. If it gets severe I take the spray under my tongue. I haven't had any yet today (severe) just feeling of being uncomfortable - "unwell" and I am so tired I almost always fall asleep while resting. This is not "me". For years I have been on the go, sometimes barely time to sit down and then collapse in a heap 8 hours then raring to go in the morning. Now I could happily stay in bed all day long. I hate being like this!

If you're just sitting reading or watching TV and get the chest pain then thats deemed as being 'at rest' in which case it means you didn't have to be doing anything prior to pain. This is indicative of the angina becoming unstable and therefore is more dangerous.
I don't know what other meds your doc may have put you on but in my case they were designed to slow me down and stop me doing sumat daft, (like going back mountaineering for example ). Tiredness is part and parcel of the symptoms sadly. If I do a couple of hours domestic chores for example I feel like I've run a marathon, its frustrating but due to the wonders of modern medicine and excellent doctors at least I'm here to tell the tale.

I'm just doing normal things Bri, housework, gardening, shopping etc. No mountaineering I promise Maybe I just need to learn to slow down or not keep going when I start getting chest pain?

I'm on atenolol and simvastatin, plus the HRT which you probably aren't on

I'll ring the surgery tomorrow morning, chase up my 's chasing-up

I'll keep you posted

Thanks for the additional info. Two male work colleagues in the past 5 years in the age range of 35 to 42 have unfortunately had heart issues. Both were otherwise fine with no history. One complained of a tight chest, not feeling quite right, for maybe a day or two then keeled over at work. The other took poorly seemed to recover and then too keeled over. I think this age range is quite typical for men, but I think it is different for females. Keeping a check on blood pressure (low salt diets etc) and blood cholesterol levels seems to be quite important.

Atenonol is designed to lower blood pressure and slow the heart rate. 25mg is the usual dose but can be as much as 100mg if in hospital under medical supervision. The max normally outside hospital is 50mg. (thats the dose I'm on currently)
Other heart meds for angina:-
Nicorandil (upto max 120mg)
Imdur (upto max 120mg)
Aspirin (75mg)
Statins. (upto max 80mg)
I'm on all the above and maximum doses too tho 40mg for statins due to adverse reaction on higher dose.
To complicate matters I'm on various supplements and other meds to combat some of the more adverse side effects of long term use of heart meds, such as B12 jabs, Creon supplement, Folic acid and the like.

I have an appointment with the on Friday morning. Today I took my mother to Tescos and while pushing my trolley around I got chest pain. Does that count as "minor exertion"? I had remembered to take the spray with me but it took 3 squirts to get rid of the pain. I had to leave Mum's after lunch much earlier than I would otherwise have done and came home to lie down. I'm now up and about and feeling much better, no pain, but then I've only washed up the breakfast pots and put my shopping away.

That would be classed as 'minor exertion' and if that was 3 single doses of GTN spray and it stopped the pain then its doing its job. The metered doses are 200micrograms per spray, it usually takes 2 sprays upto 3 times in half an hour for me when chest pain is bad. Usually 2 sprays are enough, (400mcg).
Hope all goes ok at the 's.

told me to stop taking the Atenolol as they could "screw with the result" of my stress test (this Friday). I have to report to the Diana, Princess of Wales Hospital in Gy at the Cardiology dept at 9am. Will keep you posted

Well I didn't have the stress test at all, just a chat with the heart and another ECG, then he ordered me an angiogram. You probably know this from my own journal. Anyway, he wrote me out a letter for my own for some new meds, which I posted 1st class on the day of that appt, 31st Aug (Fri). Wed I am at my own surgery with my Mum for her bloodtest. Ask for prescription for ME and am told they don't know anything about it I rang that Friday and they say, yes, got letter, has ordered a prescription and it was sent to chemist next door. Now, I have issues with this chemists. They seem to "lose" my medicines, only for them to turn up in the place they should have been and many's the time I have sat there waiting, only to watch other people walk in, ask for repeats, collect them and off they toddle. Meanwhile, they forget about me. I have *tried* to move practices. But they have refused on the grounds that I am already registered with a GP.

Today I went to collect my *new* med that was ordered for me by on 31st Aug. Chemist can't find any trace of it so I went next door to the reception. They check my notes and say "we sent the prescription across on 2 Sept". I went back to chemist. Told them, they rang surgery. I sat down and waited. 5 mins later, "Ms Croft?" I stand up. Yes? "Was your medication Isosorbide Mononitrate?" Er, probably, but I don't know as it's a new one... "Well we have found this on the rack" and hand me a bag, that was dated 6th Sept, been on the rack for collection all this time.









PS about all that, it's just good to rant sometimes.

Ah, there's a more general name for that med, its called Imdur. What dose have they started you on? This is the one thats slow release, stays in the body doing its thing for upto 12hrs plus.
When you first start on it you may get headaches for a couple of days till it gets into the system fully. Thats the one they've just increased to the maximum dose for me, 120mg.
for the angiogram.

ps. don't run out of the Imdur, make sure a repeat prescription goes in in plenty of time. It can cause complications if you suddenly stop taking it.

Oh thanks, I had a mega headache yesterday and have another today (I thought it was the wallpaper paste my s-i-l was using) but nice to know it's the new meds and will wear off. They said 2 a day (20mg), one at 7am and the 2nd at 2pm. Will I have to stay on the Imdur now then? I was assuming I'd come off that when I've had my procedure.

TBH I will be glad when the angiogram is over and done with, I am hoping they will do the stenting or whatever there and then, I have no wish to go to Castle Hill hosp (Hull) for a major op.

Thanks Briit's good to have you to talk to

Ah they've started you on low doses for now then. Thats good. They'll only continue that med if stenting or by-pass doesn't stop the angina or if what they find isn't bad enough to warrant any other invasive procedure. If stenting or by-pass is done and angina/chest pain stops then the chances are they will stop that drug altogether. Its generic name is either Imdur or Monomil.

Thanks Bri, why are you still on it? (if you don't mind my asking)

I'm still on it and other high dose heart meds because my condition is non-operable by the normal means, ie by-pass and further stenting. There are so many smaller arteries and veins blocked in and around the heart that a straightforward by-pass wouldn't stop angina attacks/pain. IF one or more of the arteries already stented became blocked they would do a by-pass to keep blood flow going but there's nothing more they could do. I only have 3 out of the 4 main arteries now anyway. 1 artery was, to use their phrase, already dead when I was first diagnosed. Apparently it was only due to the fact I was so fit at the time that I didn't suffer any consequences earlier than I did. (I was doing my mountaineering/hillwalking at the time)As well as the myriad of issues with veins and arteries the heart muscle has also been damaged so even a by-pass wouldn't repair that.