Dorothy Asquith had become accustomed to walking around with ‘a vice on
her chest’. The 60-year-old suddenly
developed crushing chest pains when she was 42 — and the pain stayed with her
14 years. Initially, she was rushed to hospital with a suspected heart attack,
but further tests revealed her arteries were free of blockages, and perfectly
normal.
Indeed, the mother-of-two had previously been ‘fit as a fiddle’ and led
an active life.
'It (chest pain) would stay for two or three weeks and then it would vanish for a month or so,' said Dorothy Asquith
However, the crippling
chest pain persisted. ‘It would stay for two or three weeks and then it would
vanish for a month or so,’ says the nursery manager from Brighouse, West
Yorkshire. ‘It was sometimes so severe that I couldn’t even get up to boil the
kettle. It felt like someone’s fist was constantly pressing down on my chest. I
kept going back to the doctors but they just didn’t know what was wrong with
me. They kept giving me pain medication but it didn’t work.’ Within months, the
active wife and mother of two was in such pain that she had ‘no quality of
life’. This continued for over a decade until doctors finally found the cause,
and she was able to have effective treatment.
Dorothy’s problem? Cardiac syndrome X. This disorder causes intense
crushing pain in the chest, identical to that caused by a heart attack or
angina. However, unlike these other problems, where a blockage in the blood
supply deprives the heart muscle of oxygen, there is no obvious physical cause
for the chest pain in cardiac syndrome X. The patients are invariably very
healthy, and the pain seems inexplicable.
Indeed, people are often told that it’s all in their head. Yet the experts agree this pain is actually
genuine. And now they are beginning to identify potential causes.
Recent studies using MRI scans have revealed that in some patients, tiny
vessels that carry blood to the heart muscle fail to open properly, reducing
the flow of blood. This results in the heart muscle being deprived of oxygen,
which triggers intense pain. The condition is not thought to be
life-threatening or to increase the risk of heart attack. The blood vessel
abnormalities thought to trigger syndrome X are only detected by MRI scans,
which may explain why the problem is not spotted during conventional scanning
methods.
'Previously I had a lot on my plate, I was very busy at work and never took a day off work, no matter how bad the pain was,' said Dorothy
Suspected heart attack patients are given ultrasounds and angiograms
that visualise the large arteries that supply blood to the heart, but these
techniques are not sensitive enough to detect changes in the tiny blood
vessels. ‘It usually comes on with any type of exercise, although in some
patients it can also be caused by stress,’ says Professor Peter Collins, a
cardiologist and specialist in the condition at the Royal Brompton Hospital,
London. These vessel abnormalities are found in around a third of cases of
cardiac syndrome X.
These patients can be treated with drugs that improve blood supply to
the heart muscle, such as beta blockers and calcium channel blockers. Other
treatments that can provide relief include asthma and blood-pressure drugs,
which help open up the small vessels, while low-dose antidepressants such as
imipramine may help tackle the pain by reducing the number of pain signals
reaching the brain.
MRI scans have revealed that in some patients, tiny vessels that carry blood to the heart muscle fail to open properly, reducing the flow of blood
Another possible cause of cardiac syndrome X is changing oestrogen
levels — menopausal women are particularly at risk of the condition, explains
Professor Collins. ‘This condition affects around nine women for every one
man,’ he explains. ‘The peak ages affected are 50 to 55-year-olds, around the
time of the menopause. In fact, we believe it could be caused by a drop in
levels of the hormone oestrogen.’
One theory is that this drop in hormones acts as a trigger for those who
are susceptible. Another possibility is that rather than actually causing the
pain, it increases the intensity of it — oestrogen is thought to help dull
pain. Cardiac syndrome X is known to affect 12,000 people, but experts say the
true number could be far higher, as many do not seek help, or are not referred
for specialist treatment. ‘I see 16 to 20 patients a week in my heart clinic. However,
many patients across the country go unmanaged— they are told they don’t have
any heart problems and are simply sent away,’ says Professor Collins. ‘They
often have trouble finding someone who will help them. A lot of GPs aren’t
aware of cardiac syndrome X, and there is even quite a lot of scepticism among
cardiologists. This leaves a patient thinking they are going mad, or that they
are imagining the pain.’
Although it can sometimes bring it on, exercise is also known to reduce
the frequency and intensity of the chest pain, possibly by improving blood flow
to the heart. Some patients prove hard to treat, even if the cause of their
pain has been found, and continue to suffer pain despite trying a vast range of
treatments. One new option is hypnotherapy — Professor Collins was aware that this
had been used to treat other types of chronic pain, and decided to try this in
his hard-to-treat patients. The results were ‘dramatic’, he says, and his team
has now started a clinical trial of hypnotherapy with 42 syndrome X patients.
As Daniel Fryer, a psychotherapist and clinical hypnotherapist who
treats cardiac syndrome X patients at the Royal Brompton, explains: ‘During
hypnotherapy sessions we try to alter how the body perceives pain. The pain
signals are still being sent to the brain, but we try to develop ways of
teaching the brain to pay less attention to them. Initially, we try relaxation
techniques, as studies show muscle tension can significantly contribute to
pain. Lots of the patients who come to us are very tense as they’ve been living
with intense pain for some years.’ He then uses visualisation techniques to
tackle the discomfort. He adds that while there’s no doubt the patients are in
pain, tackling the psychological factors that could be prolonging or
aggravating this pain is important.
‘Syndrome X patients all tend to be life’s doers and trouble-shooters. They’re
the type who solve problems for friends, family and colleagues, and are the
ones others turn to in a crisis. This can leave them anxious, frustrated and
exhausted. We have to teach these people not to take on so much, and make time
for themselves.’ Dorothy was referred to Professor Collins in 2009. Her
diagnosis came by fluke, as she explains. ‘I was reading an article in a
British Heart Foundation magazine in my GP’s surgery while waiting for one of
my many appointments when I read about cardiac syndrome X. I knew instantly
this was what I was suffering from. It even talked about how the condition was
related to a drop in female hormones, and I had a hysterectomy shortly before
the symptoms started.’
Although Professor Collins thought hormones played a role in Dorothy’s
condition, none of the treatments he tried eased her pain.
So he referred her to Daniel Fryer. At this stage, I was willing to try
anything. My husband and I had been through a short separation due to the
strain of this condition. He was bearing the brunt of everything — and looking
after the house and our two boys. I just wasn’t the person I used to be.’ She
had eight sessions with Daniel. ‘He made
me visualise scenes, such as walking down steps on to a beach. I then moulded
the pain into the shape of things and threw them into the sea. Or I’d go to a
tranquil clearing in a wood and throw the pain into a stream.’
Dorothy has not suffered with severe pain since her treatment.
‘Sometimes, I feel it coming on but I know how to tackle it — I take
myself back to the beach. And I know now that I have to relax. Previously I had a lot on my plate, I was very
busy at work and never took a day off work, no matter how bad the pain was. Even
when I first had my suspected heart attack, I was calling work from the
hospital ward checking everything was all right. I thought of myself as a
strong woman, and didn’t like to make a fuss or ask for help. I don’t know
where I’d be if I hadn’t had treatment, but I am concerned about the number of
people out there feeling like I did, but who haven’t got access to help.’
Source: Daily Mail UK
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