Micro vascular angina: I have been... - British Heart Fou...

British Heart Foundation

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Micro vascular angina

Abergele profile image

I have been treated for last 10 years for coronary artery spasm in last 6 months this is more regular. Yesterday went to have two stents to be told stents could make you worse. After stress tests, wires etc, now told it is micro vascular angina, and can only treated with medication.

Now have to see cardiac specialist every 3 months for at least a year to find meds that suit. Any help on mva please?

18 Replies

Hi I was diagnosed with CMD/microvascular spasm about 8 years ago. My GP started me originally on beta blockers which just made me really tired but i’ve Read since that beta blockers can make spasms worse. After that I went onto dilzem (dose has increased over the years) then after a bad episode a while ago where I was losing consciousness, the cardiologist tried me on Imdur. I know that does help some people but I couldn’t tolerate it, the headaches were unbearable for me. I also have my nitro spray to use when needed.

Can I ask what your symptoms were that lead to a diagnosis of coronary artery spasm ? I haven’t been able to find out exactly what symptoms differentiate coronary spasm from microvascular spasm.

Milkfairy profile image
MilkfairyHeart Star in reply to Grandma63

Hi Grandma63

Coronary artery spasms tend to be seen on ECG changes such as an ST elevation.

They tend to occur at rest in the evening and early morning. They can be brought on by the cold and stress.

Made worse by beta blockers, cocaine adrenaline.

Microvascular angina usually causes no or subtle ECG changes such as T wave flattering or inversion.

Pain is usually on exercise but can be at rest too. Similar triggers to CAS.

I live with both types both cause me a lot of pain!

Grandma63 profile image
Grandma63 in reply to Milkfairy

My ecg did show ST changes and my attacks tend to occur at rest without warning mostly in the evening .... recently I was very close to losing consciousness during one attack. Neither my GP nor the cardiologist I saw on my last referral seem overly interested in finding suitable medication to control my symptoms. It’s more a take it or leave it attitude. My GP is still of the opinion that it is a benign condition which could not result in a heart attack.

motley12 profile image
motley12 in reply to Grandma63

Hi Grandma 63

Really sorry to hear of your symptoms ,after numerous Myocardial Infarctions (MI) with raised Tropoin counts of up to 32,000 resulting with heart damage and a drastic change in my life ,no work ,no hills running etc . I can tell you first hand that your doctor is WRONG and probably half the cardiologists as well who plainly will not listen or refuse to believe that CAS is a serious condition and needs to be treated promptly and the correct meds given not the wrong ones that made my symptoms far far worse .Having had 3 angiograms an OCT 20 plus trips to A&E 8 blue light stage one trips and 8 admissions to cardiac wards .

Milkfairy is correct on the fine explanation and I can tell you that once I was seen by Bristol Heart Institute and an excellent cardio gave me the right meds the pain has become less and after a year and a half no visits to A/E .

No Stress ,change doctor and find a consultant who can be bothered to listen and medicate accordingly .

I do hope and pray you get the right help and are believed many best wishes .M

Milkfairy profile image
MilkfairyHeart Star



I live with vasospastic angina affecting my microvessels and coronary arteries. Microvascular and coronary artery spasms.

It took a very long time and trial and error to try and find the best combination of drugs that work best for me. You are fortunate that you will be seen frequently in order to achieve the best treatment for you. Many individuals are just discharged from the cardiology care because most Cardiologists have little knowledge of how to care for patients like us.

There is also a an article in August edition of Healthy Food Guide magazine with contributions from Prof Colin Berry and Prof Chris Gale and a case study if someone with the condition.

I hope you are able to work with your Cardiologist to find effective treatment fairly quickly.

Where are you based and who is treating you?

kel55 profile image
kel55 in reply to Milkfairy

Hi, another one here with the same! have you got raynauds or migraines as well because these are also MVD.

the lucky ones drop on the right mix of meds straight away, some it takes years and for the few unlucky ones they never find the mix (big sigh)

l have two types of chest pain, when both sides of my chest want to join in the middle it is CAS related and when someone starts blowing up a balloon in my left side chest it is the MVD.

it seems that there are a mix of different symptoms and we all have some of them?

lt is good to start talking to others because for me it gives me a chance to rationalise things out. It is progressive as the complications arise, ive had two heart attacks and the new relatively new one is me fainting or nearly vasovagil fainting durring CAS.

Milk Fairy hold more store in the BHF than l do but it looks like they are starting to try, never the less they still put 'l was cured in a week forward to this womens disease' unfortunately there are still loads of cardiologists out there who think the same!!! so we have to fight an over elaberate charity and some cardiologists to get our needs met. there is an active Prinzemetal facebook group, well worth the effort and also an american inspire group call womens heart that as a good sub section. they just about acept me being male, great information on there. there is also a SISTERHOOD on facebook just search Microvascular but that is nigh on women only.

ask all the questions you have, l know it helped me


Milkfairy profile image
MilkfairyHeart Star in reply to kel55

Kel I feel you are being unhelpful with your comments

I can see no where the phrase ' cured in a week' used on the updated BHF MVA information leaflet or the article by Prof Colin Berry.

The BHF have moved on and adopted the term Microvascular angina as has Prof Peter Collins . They are well aware that MVA and CAS are debilitating long term conditions which are notoriously difficult to treat.

This has been achieved by a Patient Advocate discussing with the BHF and other prominent Cardiologists the need to change their view. Perhaps you should be grateful that this individual has been able to achieve this shift in attitude. It took 2 years of work to bring this welcome change.

Rome wasn't built in a day and there is work in progress as they say.

If you want the BHF to do more I suggest you contact the Patient Engagement team.

kel55 profile image
kel55 in reply to Milkfairy

so you think this is good reporting


no mention that its a cross gender disease and that menapause or secondary MVD is only a small part of things. what about the 30yo's that get it or the number of heart attacks due to it. lve just come out again and as l looked at the A&E doctor you could tell he was thinking whats this guy talking abouthe did eventually order trops and kidney blood tests. then sat me in the waiting room for 4 hours. sorry it is the likes of this top heavy charty that makes this happen with there attitude, dont forget ive been there and talked to them. BUT l have said they are getting better, 5 years ago we were a paragraph on page 47. tell everybody about their premasies?

Milkfairy profile image
MilkfairyHeart Star in reply to kel55

Kel yes MVA and CAS is something that can affect men too.

However a much smaller proportion are men affected just like Spontaneous Coronary artery dissection also affects prodomindately women shortly after giving birth.

I have met Jennifer Waller and her problem was secondary to Cardiovascular disease. No where does the article give the impression that hers was a quick fix. She also toned down some of the negative aspects of the condition.

The article was also written about 3 or 4 years ago. The article about the Cardiac syndrome X was removed and replaced with the updated articles and information last year for good reason.

Please can I ask you to be mindful when you make your comments that you are potentially making unhelpful hurtful comments regarding an individual living as best they can with MVA.

MVD leading to MVA and vasospastic angina is complex and the underlying causes of the condition are probably unique to each of us.

All of us struggle to have the access to the care we need. I have a legion of negative experiences too however I have also had some wonderful support and care too which I prefer to focus on, when trying to change hearts and minds.

May I suggest once again that if you have any issues that you directly contact the BHF regarding the issue that men have a story to tell too.

kel55 profile image
kel55 in reply to Milkfairy

sorry milk fairy but you said it yourself. toned down and old and your out of date it is thought that it is nearer a 50/50 split gender wise, dont trust me ask Annette!

your talking like an employee protecting her job, 4-5 years ago l blasted my way through a farce called a what will we do in the next 5 years meeting, heres the laugh thedicisions were made two weeks before the meeting

the BHF have a responsibity to do things correctly because of funding status

remember what the head poncho said; as long as l am in control our focus will be 'blow it up put a spring in or bypass it' 'inside ' ' is my way of saying it'

The taxi dropped me off the other side of the triangle island because he didnt know where the BHF was. l walked up to the lights both ways popping into every home and shelter and homeless doctors surgeries! It couldnt be that ministry typebuilding with the large lions (like around nelsons columm) no it couldnt but it was!

top two floors, there own cafe. NICE still say see BHF and you want to know why heart patients cannot get benefits, yes icluding me its because the means testers read 'see BHF' and like you said out of date material that is watered down.

Yes yes yes they arebetter than they were but they still havent stood up and accepteded their resposibilities

and yes you do sound like a yes employee, the research you keep posting has already been done in 2002 so whats the use in that. is it true that the papworth hospital jounior cardiologist was let go because of her artical a few years back saying how unserious MVD and CAS was?

after a quick un scientific straw pole l recon that 40% of MVD and CAS sufferers cannot get relief not matter what medication they take

Milkfairy profile image
MilkfairyHeart Star in reply to kel55


I am not an employee of the BHF.

I am someone who has lived with vasospastic angina for over six years.

I have struggled by myself with no support to gain my PIP, retirement due to ill health and have my pain treated well too.

My pain has been so poorly treated at times that I am being assessed for Post traumatic stress disorder.

Our gender is not important our suffering is.

I am not in agreement with you evaluation of the research you have quoted.

The BHF information on MVA wa updated and published in September 2017.

Prof Colin Berry's research about MVA is due to be published later this year.

Prof Vanessa Ferreira and Dr Alex Liu' s work wax published early this year both are new areas of research.

I feel that this interchange is not one of mutual respect and honesty.

I acknowledge your anger, I am sorry you have felt it necessary to direct your anger in the way that you have chosen to do so.

This will be my last comment.

Stan2 profile image
Stan2 in reply to Milkfairy

Hi I hope your symptoms are improving .

I have recently had a stent but unfortunately I still feel uncomfortable at times with some pains( sharp) that can be at the base of the throat , top of the chest, and sometimes shoot up the throat to the jaw. It subsides fairly quickly... Is this similar to the spasm you mention?

Kind regards

Milkfairy profile image
MilkfairyHeart Star in reply to Stan2

Hi Stan2

It is not unusual to experience post stent pain.

There are several posts about this on the site.

I suggest if you are concerned that you talk to your GP.

Have you started Cardiac Rehab rhab'?

You could talk to one of Cardiac Rehab nurses or ring the BHF helpline and talk to one of the cardiac nurses.

I hope you feel better soon.

Stan2 profile image
Stan2 in reply to Milkfairy


Thanks for the reply is absolutely great to hear from others who understand.

I had the stent put in over a month ago and things should have calmed down by now. I am awaiting a meeting with my cardiologist but as yet no date has come through. I have mentioned this to Cardio but they have told me to mention it to my Cardiologist . The pains just seem incredibly similar to those described on the BHF website including the pain in the throat up to the Jaw etc and in spasms.

The mental aspect for me is getting very tough although this Platform helps.

Keep going with your advice and I hope you are seeing progress .

Kind regards

I have been diagnosed with CAS too. 5 years ago I was put under the care of a cardiologist after only managing 3 minutes on the treadmill test. I had angio done, nothing to see. Numerous ecg done apparently all normal. Was put on some drugs but things continued to get worse. Suddenly one morning at 6am over 2 years ago I woke up feeling "strange". Like my brain was going on fast forward. I got up, went to toilet and went back to bed. No, straight away I felt sick, back to toilet where I started vomiting, severe chest pain and drenched in sweat. Called an ambulance and they arrived in about 10 minutes. I was still having this attack when they arrived. After some checks they decided to get a chair to put me in ambulance. By the time they came back in the episode had stopped. All were very confused. I was transferred to local casualty where I was then transferred to main hospital a few hours later. Every medical person was adamant I had indigestion. Only when troponin came back elevated I was looked at again and sent heart attack rehab nurse that confirmed I had suffered a heart attack. Cardiologist then over ruled her and said impossible. I was kept in overnight but he was very rude to me and insisted I no way had suffered a heart attack as my arteries were clear 6 weeks previous on a CT angio. He then discharged me from cardiology and said it was probably only a spasm and would cause no harm. It took me 8 months to get back into the system to be seen again.

I have had another 2 episodes like this in the following 2 years but still they treat it very blasé and doctors insist I have not had any heart attacks. I am on CAS medication but it is never reviewed, only increased, to max now and still getting daily chest pain. I have seen my consultant twice in 2 years so at least you have a plan to be followed up.

There needs to be much more awareness of this condition. I feel like they treat me as a freak and they do not have any compassion or understanding of how stressful it is living with this.

I now think I have mva but nobody seems to be linking the dots with me.

I hope you manage to get medication that suits you and they continue to follow up and not simply discharge you.

Abergele profile image
Abergele in reply to scottish1

Thanks for your comment, you definitely need to get another opinion. I feel I am living with a time bomb. The hardest is getting my head around it. Maybe then it will settle. Thks.

Thank you for all your replies shows we are not alone.

The meds is bring my blood pressure down for the last two week it has not been above 106 /68 is this the treatment for Micro vascular angina to control blood pressure,

Milkfairy profile image
MilkfairyHeart Star in reply to Abergele

Many of the drugs prescribed for lowering blood pressure are used in treating MVA or vasospastic angina.

They relax and dilate your blood vessels so lower your blodd pressure and hopefully reduce the spasms.

Unfortunately as the underlying causes of MVA and CAS are not understood it is case of trial and error to get the right medication for you.

I take 2 calcium blockers, nicorandil, slow release nitrates, nitrate patches statins and blood thinners and use oxygen as pain relief at night.

I take my drugs at unusual times too.

I work in partnership with my Cardiologist. Finding a supportive motivated and sympathetic Cardiologist is important.

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