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British Heart Foundation
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What’s the relationship between microvessel disease and unstable angina?

Are there differences in the experience of micro vessel angina and unstable angina? I have had major vessels stented, but still experience angina when in the cold, or hot or damp, stressed, on inclines, alcohol, coffee, stairs and carrying weighty items, or speeding up too fast. GTN helps. I can exercise quite heartily, if I take time to warm up. I also get angina when lying down or resting, even being woken up by it. GTN helps but it returns quickly.

Consultants seem to have varied views of these two types of angina. Some say i have both stable and unstable angina. Some say I have microvessel angina.

What’s the relationship between the two? If small vessels are blocked then surely that can reduce oxygen to major organs, in just the same way as when major vessels are blocked? Won’t these feel the same?

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Hi Kristin,

Vasospastic and Microvascular angina are thought to be caused by Microvascular dysfunction it can be referred to as Ischaemia non obstructive coronary artery INOCA

Sometimes the smaller blood vessels fail to dilate or do not relax and constrict in a spasm.

When it happens in the small vessels small areas of the heart muscle are damaged micro infarcts .There are only very small rises is Troponin levels and maybe very subtle ECG changes.

When an intense spasms occurs in the coronary artery this can cause more damage so a larger rise in troponin levels and ECG changes such as ST elevations and depressions.

The intensity of Microvascular angina pain is well known to be more severe and last longer. It does not always respond to treatment by nitrates as well.

Acute coronary syndromes can be very difficult diagnose and sometimes not even Cardiologists can't agree whether someone has unstable, vasospastic, microvascular angina or acute coronary syndrome.

This article was written by Prof Colin Berry's team. He is a leading BHF researcher into Microvascular and vasospastic angina.

heart.bmj.com/content/104/4...

I live with vasospastic angina causing Microvascular angina and Coronary artery spasms.

I can exercise too however stress and the cold will trigger worse symptoms for me.

My condition is poorly controlled so I live in a state of stable instability.

I have pain at rest which is typical of vasospastic angina and unstable angina.

So when I have more pain even on exertion and breathlessness then it is time to go to A&E to have my ECG and troponin levels checked.

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Thank you, that’s v helpful, and together with the article, does explain how microvessel spasm can cause angina at rest, and therefore is named unstable. I don’t think Ive heard the word spasm used in my consultations.

In your view is it possible to have unstable angina from blockages of microvessel.....not spasm?

I also gather from the article that the meds might be different. Am I wrong? Good to see BHF is sponsoring such research.

Your experience is v interesting, too. Do you have a long recovery time, if you get a phase of unstable angina? Mine can hang around a long time, GTN just causing a blip! and recovery back to normal, takes a day or so, sometimes.

It sounds as if you’ve adapted well to yours? Pacing seems the key, for me.

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Anything that interferes with the smooth flow of blood through your blood vessels can cause problems be it a clot, plaque rupture or temporary narrowing due to a spasm.

I have been prescribed clopidogrel to prevent clots forming due to my spasms.

Statins to reduce inflammatory changes in my blood vessels.

I also take 2 calcium blockers, nicorandil and Isosorbide mononitrate XL, nitrate patches and use oxygen at night.

I don't use short acting nitrates. The spray would work briefly then I would have even worse rebound pain later.

It takes me days to get over a really bad episode it feels as though I have been run over by a steam roller!

Microvascular angina is the symptom of several different underlying causes of a lack of blood supply to the heart muscle . Which is why it is trial error to find the right combinations of medication to treat each individual patient.

Most patients live with either Microvascular angina or Coronary artery spasms some like me have vasospastic angina effecting all my coronary blood vessels.

Perhaps share a copy of the article with your Cardiologist.

Also you might be interested in this article too. It is about the latest research findings about MVA and Vasospastic angina.

mdedge.com/familypracticene...

The longest I have managed without a hospital admission is 13 months....I was last in hospital for a week this time last year.

Keep your fingers crossed for a mild winter and I may get away with not going in this winter!

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Hi again. That article is so interesting. I must open discussion on this at my next Cardiac appt in January, when they want to know if I want another angiogram. I now have a good reason to do it, if they do the pressure work.

Now you.....you mention worse angina, a kind of bad reaction to GTN spray. I’m interested then in how you deal with bad angina....do you take sprays or just get straight into A and E?

I’m told angina is not good for the heart, but how do you manage it when it happens?

It’s a bit of a journey for us, isn’t it? The article reminds me that it’s the same for the Medics, too.

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This is how I manage my cluster of severe angina episodes.

I use breathing and relaxation techniques such as visualisations and meditation.

I listen to this free app which has loads of different types of meditations and nature sounds.

I like listening to the rain and thunderstorms.

insighttimer.com/

healthline.com/health/alter...

I also use a TENS machine like women in labour do and use oxygen which helps with my breathlessness.

I do increase the amount of oral nitrates I take and apply more nitrate patches this is all with the agreement of my Cardiologist.

If I feel I need more support I go into hospital.

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Microvascular angina sure is a very head scratching condition which seems to present itself in different ways. I was given a diagnosis of "probable microvascular disease" after an angiogram which showed my main arteries were not in too bad shape but my stress echo had shown fairly global ischaemia. What makes it more difficult for me to understand what is going on is that I never get chest pain or even feeling of discomfort. Just a lot of breathlessness on exertion. Add into the mix being overweight and up until recently very inactive and it's difficult to separate out cause and effect.

I'm assuming that the breathlessness is caused by failure of the microvessels to dilate rather than being blocked as such. But who knows? There was a person recently posting about blockage of the OM artery which is like in the middle between the main arteries and the microvessels, so maybe we can throw that possibility into the mix as well?

I do seem to be responding well to my medication which at the moment is statin, ramipril and long acting isosorbide mononitrate. I'm building up my exercise regime ok and losing weight.

What we all seem to share is a dislike of the cold! Let's hope for many more weeks of mild weather.

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yes this is what I was thinking too . I have blockages in minor arteries e.g 100% block after LAD diagonal1 ,Diagonal 2 Proximal 50%,LCX Distal 90%,OM1 mid segment 90% ,RCA PLV proximal 90% ,RCA PDA has diffuse 90% .. This could be the reason medical therapy just works for us along with support from collaterals

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Very interesting controlcause. How did these blockages get diagnosed?

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got detected in angiogram in feb17 then stenting attempt in jun17 failed due to calcified nature .. last 2 years i am on medical therapy

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