I have suffered for 15 years with central chest discomfort, had 2 clear angiograms, negative stress tests, scans of arteries, numerous ecg all fine, no issues with blood tests. Two cardiologists have stated MVA currently on Isorbide dianitrate, bisoporol, statins and aspirins, tried renaxa did not agree with me at all. But no one will actually confirm where problem is arising from and just want to change meds to try and resolve, gp even suggesting not heart related and referring to gastro specialist. I have only used a GTN 5 or 6 times in this time walk briskly every day 3 to 4 miles with limited discomfort and heart rate recovers fine. Brief spell of burping often stops discomfort whilst exercising. Sorry for long post but just want an accurate diagnosis.
MVA: I have suffered for 15 years with... - British Heart Fou...
MVA
Gosh I'm amazed all your tests are clear yet you are on so many meds, I was diagnosed with MVA but given nothing, just told to live with it 🤔
The normal first-time drugs for MVA are calcium channel blockers, especially diltiazem. I am taking two CCBs, namely diltiazem and amlodipine. They help. Also, a statin and an ACE inhibitor, e.g. perindopril, would I believe be recommended.
I was initially given Bisoprolol as my heart runs a bit fast but then taken off it and nothing since, as all my tests were clear I think the MVA was an afterthought and now forgotten although still on my records.
Current battle is getting treatment for seriously symptomatic ectopics, hard work !
Incredibly frustrating for you. My cardiologist advised me to take magnesium as I have sometimes suffered arrhythmia. Have you ever had ischemic indications on ECGs?
My magnesium level is good so taking extra wasn't advised, ECGs and angiogram were ok, MVA was said because of the symptoms, ECG now shows lots of pauses with the ectopics, also have raised BNP but they aren't bothered about that ! Very frustrating indeed.
One thing for sure is that vasospastic and Microvascular angina are complex and poorly understood conditions.
There is no standard treatment as the causes of each individual's type of Microvascular angina can be unique to them. We all respond to medication differently. For me there is a balancing of side effects such as my low blood pressure and effectiveness of a particular medication.
It is case of trial and error to find the best combination of medication that works best for you. This requires a knowledgeable, motivated and engaged Cardiologist with whom we can work in equal partnership to achieve this goal. We all know this type of Cardiologist is as rare as hen's teeth.
See Table 2 of the article below for treatment suggestions for the many possible causes of MVA.
heart.bmj.com/content/104/4...
As none of us are registered healthcare professionals I feel we should consider whether it is appropriate to say which particular medication regimes are appropriate to treat such a complex condition as Vasospastic or Microvascular angina.
Great care perhaps should also be taken when expressing an opinion about another person's possible diagnosis.
Do you get aids effects from diltiazem? Can you drive with it ? Can you take it with nitrates ?
Hi Copsem,
I take Diltiazem modified release and Isosorbide mononitrate extended release along with GTN patches and Nicorandil.
No problems driving for me. I am very tolerant of nitrates.
This is typical of those effected by vasospastic angina.
We are all so different!
Just felt sick all the time, lethargic and generally not great. Plus didn't notice any difference.
Think I would be asking to see another cardiologist.
It's incredibly frustrating to feel ill but to be unable to obtain a diagnosis. It took me 10 years to obtain a diagnosis of MVA, and your 15 years of undiagnosed illness is appalling.
I am not convinced that you have MVA, because I think you would sometimes be feeling worse than you seem to. What you surely do need to demonstrate to support a diagnosis of MVA is ischemic ECGs. For example, I have had ischemic ECGs when bad MVA attacks have taken me to hospital in an ambulance.
Do you want to tell us more about your symptoms, e.g. when they occur?
My understanding is that GTN has multiple functions and can affect the oesophagus as well as the heart, for which reason it cannot be used diagnostically.
Jonathan
I think the irritating part is don't feel really ill, just nagging discomfort in centre of chest yesterday not great today fine, blood pressure is good 125 - 75 most days, get occasional light headed, and feel nauseous but goes away gaviscon sometimes helps. At 64 still active and hate taking medication especially when not convinced of issue. Think next route is MRI perfusion scan but gp a bit reluctant on that one.
I am sorry: illness is never pleasant, not nagging discomfort and certainly not light-headedness. Untangling what is causing chest pain is very problematic, and all the more so since the heart and the oesophagus can influence each other via the vagus nerve. My MVA has associated gastro-oesophageal problems, and an association between gastric and oesophageal disorders is documented, for example an American doctor called Cannon noticed that many of his MVA patients also had something called nutcracker oesophagus. I have found scientific papers that report on heart disorders having an effect on the oesophagus and vice-versa. For a long time, the only hypothesis I had been given as to my disease was that reflux was causing my heart to misbehave.
I think that you do need further investigation to find out what is going on, perhaps via referral to a consultant with expertise with MVA (of which there are few). I believe that there is some relevant expertise at the Royal Brompton in London. You can find on the internet publications to the effect that MVA increases the risk of major adverse cardiac events (MACE) and this justifies further investigation. If I remember, I will spend some time over the weekend trawling through my literature collection for one or two useful articles for you to present to your GP in this regard. The leading MVA specialist is unfortunately in the process of retiring and has given up his NHS practice but seems still to be accepting private patients (Prof J-C Kaski).
I resorted to do-it-yourself cardiology and bought via Amazon a small hand-held ECG machine called a HealForce Prince 180B (made in China). I then downloaded from the manufacturer's website onto my laptop processing software that allowed me to print the waveforms into pdf format, and then to print out or email the pdf's. I also downloaded a couple of introductory booklets to interpreting ECGs and learned to spot signs of ischemia like T-wave flattening and ST-depression. On one occasion I captured a more serious ST-elevation and was "rewarded" with an angiogram. I used to have severe attacks that I monitored in this way and I don't know whether you would be able to spot very subtle changes associated with your rather subtle MVA, if that should be what you have. (By the way, the algorithm on the ECG machine looks for arrhythmia, not ischemia).
I would add that an MVA specialist such as Prof Kaski can probably see things in ECGs that most other doctors can't.
Good luck!
you mentioned the word ischaemic.. just wonder if you answer this query.. cardiologist also diagnosed me with MVA.. couple of years ago i had to call for an ambulance .. paramedic carried out an ecg.. heard him taljing to his colleague and he mentioned ischaemic activity... what does that actually mean?
Ischaemia lack of blood supply to the heart may be seen as changes in the wave patterns of an ECG.
You'll hear medics say T wave inversions/ flattening , ST elevations and depressions these may indicate ischaemia especially if you have chest pain.
However ECG changes can be due to other reasons e.g. some medications, raised pressure within the brain, pulmonary embolism, cardiomyopathy and some heart rhythmn changes.
An ECG is just one piece in the puzzle so cannot be seen in isolation.
I expect the paramedic saw some of these wave patterns changes so described them as 'ischaemic activity '
I hope your MVA is well treated and you have a good Cardiologist.
I always find it so encouraging to hear other people getting the care they need.
yes has me on ivabradine, isorobide and tildiem retard plus on a couple of bp meds and a statin
Ischaemic means that blood supply is restricted resulting in insufficient oxygen reaching the heart or other affected tissue. So in MVA small blood vessels to the heart don't function properly, resulting in insufficient blood/oxygen supply.
I’ve had mine since been a child with it getting worse. Over past 20 years and have been under different Cardiology consultants and all test R clear.
Only thing that has eased pain was about 20 year ago had a spell of taking Gliserine tables with GTN SPRAY which reduced pain, but was stopped because said didn’t have heart trouble.
Started again in last month and already noticing reduce Chest pain but doesn’t do owt for breathing.
Jeff
What a frustrating situation! As Milkfairy says microvascular angina is a very complex condition and is poorly understood even by cardiologists, so it's little wonder that folk can be left bewildered and frustrated. It's not straightforward to diagnose so either the possibility of MVA can be ignored completely or you can get an MVA diagnosis by a route of well it's not a, b and c therefore it's likely to be d (ie MVA). So it becomes a bit of a catch all.
In my case the diagnosis came about via a stress echo which showed extensive ischaemia but the angiogram revealed only mild atheroma in one of my main arteries. So the diagnosis was "probable microvascular disease". I then took myself off to a MVA specialist privately who confirmed the diagnosis - he was able to access my stress echo and angiogram results as he is in the same Trust as the hospital where they were carried out. But even he had a wobble and said at one point he wasn't sure it was MVA. I don't get any chest pain or discomfort, just breathlessness when I exert myself.
This cardiologist said an MRI perfusion scan would nail the MVA diagnosis. i didn't have one in the end as it would have cost me an arm and a leg and by this point he'd come back to a firm diagnosis of MVA.
I think part of the problem is as well that consultants tend to look for answers within their own specialism. So if you have chest pain a cardiologist will think of heart issues whereas a gastroenterologist will be thinking of gut issues.
Not sure whether this helps but I wish you all the best with your quest to find answers.
Yes to your first question! it is apparently characteristic of CAS and it is very possible to have both MVA and CAS.
Absolutely!
The consultant at the Royal Brompton you make reference to, has only recently adopted the term Microvascular angina and updated the Royal Brompton hospital website accordingly.
He was my former Consultant. He told me MVA is harmless and I was more likely to die from breast cancer ( my mother had just died of breast cancer so his timing was not great)
I suggested my problems were due to vasospasms he said no they weren't but with good grace referred me to Prof Kaski at my request.
Prof Kaski sent me for an angiogram with acytelcholine all my other tests including cardiac perfusion test MRI were normal.
During the angiogram I had spontaneous and acytelcholine induced ST elevations and ST depressions , coronary vasospasms and lots of chest pain. Spasms were seen in my small vessels- Microvascular angina and large vessels Coronary artery spasms.
I live with a vasomotion disorder of my cardiovascular system so all the blood vessels in my body have a habit of going into spasm.
An angiogram with acytelcholine is unfortunately the only way to confirm Microvascular and Vasospastic angina ( the BHF and specislist in this field including researchers now use this term rather than Printzmetal/ variant angina or Coronary artery spasms )
A few centres carry out this type of angiogram. One in Glasgow also at St Thomas's and Kings College hospitals in London.
A very clever switched on Cardiologist is able to diagnose Microvascular or vasospastic angina on listening well to their patients symptoms.
I was over 6 years ago by my Cardiologist.
A 12 lead ECG is the usual way to detect a lack of blood supply the heart muscle- myocardial ischaemia. An ECG is dependent on the skill of the person applying the pads and the interpretation of the findings by an experienced and skilled clinician.
Some of the cardiac nurses I have met in CCU are better than their medical colleagues in this task.
As I think Nicky said you have to 'kiss a few frogs to find a prince'
And even supposed princes are not what they seem.
bhf.org.uk/informationsuppo...
This BHF leaflet was written with advice from Prof Colin Berry and an expert patient advisor.
I am in a similar situation to yourself, had echocardiogram, angiogram and myocardial perfusion scan.
Angiogram showed mild to moderate atheroma in one artery and extreme slow flow in all three.
I have been told it could be microvascular angina, but that is just an assumption.
When I asked my gp if I could come off some of the medication she explained that it was an aggressive treatment plan to prevent further angina type pain and possibility of heart attack.
I am on lansoprazole, aspirin, bisprolol, isosorbide mononitrate, ranolazine, rosuvastatin, losartan....
I have every sympathy with you.
We are all between a rock and a hard place.
I do not like having to take my personal cocktail of medications with all their combined side effects.
My specialist emphasised the importance of secondary prevention. He gave me a very stern Paddington bear stare when he said it.
What we all need is a definitive diagnosis so we can be treated appropriately. That is as yet not widely available along with access to the Cardiologists who have the knowledge and patience to work towards the correct combination of medication that will work best for us each individually.
Otherwise some individuals are over treated taking medication unnecessarily or others do not get the best treatment to reduce their angina, avoid heart attacks and possible heart failure in the future.
Fortunately I seem to be fairly side effect free, very occasional dizzy spell, joints ache but I already had that from the operation sites right knee arthroscopy to repair torn meniscus (judo) in 2013 and arthritis in left shoulder after a bad dislocated shoulder (judo) in 2015, needless to say I had to stop judo after 13 years training and coaching....
Bisoprolol to fix ectopic beats?
6 months post Heart Attack
Mva
ectopics and Bisoprolol 
