Blockages and Micro Vascular Angina

[CretanBob]

Hi everyone. I'm not sure if this is too technical, but does anyone know, when you are in the cath lab awaiting your stent emergency procedure, how does the Cardiologist know from the screen, whether or not the blockage is platelets breaking away from the artery or a spasm causing the blockage ?

[Chappychap]

I don't know if this answers your question but I don't believe a specifically micro-vascular blockage would be visible on the screen. As far as I know the smallest resolution possible on the screen from CT scans or angiograms are arteries that are about 0.5mm wide. The "micro" arteries referenced in "MVA" are just a few microns wide and therefore effectively invisible. If anyone knows otherwise then I'd be happy to be corrected.

[CretanBob in reply to Chappychap]

Thanks for your reply CC. I'm not sure about some of this, but I thought that MVA could cause a main artery to block. I had two main arteries blocked (which only became apparent after the CA) but had none of the markers to justify that happening despite being monitored. Just trying to understand what happened and possible causes.

[Milkfairy Heart Star in reply to CretanBob]

Hi CretanBob,

It is not possible to see spasms in the tiny microvessels during a routine angiogram as Chappychap says they are 'invisible '.

However if the larger blood vessels coronary arteries go into spasm this can be seen.

My Vasospastic angina was diagnosed by my symptoms and confirmed by an angiogram with acytelcholine. Normal blood vessels when acytelcholine is injected should dilate. Mine constricted in spasms.

My ECG showed ST elevations and depressions and they could see the temporary narrowing of my coronary arteries at the same time my microvessels went into spasm too and they could say this was happening because the way the blood flowed changed.

I of course had chest pain too!

If you have an angiogram and have chest pain tell them very loudly and clearly if they can't see any spasms in the coronary arteries you could well be having microvessels spasms...Microvascular angina.

What can happen if you have MVA due to spasms is clot formation or a rupture of plaque and this can occur anywhere.

I have been prescribed clopidogrel and statins to help prevent this happening.

I suggest you discuss this with your Cardiologist. However there is still so little knowledge or understanding about Vasospastic and Microvascular angina that you may not get much of an answer.

[CretanBob in reply to Milkfairy]

Thanks once again MF. As you may remember, I'm in the North West which is a MVA free zone so am talking to my GP about a referral down to London or elsewhere to investigate further for proof. I managed to get him to prescribe a nitrate to add to my other meds.

[Milkfairy Heart Star in reply to CretanBob]

I have sent you a PM