I'm just past my 1 year anniversary of having stents fitted for a couple of blocked arteries. Over that past year I've had a number of chest pain episodes that have until recently been dismissed as imaginary (as cardio rehab nurses referred me to the psychologists on the back of my pain history report when they discharged me), indigestion , or physical muscular problems the latter two suggested at visits to A&E . No evidence was available to back up these views presented so I was left to my own devices ie sink or swim in effect. After a change in my GP practice lateish last year (it was previously staffed entirely by locums as original GPs retired which meant "continued" health care from the practice didn't appear to be happening) I managed to get referred back to cardiology . Long story sofar (apols-maybe a much needed whinge) I had another angiogram (joy) which came back as the stents are patent (which apparently means clear in laymans speak- ) . So eventually I had a cardiologist state I might have MVA (micro vascular angina to those who hate the acronym hell that is cardiology ;p ) , though there was no further advise given other than to take increased does of Isosorbide mononitrate (a low dose had been prescribed at my last A&E visit as a try that see what happens (shortened words but that was the gist of the conversation) . So I'm now on 20mg Isosobide mononitrate taken 1st thing and midday which on the most part works well.
BUT (I should have started this question here) when I have days the MVA shows up even after a tablet I find the recommended GTN toots does very little (maybe 5 mins short relief).
therefore my real question is what do others do to alleviate the symptoms (other than visiting A&E as that doesn't do much bar putting me closer to treatment should an MI be looming) . As I find GTN less effective than ideal, is there other MVA management techniques out there , rest, dark rooms, lots of pain killers ? just asking as my I suspect local cardiology aren't fully clued on this, the consultant did say they didn't have an effective test that would be conclusive either way, and beyond the Iso dose increase didn't advise much else other than we'll see you in 4 months (still waiting for that appointment to arrive-must chase) . In other stuff maybe relevant my BP is the reasonable side of healthy 110/70 , I'm reasonable fit male slim with very low cholesterol numbers (since stenting- via diet change and meds). Also take a min does of Bisporol 1.25 mornings and same Lisinopril at night with the seemingly obligatory 80mg statin with pain meds as PRN and MVA isn't a regular event , i'm still trying to see if there a identifiable MVA triggers but nothing seems consistent sofar as I've had it on slothful days as well as having it post an hours cardio exercise but not always. When it does occur it seems to run for either a few hours or longer on the worst ones though since getting Isosorbide its never at a level that is above a 4 on the very subjective and personal pain scale.
Apols for the rambling, I had cut a lot out as it was more a whinge at the lack of continued care from hospitals/GPs so not really relevant
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BillyMct
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Some patients have Microvascular angina and Coronary heart disease too!
There are several theories about the causes of Microvascular angina.
Either your small blood vessels fail to dilate or constrict or lose their ability to stay relaxed.
Some people have spasms temporary constrictions in their large blood vessel Vasospastic angina aka Coronary artery spasms , Printzmetal or Variant Angina.
Some poor sods have spasms in the their small and large blood vessels.
Coronary Vasospastic angina- Microvascular angina and Coronary artery spasms. ( I am in that camp)
It is very difficult sometimes to tell Microvascular angina and Vasospastic angina apart.
There is a test an Angiogram with acytelcholine that confirms the diagnosis. Only problem it has to be carried out by an experienced confident cardiologists in a major heart centre.
In the UK that's Glasgow and London.
Other members of the 'unicorn' club will chip in there are quite a few of us.
One theme I have noticed many of us use Meditation to help with managing our pain and the anxiety that pain brings into our lives .
"Yes Gunsmoke you are correct Microvascular angina is the term that has replaced the now thank goodness increasingly historic term Cardiac syndrome X ."
I heard a different definition, where Cardiac Syndrome X is a broader category that includes both ischemic (restriction to blood supply) and non-ischemic conditions, but that MVA only relates to ischemic conditions.
According to this definition the two terms are not synonymous and both still remain in use.
This article contains a useful chart that illustrates the relationship between "Cardiac Syndrome X" and "Microvascular Angina"
The research article you have quoted was published in 2015.
It is an evolving field and the term Cardiac Syndrome X is not being used by the experts researching into the field.
The BHF adopted the term Microvascular angina 2 years ago 2017.
Cardiac syndrome X is not helpful as Prof Colin Berry states
'Syndrome X is a historical term stigmatized by its associations with the female sex, obesity, and psychology, leading to therapeutic nilhilsm in the minds of some clincians.'
With the greatest respect those of us with a lived experience of this debilitating pain condition are the experts by the lived experience of struggling to have our pain acknowledged and treated appropriately.
Prof Berry's CorMicA research also showed that 'the diagnosis of chest pain of non cardiac origin almost dropped off the map' and Cardiologist adopted the European Society of Cardiology treatment for Vasospastic and Microvascular angina.
Your replies always make interesting and informative reading. I had a double bypass two years ago (circumflex too calcified to bypass) and immediately afterwards reported chest pain. This was initially put down muscular problems or post operative settling down. A ct cardio gram revealed a possible narrowing but a subsequent angiogram didn’t show this and reported a good blood flow. Numerous ecg ‘s and a Drug stress echo were all normal for a bypass patient. I wonder if , besides pain possibly caused by the blocked circumflex I am getting the spasms you discuss. I am under the North West heart and lung centre at Wythenshawe hospital. Would you include this with the London and Glasgow centres?!
There is a growing awareness that microvascular or coronary artery spasms can occur following stents or even bypass surgery.
The European Society of Cardiology published it's new guidelines in the diagnosis and management of chronic coronary syndromes.
Buried deep in the guidelines is some information about MVA and vasospastic angina also Refractory angina
See sections 6 and 8.4.
The present President of the British cardiovascular society is based at Wythenshawe hospital so you would hope he was aware of these new guidelines as they recommended Prof Colin Berry's CorMicA research as a diagnostic test .
I hope you are able to find the cause of your ongoing pain .
Hello BillyMct. Thought I would chip in although not sure I can be terribly helpful. MVA is a very perplexing condition. There is no clear view on what causes it. But as Milkfairy says the main issue is failure of the microvessels let blood through to where it's needed. So one of the main treatments is isosorbide mononitrate which acts to dilate the blood vessels.
Within the MVA "spectrum" the condition affects different people in different ways. I am very fortunate in that I don't get chest pain at all, but I get short of breath particularly when I exercise. So there's not a one size fits all approach which is going to work for everybody. When I was diagnosed with "probable microvascular disease" following an angiogram which showed only mild atheroma in the LAD, I took myself off privately to a specialist in MVA at the Royal Brompton. He worked with me to tweak the medication to get the right combination for me. We tried Ranexa and Adizem, which are both newish angina drugs, but neither worked particularly well for me.
I would echo Milkfairy's comments about finding ways to manage anxiety. I went through quite a bad patch earlier this year which was mostly down to anxiety. Again it's a personal thing, whatever works best for you.
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Advice on chest pains pls.
Chronic back pain and pain relief?
Clear Angiogram but angina symptoms persist
Isosorbide mononitrate 
Just need to talk to someone that might understand. Sorry about the long story
