Not angina so now what!?: Had a stress... - British Heart Fou...

British Heart Foundation
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Not angina so now what!?


Had a stress echo on Wednesday they stopped me after 9 minutes as still going strong on treadmill. Not angina, heart and vessels healthy. Asked about microvascular disease, cardiologist said no! Might be coronary artery spasm or oesophageal spasm which he said have no treatment so stop all medication!!

26 Replies
MichaelJHHeart Star

Sorry no idea of the background to this. What prompted the exercise echocardiogram?

WIgranny in reply to MichaelJH

Hi, classic angina symptoms (except not caused by exertion or other usual triggers) most of last year, saw cardiac nurse on Xmas Eve and started medication referred for echo which finally had this week

MichaelJHHeart Star in reply to WIgranny

Sounds like it could be MVA. I have no real knowledge of this but have members who do. Hopefully, one will be along later.

MilkfairyHeart Star

Hi Wigranny,

Michael has suggested Microvascular angina.

Along with vasospastic angina the condition is poorly recognised and understood.

I met during my recent hospital admission the very senior Cardiologist who told me 7 years ago quite firmly I couldn't possibly have Cardiac chest pain because my angiogram showed I have clear arteries.

He now acknowledges the cause of my chest pain is due to a lack of blood supply to my heart due to spasms in my microvessels and coronary arteries.

He was actually very sympathetic and supportive a complete 180o turn about.

It was quite a moment when I heard him tell everyone on the ward round that my diagnosis was Vasospastic angina and how he had every sympathy with me living with such a challenging condition!

I was fortunate to be diagnosed by a very clever and astute Cardiologist and I had a very specialised angiogram.

It has been a long journey but worth the effort. You do need to be persistent and advocate for yourself.

The BHF has the following information. Including treatment options.

Perhaps print it put go and see your GP and ask to be referred to a more sympathetic and knowledgeable Cardiologist.

The response you have received so far reflects the lack of knowledge of the MVA and VSA by the Cardiology world.

There are quite a few of us around with either MVA or VSA or both who will be able to share the experiences too.

WIgranny in reply to Milkfairy

I asked about mva but he was pretty sure I didn't have it as no chest pain after 9min on the treadmill,said it may be coronary artery spasm or oesophageal spasm but offered no treatment for these!

MilkfairyHeart Star in reply to WIgranny

I live with microvascular angina and coronary artery spasms and it does need to be treated appropriately.

These are not as thought in the past benign conditions.

I can also exercise. I get most of my chest pain at rest and at night.

I suggest you ask for a second opinion.

I saw a world expert in MVA and VSA and am now cared for by a Professor who is a BHF funded researcher into the conditions.

Doctors are human and cannot know everything. Sometimes you have to go on a hunt to find the right Cardiologist.

Rosei in reply to Milkfairy

What is the treatment for MVA please?

MilkfairyHeart Star in reply to Rosei

Hi Rosei

There is no simple short answer to your question as treatment depends on the underlying cause of MVA.

It's a complex condition with lots of possible causes and hence treatment.

As there is no standard treatment it needs a skilled and patient Cardiologist to find the best combination of medications to help you best.

There is no one size fits all.

We are all affected differently and some worse than others.

Many are successfully treated with just one or 2 medications.

A small minority like myself have a condition that is very challenging to treat.

Because my MVA and Vasospastic angina are caused by spasms I am treated with 2 calcium channel blockers, nicorandil and oral nitrates and patches.

Beta blockers and Ranolazine made my spasms worse but help other people.

ACE inhibitors and ARBs can also reduce the angina episodes.

I take statins to reduce inflammation and prevent the build of plaque.

Colpidogrel to prevent micro clots forming.

Then there's the stuff we need to do to help ourselves to live with this challenging heart related pain condition.

No smoking, keep you weight down and exercise as much as you can.

I am a Mediterranean diet fan others adopt other dietary strategies. It's an individual's choice.

I use a TENS machine for bad episodes of pain.

I manage my stress and learn my triggers which for me are the cold, emotional and mental stress. CBT and pacing are useful strategies.

I practice Mindfulness meditation, TaiChi and yoga. I try to get into my garden as much as possible and I am now learning to paint.

I am fortunate that I have a established a good relationship with my Cardiologist and we work together with input from a physiotherapist, psychologist, Pain Team, GP and hospital staff.

Rosei in reply to Milkfairy

Thank you so much for your comprehensive reply. I am 84, slim and walk everyday for two miles, my diet comprises of lots of vegetables and fruit, small amounts of chicken or salmon. I get my pain first thing in the morning for about half an hour. My medication consists of Clopidogrel, bisoprolol. I think I will be content with my lot, I consider myself lucky to be alive.

Once again, I say thank you, I read your interesting replies to others.

MilkfairyHeart Star in reply to Rosei


Thank you!

Your reply gives me so much hope too.

I am much younger but it's great to read of others on the forum who find their way to live well with their heart conditions.

dunestar in reply to WIgranny

Hi WIgranny

I have MVA, diagnosed initially at Harefield hospital and subsequently confirmed by a consultant at Royal Brompton, so top notch places. I've never had chest pain.

MVA manifests in different ways. With me I used to puff like a knackered steam train and on hills I was forever stopping to "admire the view" ie have a quick rest. With my meds I accept scaling Everest may be a bit of a stretch but I can scoot around reasonably well.

I didn't have a treadmill test but a stress echocardiogram which showed a lot of ischaemia (restricted blood flow). Multi artery blockages were suspected and I convinced myself I was headed towards by pass surgery, but an angiogram showed only mild atheroma in one artery.

Hope you get to the bottom of what's causing your pain and can get the best treatment. So difficult when even cardiac specialists are not on top of their game.

JonathanH in reply to WIgranny


I agree with Milkfairy. I write as another MVA sufferer. The disease is variable and unpredictable, and I don't believe that 9 symptom-free minutes on a treadmill necessarily means that you don't have MVA. Both MVA and CAS can generally be treated with calcium channel blockers, as I understand it, especially diltiazem.

It is of course possible that you are suffering from oesophageal disease, or from both MVA/CAS and oesophageal dysfunction. There is an association between the two. I used to experience a lot of oesophageal and gastrointestinal problems as well as MVA. After being treated with ECP (external counterpulsation) for my MVA it was the gastrointestinal and oesophageal symptoms that were most decisively treated.

It took me 10 years to obtain a diagnosis and on the way I bought off Amazon a hand held ECG (Heal Force Prince 180B) and downloaded onto my laptop from the manufacturer's website the software required to save the ECGs in pdf format. When symptomatic, I captured ECGs with subtle indications of ischemia (T-wave flattening and ST-depression). If you get desperate - and you may - you could consider doing this.

MilkfairyHeart Star in reply to JonathanH

Jonathan you'll love this tale.

I was fitted with a holter yesterday.

The physiologist gave me a look....

I said oh what can you see?

I told him I had chest pain at that moment.

I then got an even more of a look as he showed me the ST depressions that the holter was picking up.

I calmed him down as he was ready to send me A&E etc until I explained that I have vasospastic angina and I was just feeling my usual chest pain......

Detecting ECG changes associated with spasms is like catching the will o' the wisp

JonathanH in reply to Milkfairy

That is indeed a lovely tale and I have to say that I am rather impressed that the physiologist actually took the ST depressions seriously, and the will o' the wisp thing is true.

Acid reflux or GERD can mimic all the signs of angina and or heart attacks I had both reflux and angina it was hard to determine when I was having what I took ranitidine for the acid and gnt for the angina if I had any symptoms

I take calcium channel blockers for coronary artery spasm don’t know why he’d say no treatment 🤷‍♀️

Exactly the same, cardio said angigram completely clear could well be Oesphageal spasm, off all heart med and on Omeprazole. Two weeks later still having chest discomfort/pain though. Be interested to know how you get on. Sue

MilkfairyHeart Star in reply to Susieque21

There is more research going on here in the UK into MVA.

The problem is the lack of awareness of MVA and vasospastic angina amongst Cardiologists, cardiac nurses, GPs and the public alike.

I hope you can find the cause of your symptoms too.

Susieque21 in reply to Milkfairy

Thank you Milkfairy, I was thinking on that route myself previously. Sometimes they have this knack of leaving you feeling like you're imagining it all. I will certainly read info, thank you.

I have MVA and also have 3 stents to My LAD the MVA was diagnosed last year after stay in hospital and lots of tests including a treadmill stress test which I passed but had pain later on. It is a very difficult condition to diagnose, and I assumed that I was given this diagnosis due to My symptoms alone being breathlessness exhaustion and chest tightness,but at a recent appointment with a cardiologist he confirmed that I have disease in both the large and small arteries and that although the cannot see into the smaller arteries I have definite signs which I assume have showed up on previous tests, I have had every test over the last 3 years. I am on nitrates as well as the usual cardio meds and this does work for me. I have to manage my activity and Can do most things vs on a good day and on a bad day just rest until I feel better. Now I know it's MVA I can relax when I get pain and not worry im having a heart attack! If you continue to feel bad then go to A and E you know how you feel it took me a long time to get diagnosed, and I suggested MVA to one cardiologist during a visit to A and E who said no no I'll do the diagnosing but it doesn't always show in every test so if you still get symptoms then be persistent.

Best wishes

MilkfairyHeart Star in reply to Sunshinebrew

Hi Sunshinebrew

A delayed response to exercise with pain later seems to be a common symptom MVA.

I have the same experience.

Good to hear you have a Cardiologist who recognises MVA and Vasospastic angina.

Yes this site has been invaluable to hear of others experience. Because my pain wasn't text book as such the doctors didn't take it seriously at first and you start to doubt yourself when tests are clear I was told I was anxious and had indigestion, even had a gall bladder scan before I was finally diagnosed with heart disease.

I could quite easily do more than 9 minutes on treadmill and I have unstable angina. Never had symptoms on exercising only at rest! I'd get a second opinion if I were you.

I've got conorary artory spasms, on the usual heart meds and put on ranexa which has relieved it. Don't let them fob you off if you think there's something wrong. Best of luck 👍

I have AF which manifests as short spells of palpitations but with radiating chest pain afterwArds. Usually on exertion. Thankfully these episodes are short lived and not every day. It was initially thought this was angina due to CAD but an angiogram showed my arteries to be clear. I was initially prescribed bisopropolol and from February Sotalol. Unfortunately neither drug has eliminated/impacted on my symptoms so I will be seeing cardiologist again soon. Your “angina” symptoms may be due to AF?


There is a huge resistence to accepting this condition in Cardiology. Anti-MVA.

I saw one Cardiologist whom Milkfairy very generously informed me of his name when querying as to which consultant who could deal with this. I simply picked this chap only because he was baseed at the same hospital as I did attend before.

The other consultant (my first choice) was a little too pricey, unfortunately. He was no longer practicing on NHS, either. Unfortunately, not only the one I picked had a really bad bedside manner, he had absolutely no interest, openly expressed his anti-MVA stance whilst oddly, his younger registrar was far more open-minded. I knew I wasn't going to see this younger one again. I was dazzled by the huge difference in attitude between these consultants. My ECG was always abnormal. CMRI abnormal. They still try to dismiss you.

He's a smart chap and he knows there are problems. He denies, denies and denies, whilst the younger one was far more open-minded. (I don't think he will last there too long...)

I don't get an impression the consultant thinks this is a priority area in General Cardiology; it means it does not need to be taken care of under his Cardiology Team whilst the younger one was very open-minded. Just be careful as to which one you pick. My experience with this chap was very poor. The young registrar was absolutely wonderful.

I'm sure this consultant is aware of politics within the hospital. It's always the way. Is there anybody, who went to Scotland to see Professor Colin? Would you please PM me? Thank you. :)

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