I have Vasospastic angina ( microvascular dysfunction ) which is probably secondary to my rare, auto immune disease. I have never smoked, have exemplary blood pressure, am not diabetic, have exercised all my life, am not overweight and have a mainly plant based diet.
I have struggled to get good symptom control and am currently taking nicorandil and nebivolol. One of my earliest symptoms was shortness of breath on exertion which persists, my chest pain mainly comes on at rest and can last for up to 3 days.
Recently I have noticed my ankles swell if I have been busy and don’t manage to elevate my legs during the day. A recent echocardiogram was negative. I am currently attending cardiac rehab classes which I enjoy but they wipe me out the next day.
Has anyone with microvascular angina developed heart failure with preserved ejection fraction? I worry that my shortness of breath and occasional ankle swelling is pointing to this. I did some research online and there does seem to be an association between the 2 although I don’t have any of the other risk factors.
I don’t see cardiology regularly, my feeling is that they view microvascular and vasospastic angina as benign diseases despite evidence to the contrary. Would welcome any thoughts/ experiences.
There is growing evidence that microvascular or vasospastic angina can lead to heart function problems.
Vasospastic angina is the term used to describe spasms in the coronary arteries whilst microvascular angina can be due to spasms in the microvessels or microvascular dysfunction. Microvascular dysfunction effects the small vessels rather than the larger coronary blood vessels. Though you can have spasms in both.
A Coronary flow reserve of less than 2.5 is considered to indicate microvascular dysfunction.
Beta blockers can make vasospasms in the coronary arteries worse but help microvascular dysfunction.
Calcium channel blockers can be effective along with nitrates for coronary artery spasms.
Ranolazine is another medication that can be helpful too.
It can be trial and error to get the best combination of medication to work best for you without too many side effects such as swollen ankles.
I now have my NT-proBNP checked as this is useful test to check for heart function issues.
I have in the past had problems with diastolic dysfunction but this has improved overtime with exercise.
I also have times when my ankles are swollen and I get breathless but so far my blood tests are normal. I am totally wiped out with much more pain at the moment because it is so cold. I can't wait for warmer weather.
I am having another perfusion MRI soon to check my heart muscle.
I am very fortunate that I have had the same Cardiologist for 7 years. We have learned together over the years how best to manage my condition.
He is a heart function specialist so has the right skills to care for me.
His eye I know is very much on my heart function.
Is it possible to ask to be seen more often by a Cardiologist?
Or will your GP be able to check your NT- proBNP levels?
I haven’t seen that article but did find this one where they found that 75% of mainly female patients with heart failure with preserved ejection fraction had micro-vessel Disease.
I have never seen a Consultant Cardiologst, at my last appt they organised an echo, reading between the lines I think they are reassured that it was “ normal “. My GP is great but I suspect they would be unwilling to check my NT- proBNP levels without being asked by the cardiologist.
I do think the real issue for me is that my Rheumatologist understands my autoimmune disease and my cardiologist understands heart disease but no one is looking at me and my symptoms holistically. If it is inflammation that’s causing the symptoms, despite immunosuppressants, then surely that will continue. The cardiac meds treat the symptoms but don’t correct the underlying problem.
Hello. I have vasospastic angina/variant angina/prinzmetal angina/coronary artery spasm (I wish they would stick to one name), an autoimmune disease (RA) and POTS amongst others. I find that inflammation is one of the triggers for my angina. Whenever I have an infection, I always have attacks. I take amlodipine, which makes my ankles, feet and lower legs swell but it's the isosorbide mononitrate that has really helped. I'm sorry, I don't have microvascular angina, so can't answer your question but I just wanted to say Hi xXx
My diagnosis has certainly evolved over the years!
Latest Coronary vasospastic angina!!! Apparently because I have spasms in my microvessels and coronary arteries
The BHF adopted the term Vasospastic angina as this is the term now being used by researchers as it better reflects what's happening in the blood vessels.
How was your Vasospastic angina/ Coronary artery spasms diagnosed?
It is interesting that you have POTS and RA too.
My main trigger is definitely the cold as I live with Raynauds Phenomenon too.
I was diagnosed as my stress echo showed my arteries were clear and I had a typical angina episode where my heart rate dropped to 42 bpm. I had previously had episodes which sometimes did and sometimes did not respond to GTN. I was initially told it was all in my head but changed cardiologist. My dad also has it, with exactly the same symptoms but he was immediately believed. My cardiologist doesn't do provocative angiograms because there have been adverse events reported. Cold triggers mine too as well as being very tired. I don't have raynauds but have a sister that does. I've had auditory artery spasms too.
The first cardiologist told me women of my age who don't drink or smoke don't have heart disease. Even when I said my dad had exactly the same symptoms, he wasn't interested. Another consultant on the ward told me to put a complaint in.
The additional symptoms you experience sound horrendous! You have my sympathy.
I don't think I have MVA as I have no symptoms on exertion. It was interesting reading the Prof's research. I'm actually taking all 3 medications mentioned, CCB & l.a. nitrates for VSA and beta blockers for POTS. Unfortunately I can't function without any of them. I don't have too many episodes of VSA as long as I am not cold, over tired or have an infection.
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Any others with microvascular angina?
From heart failure to preserved ejection fraction 
