Microvascular angina? Is it worth getting a second opinion?

[jerry12953]

I have been getting chest pain on exertion (esp. walking uphill) for several years. At first it was the exception, now it is pretty regular, but still variable. Sometimes I can do a similar walk with a lot of pain, sometimes very little.

I've had the following tests -

Exercise CT scan; CT Coronory angiogram; Myocardial perfusion scan; and most recently a whole chest CT scan.

All have proved negative. I have been discharged back to my GP. So I am kind of re-assured that there is nothing "seriously" wrong with me, but I still have the symptoms and they are gradually getting worse.

I've diagnosed myself with microvascular angina, which neither my GP or any of the Cardiologists seem to have heard of..... !

I am due to speak to my GP tomorrow. What should I say/ask for? Is it worth trying to get a second opinion? Can anything be done about M.A. anyway? I'm getting mixed messages about that.

Any thoughts welcome. Thanks.

[MichaelJH Heart Star]

Hello and welcome to the forum! There are a number of people with MVA on this site and I imagine they will drop by. Your heading clearly mentions the issue so will not be missed. I believe some MRI scans can pick this up but I stand to be corrected!

[jerry12953 in reply to MichaelJH]

Thanks.

I should have said that I'm taking a statin and aspirin. GTN spray doesn't seem to make any difference unless I am using it incorrectly. I also took Bisoprolol for a month but that didn't seem to make much difference so with the agreement of my GP I stopped using it.

[MichaelJH Heart Star in reply to jerry12953]

I believe an anti-anginal drug like isosorbide mononitrate can be beneficial in the relief of symptoms. Hopefully others will add more before your appointment tomorrow.

[Milkfairy Heart Star in reply to MichaelJH]

Hi Michael

The newer MRIs can detect some types of microvascular dysfunction causing microvascular angina.

Perfusion MRIs are usually less able to detect microvessel vasospasms.

[shopman]

This is something I wonder about. There appears to have been an explosion in the number of "Cardio depts & Cardiologists" in different areas of the country. I often think this is done to show something is being done and that appeases our Lords & Masters in Government. Taking myself as an example I was told the new system was to have to go to the Rapid Access Chest Clinic back in 2015 as had started getting angina again. Never really had a problem with that apart from the fact they couldn't do anything for me and I should have been at the Main Cardio hospital in the region instead. 2017 saw me taken to A&E on more than 1 occasion and seen by their Cardiologists who eventually confessed they could little for me and I should be referred to the Main Cardio hospital instead.

My Consultant wondered why I had been sent to 2 different hospitals when I should just have been referred straight to him again. I've now been discharged but if anything happens again my notes say to contact my Consultant directly for further instruction. Some forget that there is no 1 size fits all and some are more complex than others.

[Sunshinebrew]

I have MVA and take isosorbide mononitrate. The dose has been gradually increased to 60 mg twice a day. I also take aspirin nebivolol and atorvastatin. The MVA was diagnosed after continuing symptoms which did not go away after having stents fitted, I also had narrowing in the large artery. The MVA for me causes chest tightness and pain which can be brought on by stress, doing too much and not resting enough, or just happens sometimes for no apparent reason. I also get very breathless and extremely tired. I am sure the medication helps but they don't stop the symptoms completely I have had to learn to listen to My body and rest more when I need to and keep as active as I can when I'm feeling good. l also find meditation and yoga helps with relaxation and anxiety. It is difficult to get a diagnosis it does not necessarily show up on tests and not all doctors and cardiologists are aware of it.

[jerry12953]

Thanks.

I have just had a conversation with my GP who is referring me back to the cardiologists locally in the hope that they can refer me upwards to someone more knowledgeable elsewhere.

Interestingly, I used the GTN on a walk yesterday evening and for the first time it actually seemed to work! Or it could have been a co-incidence.........

[Milkfairy Heart Star]

Microvascular and vasospastic angina are poorly understood conditions .

I suggest you printout the information from the BHF website about MVA and the link below and take them to your appointment with the Cardiologist.

It can take sometime to find the right Cardiologist to help you.

heart.bmj.com/content/104/4...

Good luck!

[jerry12953]

Thanks, Milkfairy. I have read some of your other posts and appreciate you passing on your knowledge to me.

I don't claim to understand that paper but I think I read that 39% of angina sufferers have no evidence of blocked arteries.......

[Milkfairy Heart Star in reply to jerry12953]

No problem.

My Cadiololgist found the paper very helpful hopefully yours will too!

If you need to pick my brains further just ask me.