Hi just joined the group as I have been recently diagnosed with angina. I’m, or was, very fit and healthy running swimming and cycling regularly. I am really frustrated as exertion brings on the angina symptoms. I’m back at the hospital this week and having read up on the BHF site think I have Microvascular Angina and also think it might be linked to the menopause. I’m wary of telling the doctors about my suspicions- I don’t want them to think I’m stepping above my station. No one has asked me anything about menopause etc but there seems a link between the drop in oestrogen and small vessel heart disease. Any advice? I’m also really struggling not being able to do the exercises I enjoy and keep me well mentally . I am using a GTN spray but my stamina is shot.
Microvascular angina: Hi just joined... - British Heart Fou...
Microvascular angina
Not an expert in this, but experienced lol
Cardiologist always asks " Have I noticed any changes to symptoms since last visit "
So they do listen to what you have to say.
Then comes the tests, and they have so many tests they can get to the bottom of cause and effects of all/most heart related problems !!
It may take a while but trust in them they are the Experts. Sounds like they have you on the radar if they have given you a GTN spray and you have an appointment.
Sure someone will be along soon who knows a lot about Microvascular Angina. One observation if it was linked to the menopause Cardiology would be full of Ladies over 50 !!! That's not a flippant remark just an observation. Mention everything and then be reassured.
Wish you Well
From my observation Cardiology is full of ladies over 50, mainly because we have to keep going back as problems aren't resolved.
Careful Prada47......
Could I ask you to reconsider your comment about menopausal women.
Vasospastic angina/ Coronary artery spasms effects women and men equally.
Some types of Microvascular angina often show themselves during the menopause. Oestrogen is thought to be involved in the perception of pain so as Oestrogen levels fall women perhaps become aware of the silent ischaemia that was already happening.
Very few women are prescribed Hormone replacement therapy with MVA because it doesn't always help and may increase a woman's risk of cardiac events.
Unfortunately both Microvascular and vasospastic angina are poorly recognised and understood conditions.
There are very few Cardiologists who have the skills and knowledge to appropriately to diagnose and treat this marginalised group of both men and women.
Hi Highbury Hill
Welcome to the form.
I suggest you printout the information leaflet about Microvascular angina and that this to your hospital appointment so you can discuss your symptoms with the doctor.
bhf.org.uk/informationsuppo...
There is some debate about the role oestrogen plays in the development of Microvascular angina.
It is not routinely prescribed to treat MVA as it doesn't always help and may increase a woman's overall risk of other heart problems.
I can exercise I get chest pain at rest in the night In response to exercise and my other stressors later. The cause of my angina is spasms in all my blood vessels.
Yoga and Tai Chi can be helpful as well as Mindfulness meditation as strategies to exercise both your mind and body.
Some types of Microvascular angina are thought to be due to the small vessels being unable to dilate in response to extra demands such as exercise.
Extreme tiredness is a classic sign and a sense of unease of all is not well are common.
I have lived with Microvascular and vasospastic angina for 7 years and it took me sometime to get my diagnosis. I now receive very good care.
As your name is Highbury Hill does that mean you live in North London?
There are quite a few of us with Non obstructive coronary artery disease another term used to describe Microvascular and vasospastic angina.
I am sure the others will be along too to share their experiences with you.
Thanks for this. I’ve had lots of blood tests which concluded that my cholesterol is really low, no thyroid issues, no liver issues etc etc. I had the stress test on the treadmill with a cardiologist but had to abort as my symptoms really flared up. He reported back to my GP that my risk of a heart attack or stroke is very low. I also had a diagnosis of high blood pressure which I have been taking a very low dose of ramipril for. It seems better but if I exercise it spikes hugely. I haven’t had a period for about 9 months then just recently had a short one. I’m aware that other posters perhaps think this is unlinked but as someone who has always enjoyed excellent health I just feel this is linked somehow. I’m going to take the information I have from the BHF site with me and also be open with the doctor this week that I’m struggling to exercise due to the symptoms- I’m desperately keen to get back into a routine as it helps me feel so much better mentally and physically .
It sounds as though your Cardiologist is not up to date as perhaps they could be regarding MVA and VSA.
There have been some studies in particular the WISE study in the US and you will read that the BHF information also suggests that MVA is associated with a higher risk of heart attack, stroke and heart failure if not treated appropriately.
I suggest you ask for an appointment with a Cardiologist who is more up to date or willing to learn. It is really important to establish a good relationship with your Cardiologist as it can take time to work together to find the best combination of medications that will work best for you.
Below are some research articles written by BHF funded researchers into MVA and Microvascular dysfunction. These I would suggest you also share with your GP and Cardiologist.
If you are still having symptoms of chest pain and extreme tiredness these need to appropriately treated.
heart.bmj.com/content/104/4...
heart.bmj.com/content/early...
ahajournals.org/doi/10.1161...
Everyone knows I am a research junky if you need anymore information just give me a shout.
Hi,
I have just joined and seen your post...I have MVA, and like you was extremely fit, regularly competing in mountain biking...I have now had to sell my bike as any exercise brings on sometimes incredible pain. It took 2 years to be properly diagnosed, and this was only after being asked to be referred to the Royal Brompton...they have a world leading experts there in this condition. ( professor collins) I am a 47 year old male but I believe the condition is more common in women of the same age. There are some treatments that can help you, ( I was given Ranexa to start with ) although they don’t work for everyone (I’m struggling as nothing seems to work for me apart from GTN spray, trinitrate patches and a hot water bottle placed on my chest). It’s very difficult to find any information, forums, support groups or anyone else to talk to with the same condition!
Hi MintTeaPlease,
Hello and welcome to the forum.
Have you had a look on the information on the BHF website about MVA and vasospastic angina?
It was written with input from an expert patient.
There quite a few of us around on the forum with either MVA or vasospastic angina or unlucky like me both.
I was officially diagnosed 7 years ago. It can take sometime to find the best combination of treatment that works best for you.
Prof Colin Berry in Glasgow is a BHF funded researcher actively researching into MVA and vasospastic angina and there is hopefully going to a trial of a possible new medication to treat the conditions starting early next year.
heart.bmj.com/content/104/4...
This is recent article written by my specialist's research fellow who is also researching into Microvascular dysfunction.
heart.bmj.com/content/early...
Hi Milkfairy,
Thanks for your reply...interesting to hear about the trials. I’m currently on my 10th or 11th drug trying to find something that helps...
I am sorry to hear that.
Hot water bottles are in my survival kit too.
I also use a TENS machine which I find helpful.
Have you had a cardiac MRI ?
The Royal Brompton are not taking part in the trial but there are several centres around the country who will be.
Yes, had the stress MRI...traumatic as you probably know!! Will be trying a TENS machine I think, do you find it helps you?. Will look into the trial, thank you. The Royal Brompton were looking for funding for a trial where a stent is put into the heart to restrict an artery thereby putting pressure on the small arteries to keep them open...don’t know it that is going ahead or not.
The other thing I use when I’m bad is heat patches stuck to the inside of a t-shirt.
Generally a bad idea.
Madness, I would say.
RBH ought to be part of the trial.
Hi MintTea,
Sorry I’ve just seen your post and it could have been me. Exercise was always my thing and the crippling pain floored me. Just to bring you up to speed and but not to alarm you. Here’s and update on my situation. After a few months of faffing about in the NHS and being told it was likely MVA or syndrome X I decided to speed things up and paid to see a private consultant. He was in agreement that my lifestyle and blood results were at odds with cardiac disease and that syndrome X was the likely issue. He considered me robust enough emotionally to deal with the diagnosis but wanted me to have an angiogram to essentially eliminate any heart issues. I went in on Thursday and had a private angiogram yesterday morning. To my consultants shock, and mine, the angiogram showed part of the main artery only had 1% blood flow. He then made a decision to put in a stent - again I have paid for this - that’s not a stealth boast I just want to raise awareness on how hard this is to get on the NHS if you are not considered an at risk patient. Anyway I had the stent put in and am home . Bit sore but hugely relieved that I was so seriously in danger of an ‘event’. Whilst I have a family history of heart and strokes issues various professionals have told me that grandparents etc do not count. I asked yesterday and was told this is genetic so your parents, their siblings, grandparents etc do count. My husband as you can imagine was utterly shocked. I’m 51 and even during the time I’ve been experiencing symptoms since June I have cycled to work and been walking at least 8km a day as a I miss the type of exercise I used to do.
Feel free to get back in touch. I feel empowered now to pursue how fit people are progressed through the NHS process. My private angiogram was £1650. To get that on the NHS would probably have seen me wait until the early New Year - at least. My stent was £2000. If I’d opted out after the angiogram and asked to go back in the NHS system the estimated time was again Christmas or New year. Scary really.
Feel free to get in tough. I’m keen in recovery to look at doing something for those of us who find ourselves in this situation.
Ooh that sounds a very bumpy journey indeed.
I am surprised that the Cardiologist you saw still used the term CSX it is so old school.
It is scary.
I had an angiogram 7 years all my coronary arteries were clear so prescribed beta blockers because oh you only have CSX nothing to worry about.
I nearly had a heart attack a few months later because the beta blockers made my then undiagnosed Vasospastic angina worse I had huge coronary artery spasms which were only stopped when I was seen by a very astute Cardiologist ( he's still my Cardiologist) who guessed what was going on and was started on IV GTN. I had to stay in hospital for 10 days until I had had cardiac MRI to check everything was okay.
I wish you a speedy recovery.
It is so unfair that you have had to pay though for treatment that you should have received on the NHS.
Im sorry it took an actual attack for you to get somewhere - I understand how hard it is to diagnose immediately but the more stories I hear the more it does seem diagnosis is hit and miss. That’s not a criticism, more an observation. I could have schlepped through the NHS system but as I have mentioned I score so low on all of the other potential complicators that I’d just have had to wait in line. I’m just relieved that I am able to do what I did as longer term I won’t be an added problem to the NHS - hopefully. This might help save someone else in the system that cannot always cope with healthy presenting people find themselves.
Yes I was ' low' risk too.
There is an issue about unconscious bias in Cardiology and recognising women present their heart conditions in different ways.
The BHF are going to launch a campaign about this issue soon.
I had a really interesting and refreshing conversation with the Head of Cardiology at my local hospital and he acknowledged this unconscious bias and as a team they are trying to find ways to address the issue.
Will you be able to go back to the NHS for your Cardiac Rehab ?
It a really important part of your ongoing recovery.
Hi, yes I’m referred to the Cardiac Rehab dept at my local NHS hospital and intend to fully make use of their help. I’m really interested in any research and want to - once I’m feeling a bit less battered after yesterday- raise awareness in both men and woman who are considered ‘low risk’ not to accept the slow flow - no pun intended- through the NHS system. In my Cardiologist’s words - you have been far too stoical in how you have presented yourself and your symptoms.
Perhaps get in touch with the BHF and join Heart Voices?
bhf.org.uk/how-you-can-help...
With a name like Highbury Hill are you based in North London?
Already emailed them! Thanks for the link..location is my favourite road and where my son and daughter live . So I’m an adopted N5 er! Highbury Barn shops and Upper Street are my one of my favourite places to visit. Thanks for the advice. I’m feeling empowered to ensure fit and low risk patients are given priority as well as those who pose a serious risk due to lifestyle. Conscious bias must be such a difficult choice for clinicians.
Excellent.
I used to live near Highbury Hill great cheese shop!
I live a little further North now and receive my care at the hospital everyone knows in Hampstead . The CCU is on the 10th floor so a good view of Hampstead Heath.
I volunteer for the BHF to raise awareness about MVA and Vasospastic angina.
Good luck !
Done!
The sinus coronary reducer is a small metal hour glass stent that is inserted into the coronary sinus to slow the flow back from the heart
The theory is that by the blood pooling in this way it might reduce angina symptoms.
Rmedscape.com/answers/150215...
ncbi.nlm.nih.gov/pmc/articl...
Here's some information about what the BHF funds
Hi again,
It’s interesting to read the comments about perceived low risk etc, it’s obviously very complex and affects you whether you are a nan or a woman...my partner has told me that I am to stoical in describing my symptoms and in my response to the question “how are you?”...
I was in fact sent for an angiogram early in the diagnosis process (a good gp); result was clear and so was the comment in the cardiologists letter...”pain not cardiac related”! As a result of this letter I was referred to respiratory and treated for asthma for a year (medication going up and up and not a single test performed). It wasn’t until I pushed to be referred to the Royal Brompton that I was told that there were no pain receptors in the lungs and it was unlikely I had asthma (I didn’t).
Diagnosis Cardio Microvascular Dysfunction or MVA. This was proved with the stress MRI I had last year.
I think there is a certain amount of luck in which consultant you see, and you do need to push to get answers...you know your own body better than anyone, people just need to listen to that!
So glad you pushed for the treatment, so easily could have ended differently....all the best with your recovery!
Morning Mint tea,
I actually just re read the thread after your use of “stoical”. As I was on the table on Friday in theatre the consultant came to me and said - “can I ask if you have been stoical in explaining your symptoms?”. I suppose the answer to that is yes. I’ve always arrived smart and smiley at appointments and possibly underplayed how I was feeling. I guess, and I get angry at this, you need to play the system so you are heard.
I’m looking forward to the interaction with the cardio rehab people which I hope happens this week. The tricky one for me has been work. I’ve been able to reduce my hours recently and they have been very supportive. The cardiologist has signed me off for a month which is just so alien to me. I think I have had 4 days sick since 1984. That said it’s a huge relief as I can focus on getting better without the added pressure of spinning lots of plates everyday - metaphorically - I don’t work in a circus!
I’m not rushing into anything but as part of the rehab I want to investigate just where those of us who adopt a healthy lifestyle generally actually fit into conscious bias diagnosis when we present with symptoms.
Love to hear what exercise you are now doing. I exercise as much to keep my mind in check as I do for the vanity of looking ok.
Unfortunately I can’t exercise as it brings on the pain and breathlessness...have now sold my bikes. I’m a self employed plumber, it affects my work badly as well, but keeps a certain level of activity...I have to be very careful with the work I take on and have to pace myself and take regular time off. Trying to think of other ways to earn money!!! I can go for walks when I’m feeling ok, that’s about all I can manage though.
Hi mint tea,
So have you had any actual treatment aside from medication? I’d seriously consider being less stoical and explaining this is affecting your whole life. Easy for me to say I know - but I was far too timid and strong at the same time in pushing for advances in working out my issue. Both my cardiologist and I genuinely believed all the angiogram would do is show that my main artery function was good and this syndrome X or MVA was the issue. I honestly believed until this week this was linked to my age and a drop in hormone levels which can enhance your perception of pain. I’m not technically minded but hormone levels around men and women must impact in similar ways. Absolutely no way did I expect to see what I did. Literally a heart attack waiting to happen. Ironic that I see young people who are so scarily obese around and about and use the phrase ‘a heart attack waiting to happen’ yet there was me just that. Please go back and use some of the experiences on this forum and try to get further help. For one thing the worry about financial issues is really not good. Let us know what you can find out. The system seems to not be there for those of us who help ourselves
I’ve exhausted medication pretty much and am now starting “pain management “, and also trying other things like grounding and reflexology which can help a bit. Milkfairy has given me some good advice and I shall be reading more threads as I get time. Thanks for talking and hope you make a full recovery!
Hi Highbury Hill and MintTea Please
Cardiac Syndrome X is an outdated term and it's use is associated with the belief that MVA is a 'troublesome but harmless' condition. There is growing evidence to say otherwise.
The change in terminology also helps to get way from the idea that only women are affected and it doesn't need treating.
There is also alot of judgement about pain and how women feel pain.
There is very poor provision for anybody living with chronic pain even poorer for heart patients.
There is an acknowledged problem of unconscious bias in Cardiology towards female patients. Women often have their symptoms overlooked and do not always receive the same treatment as men.
ahajournals.org/doi/10.1161...
When a Cardiologist uses the term CSX I have found that they are not up to date nor do they understand non obstructive coronary artery disease.
The European society of Cardiology has redefined angina
Now Chronic Coronary syndromes
escardio.org/Guidelines/Cli...
MVA and vasospastic angina are now included see section 6
Microvascular dysfunction is thought to be the cause of some types of Microvascular angina.
Other causes are vasospasms in the small vessels or coronary arteries. Vasospastic angina.
The BHF updated the information on MVA 2 years ago and Vasospastic angina a few months ago.
My angina is also resistant to treatment despite being on many different medications.
The landscape has changed since my diagnosis 7 years ago. I end up needing to go into hospital about once a year for my angina to be stabilised. My care has improved a great deal.
I have an admission plan, the nurses know me and the on call Cardiologists I ask to speak to my St Thomas's Specialist and my role as an expert patient by experience acknowledged.
Finally there is hope more research is taking place and a new drug trial is on it's way and there is a growing interest and understanding in this area of Cardiology.
See if you can get a referral to cardiologist and ask them if you can be put on Ranolazine which is used to treat the small arteries. I was house bound for nearly 3 months unable to climb my stairs without chest tightness and difficulty in breathing. Finally managed to see senior registrar cardiologist who started me on Ranolazine at 375mg rising to 750mg. Since being on this medication my lady says that she has her man back as I am now able to do light exercise without chest tightness and shortness of breath. I can't have a MRI scan due to having a pacemaker fitted, and according to the article in the bhf magazine it is the only way to see the micro vascular vessels. Hope this helps you.
Hi Papabear752
Yes Ranolazine can be very helpful for some. I am really pleased it has helped you.
It is a bit like marmite though. It either works or causes severe side effects.
It doesn't help those with microvessel spasms causing their MVA which can not be detected by a cardiac MRI.
One thing for sure non obstructive coronary artery disease is a very complex and poorly understood condition.
The wheels have fallen off again. After doing really well since mid May I had an episode which resulted in emergency trip to A&E and a two day stay in hospital where I had various tests carried out with no conclusions as nothing showed up. I am back with having difficulty in walking distance and constant tightness in upper chest. I feel as if I have gone two steps forward and four back. Still being treated for microvascular and as this symptom will not show up on normal tests they are saying that the tightness wasn't caused by my heart. I shall have to await my next cardiologist appointment and pacemaker check up to see what they say.
Microvascular Angina (CSX)
Microvascular angina and exercise 
Microvascular Angina
Microvascular angina 
