Microvascular angina

[winter2019]

I’m new here so looking for advice. Due to the symptoms I have and much research I suspect I have microvascular angina I have had an angiogram etc but nothing showing therefore I remain undiagnosed. My doctor tells me even if I have this there is little that can be done ....any help / ideas please as living with these symptoms is worrying.

[Milkfairy Heart Star]

Hello Winter 2019

Welcome to the forum.

Microvascular angina is a complex and not well understood or recognised condition. It does increase your risks of further heart problems if not treated appropriately.

An standard angiogram will not be able to detect Microvascular angina. Though a team at St Thomas's hospital has just developed a new technique to detect some types of MVA caused by microvascular dysfunction this is when the small blood vessels fail to work properly.

The usual treatment is by medication. However it can be trial and error to find the best treatment for you as an individual.

It is important to be under the care of a Cardiologist.

I suggest you printout the BHF information about MVA and take them to your GP for discussion and ask to be referred to a Cardiologist who has some knowledge or is willing to learn about MVA.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

There are quite a few members of the forum who live with either Microvascular angina or Vasospastic angina .

A few live with both which is unusual and unlucky.

[winter2019 in reply to Milkfairy]

Thanks Milkfairy, appreciated, just not sure if I should just get on with life and just accept and live with my symptoms symptoms as my GP and cardiologist are not proving helpful.

The cardiologist has diagnosed A typical chest pain as I get tight chested with left arm pain when walking especially in cold or walking up hill, all very typical of Angina. As the cardiologist couldn’t find anything he referred me to a respiratory consultant who suggested I could possibly have cardiac syndrome X but the cardiologist says this is not a diagnosis.... (I believe this to be the same as MVD ). All tests proved negative, cardiologist suggests I try diltizan (incorrect spelling) and doesn’t want to see me again. I have slight high bp for which I take a low dose of felodopine with no side effects so not sure if I should change. My GP says there isn’t anything more that can be done and just get on with it so on that note I am currently seeing a Chinese doctor who is treating me with herbs and acupuncture , so far it seems to be helping ! I am interested in ECP but sadly nothing in my area and very expensive . Any suggestions please as this is so frustrating .

Kind regards

[Milkfairy Heart Star in reply to winter2019]

You need to see a different Cardiologist.

I suggest you go back to your GP with printouts from the BHF about Microvascular angina and ask for a second opinion.

CSX is an outdated term.

Microvascular angina is a real heart condition and is not without consequence.

Microvascular dysfunction and Vasospastic angina are listed as possible causes of a heart attack in the 4th universal definition of a myocardial infarction.

See section 7.2

academic.oup.com/eurheartj/...

Here's some other research some of which has been carried out by my specialist and his research fellow who has just gained his PhD for his research into Microvascular

There is alot of research about women and how the term atypical angina does not serve women well.

sciencedaily.com/releases/2...

ahajournals.org/doi/10.1161...

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

heart.bmj.com/content/105/2...

The BHF have just launched a 3 year campaign about the unconscious bias towards women heart patients. They are often misdiagnosed.

There is little good evidence to suggest EECP is effective for all types of Microvascular angina or Vasospastic angina. It is not recommended by NICE for this reason .

It is available at the Bradford Refractory angina service.

[winter2019 in reply to Milkfairy]

Again many thanks for your input and yes I may go back to my GP sadly so far cannot find a cardiologist in my area that recognises MVD ...

[Abergele in reply to winter2019]

I have lived with Mvd and coronary spasm for 11 years now, you need to find the cocktail of drugs that settle you, you will learn what triggers the attack. Sometimes it sneaks up on you, but you need to life your life as normal as possible, good luck. Welcome to the club.

[winter2019 in reply to Abergele]

Hi Abergele thanks for your reply, I have had this for around 6 yrs and slowly getting worse but does not hinder my activities as of yet, my symptoms are always the same, exercise, change of air ...much worse in the winter. So far no medication as non prescribed apart from low dose Felodopine

[winter2019 in reply to Abergele]

Can you tell me how you were diagnosed please as all my tests proved negative !

[38Red in reply to winter2019]

Hi,

I'd had recurrent episodes of atypical chest pains - angina-like but could last for hours. ECGs, bloods etc all normal. Eventually had angiogram which showed very mild narrowing of one coronary artery due to plaque. Normally this wouldn't have yet warranted much intervention, but, luckily for me, they were seeking recruits for a trial of biosoluble stents. As part of a six months follow-up I had another angiogram with the extra tests described by milkfairy below. This showed MVD with endothelial dysfunction.

Conventional tests mainly look for abnormality in the major coronary arteries and tend to miss MVD. MVD is thus underdiagnosed and undereported, underemphasised in medical training and the cycle continues. It's started to gain more traction recently but you might need to do a bit of research to find an appropriate cardiologist. Your GP can refer you out of area but you might need to be quite pushy.

Their are some very supportive Facebook groups - 'Heart Whisperers & Cohorts', and 'Microvascular Angina, Coronary Artery Spasm(Vasospastic) & CMVD Community' for starters

[Milkfairy Heart Star in reply to winter2019]

You need to be persistent.

7 years ago I nearly had a heart attack but a very astute Cardiologist ( he's still my Cardiologist) guessed I might have vasospastic angina and they started an IV infusion of GTN and my pain and spasms stopped.

I then had a very specialised angiogram when acetylcholine was injected into my coronary arteries. Normal blood vessels should dilate. All my blood vessels constricted lots of chest pain, ST elevations and depressions on my ECG , an excited Cardiologist and a dose of morphine the result.

My diagnosis microvascular endothelial dysfunction causing microvascular and vasospastic angina (microvessel and coronary artery spasms)

My perfusion MRI was normal though the adenosine triggered my vasospasms.

All the tests you are offered are designed to detect coronary artery disease so not that useful to diagnose non obstructive coronary artery disease

A perfusion MRI can in some cases detect microvascular dysfunction in some people.

[winter2019 in reply to Milkfairy]

Again thank you ...just returned from A &E after visit for tight chest and left arm pain to no avail ... first A&E visit 😖been given Script for GTN hope it helps. The specialised angiogram you had sounds iffy ...how bad was it !!

Please can I ask once diagnosed how are you treated re medication ?

[Abergele in reply to winter2019]

Do not worry about angiogram, I have had 3. Once in groin 2 in wrist. Seems scary but the Doctors do many each and every day. Take it as an experience of life, good luck, keep positive

[Milkfairy Heart Star in reply to winter2019]

Morning,

First I will say that I am badly affected because I live with vasopasms in my small and large blood vessels in my heart, brain and kidneys. This I expect and hope will not be your destiny. I live with Refractory angina which others on the forum do as well.

The Angiogram was not pleasant however my care has improved. Cardiologists love a result in black and white.

It also helped me to be able to retire early on the grounds of ill health and be awarded a PIP on the higher rate.

I also have a written Admisdion plan to guide the staff how to care for me when I am in hospital. I need to go into hospital from time to time to be treated with IV GTN and morphine.

I live with frequent episodes of angina mostly at night and at rest a classic sign of vasospastic angina.

About 20 % patients get better, most stay the same 20% get worse.

I take 2 types of calcium channel blockers

Clopidogrel to prevent micro clots forming due to the spasms

Statin to reduce inflammation and stabilise even tiny sections of plaque

Nicorandil

Isosorbide mononitrate extended release tablets and patches.

Oxygen at night to help me sleep.

I don't use GTN spray as it just helps briefly then I have worse rebound pain afterwards.

Others find it really helps so I hope it works for you.

I don't sit at home.

I volunteer in various roles advocating for better care for all heart patients.

I exercise and attend Tai Chi and yoga classes. I try and get out in my garden tricky today as it's cold.

It can be possible to find the right combination of medication that works best for you and control your symptoms. It is trial and error.

That's why you need to find a knowledgable and interested Cardiologist.

Prof Colin Berry's CorMicA research showed just that.

mdedge.com/chestphysician/a...

tctmd.com/news/vasospasm-mi...

For some really heavy duty evidence see the European society of Cardiology guidelines into the management of Chronic coronary syndromes.

It lists Microvascular and vasospastic angina in section 6

academic.oup.com/eurheartj/...

Unfortunately very few GPs , A&E staff or Cardiologists or Cardiac nurses have much knowledge about Microvascular or vasospastic angina.

Be prepared to advocate for yourself 😊

[winter2019 in reply to Milkfairy]

Wow . ...you certainly have your cross to bear ...in comparison mine is nothing but all the same I would like @ proper diagnosis . Having read stuff on MVD or the old Cardiac Syndrome X did you know it is more common in women after the menopause and possibly connected to lack of Oestrogen.

I want to thank you all for this chat I am learning more through this site than any doctor !!

[Milkfairy Heart Star in reply to winter2019]

CSX is an outdated term.

It is associated with the belief that CSX is a ' benign nuisance of a condition ' not worthy of treatment.

The connection to a fall in oestrogen is disputed.

HRT can help some women with microvascular dysfunction but not many.

Men also live with Microvascular angina too.

We all have our own particular version of our angina.

There is no one size fits all.

The BHF adopted the term Microvascular angina in 2017 at the request of a patient when they updated the information on the website.

The BHF information about Microvascular and vasospastic angina was produced with input from Prof Colin Berry and an expert patient by experience.