Angina pain despite clear coronaries? - British Heart Fou...

British Heart Foundation
19,601 members13,362 posts

Angina pain despite clear coronaries?


Well my angiogram done yesterday, and not as easy as I was led to believe, apparently my radial artery is tiny, hence a lot of pain initially. However I think I slept through the rest!!

Now I am confused, cardiologist who was not the most approachable of men, said arteries where clear but my coronary artery was 'spiralling/ due to very high blood pressure!! It did look a funny twisty shape when i looked on monitor.

I Really do not understand what he meant. He came round later and spoke incredibly quickly about changes to meds, and said I should not keep turning up at A&E just because my BP was high! I hadn't, only once when my GP had sent me. Thanks to sedation I was not up to arguing with him .

But my question is is it possibly to get angina without blocked coronaries? Can it be due to hypertension? Because I certainly get pain and discomfort on exercise which is relieved by GTN.


17 Replies
MilkfairyHeart Star

Hi Cyclemania

It is most certainly possible to have angina due to temporary constrictions vasospasms of your coronary arteries.

Vasospastic angina aka Coronary artery spasms.

The BHF have this information about Vasospastic angina

Another type of Ischaemia and no obstructed coronary arteries ( INOCA) is Microvascular angina which is when the small blood vessels are affected.

The majority of people with non obstructive coronary artery disease ( NOCAD) have Microvascular angina, then about 15 % just vasospastic angina and 20% both MVA and vasospastic angina.

The advice you were given by the Cardiologist reflects his lack of knowledge and understanding of the condition and I would ask to see a different Cardiologist.

Vasospastic and microvascular angina are not harmless conditions and need treating appropriately.

There are quite a few of us on the forum living with INOCA/ NOCAD

Some with Microvascular angina others with vasospastic angina or a few like me with both.

Cyclemania in reply to Milkfairy

thank you I will look at those, i think my GP is more approachable and i will start with him and get re referred if needs be

Hidden in reply to Cyclemania

Which hospital is this? They /cardiac deps must be under major strains in all areas.

Was this an "emergency" angio, given the HA symptoms?

What they are saying is, "now we spent x amount of emergency fund/cash on you, who simply had hypertension".

One would assume that they expected some blocked arteries. I bet they were deflated by the outcomes. It shouldn't be that way, but Cardiologists can be blunt when they got too much to cope with.

I feel, however that your GP is very neglectful if you had long-term hypertension and this is left for so long. Are you on any medication?

Cyclemania in reply to Hidden

This is Lister in Stevenage.

No it was a planned one having been seen previously at urgent chest pain clinic. Yes they did expect to see some blocked arteries as my brother ( much younger had 4 blocked) only last year with minimal symptoms.

I must defend my GP though, I had no idea i had hypertension until one day last September when I felt very unwell and for some reason decided to take my own BP 220/135. It was my GP that sent me to a&e as I had been weight lifting that morning and he was concerned I may have used myself some harm , I did have a stinking headache.

This time last year at my annual check I had been deemed at low, less than 10% risk of CHD!!

Yes I am on medication, i was street on Amlodipine initially, then bisoprolol and ramipril have been added, and i feel far worse on this concoction!

MichaelJHHeart Star in reply to Cyclemania

One of my best friends' wife has has excellent treatment by Lister cardiology soike everywhere there are good and bad experiences.

How much are you lifting compared to your bodyweight? Lifting really heavy weights really spikes BP. I think as one ages weights are for toning, strength and endurance but not pushing limits!

Cyclemania in reply to MichaelJH

I can dead lift my body weight easily, but just lately we have altered the programs to more reps, but less weights.

The cardiologist said nothing like that that now if it makes me hold my breathe as it will as you say spike my BP and cause a stroke. He didn't mince his words. Shame as i've come to weight lifting late in life and love it

MilkfairyHeart Star in reply to Cyclemania

Hi Cyclemania

Beta blockers are contraindicated in people with Vasospastic angina they can make coronary vasospasms worse.

I spent 5 days in CCU with unstable angina because my well meaning Cardiologist prescribed beta blockers for me before my diagnosis was confirmed.

I suggest you printout the BHF information about MVA and Vasospastic angina and go back to your GP and ask to be referred to a Cardiologist who understands about this type of angina or is willing to learn.

It is trial and error trying to find the best medication that will work best for you.

My Prof is at St Thomas's and my local Cardiologist of 7 years is based in north London.

Cyclemania in reply to Milkfairy

thats interesting as my 'angina' was signifiv=cantly worse when I started them, and after w week my pulse went far too low, i felt awful and my GP decreased them by 50%. I have stopped them myself now completely and had no angina type pain in the past 24 hours. I will print that of and have a read myself and go armed with info. I am not seeing hime though for 3 months!!

MilkfairyHeart Star in reply to Cyclemania

The classic symptom of vasospastic angina is chest pain at rest which wakes you at night.

I suggest you keep a diary of your symptoms and activities

Weather the cold triggers angina

Stress another.

Caffeine can be a trigger....oh and sorry no more cocaine I am afraid 😉

Take this with you to your Cardiology appointment .

If you need any more research articles or information give me a shout everyone knows I am a bit of a research geek.

Hidden in reply to Cyclemania

No, of course, not. GP's doing all they can to help us all. :)

I'm not medically trained, so stress this is only my opinion. Narrow arteries are just as risky because excess insulin-like growth factor (IGF-1) causes abnormal growth of the endothelial linings.

Don't follow the advice to cut fat from meat nor have reduced-fat dairy (surplus lean protein), nor exceed 130g of carbohydrate per day as they all exacerbate this by over-stimulating insulin (and consequently IGF-1) production.

Get most energy from natural fats (as our digestive system is designed for) such as olives, eggs, avocado and nuts.

as a regular weight lifter, I am well aware of the need for 'good fats' and always include these in my diet, couldn't imagine life with out!

Along with low-glycaemic veggies of course :-) .

God bless you!

yes I am just getting into them, as also now pre diabetic! I am falling apart slowly ....

I'm sorry; you're just confirming what I keep telling people, that many of these conditions are inter-related.

Hopefully the changes will at least slow the decline. The ICS-NHS Diabetes Prevention Programme has a very low-carb approach of up to 50g carbohydrates per day, at least until blood glucose/insulin levels have normalised.

Merry Christmas.

i am signed up for that programme


You may also like...