Microvascular Angina

[Jeanieintheblue]

I have 3 stents and they are all working well. I have incredible pain all the time and have been diagnosed with microvascular angina. I'm waiting for an MRI scan on the 18th but in the mean time I'm in agony all the time. I get the chest heaviness - like an elephant sat on my chest all the time and then I get the tightness - like a large elastic band pulling tighter and tighter. Nothing shows up on the ECG'S but then my 2 heart attacks last year did not show up on the ecg's but showed up on the angiograms - I've had 4 angiograms in 12months. I'm on Oxinorm for the pain but it is not a long term solution and it is only masking my pain not helping the cause. Has anyone else had similar problems or any suggestions for a way forward? Thank you

[Milkfairy Heart Star]

Hello Jeanieintheblue

Welcome to the forum.

I live with coronary vasospastic angina, I have vasospasms in my small vessels- microvascular angina and large vessels- coronary artery spasms.

Microvascular angina is often over looked and under diagnosed so it is positive that your MVA has been recognised.

It can take time to find the best combination of medication that will treat your angina best.

MVA can be due to temporary constrictions due to spasms or the inability of the small vessels to dilate in response to exercise etc microvascular dysfunction.

A perfusion MRI can pick up MVA due to microvascular dysfunction but not vasospasms.

I live with a lot of angina pain and have various stratergies to help me cope.

Avoid my stressors, the cold, mental and emotional stress

I practice Tai Chi, yoga, Mindfulness meditation and use CBT.

I attended a Pain management programme so perhaps ask your GP to refer you.

I pace myself.

I use 2 hotwater bottles, a TENS machine and breathing and relaxation techniques.

The BHF has this information about MVA.

Being in pain can be isolating, nobody can see our pain.

There are a few of us about living with either MVA and or vasospastic angina and I expect they will be along to share their experiences with you too.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

[Jeanieintheblue in reply to Milkfairy]

Thank you, that's really helpful.

[Billyjean123 in reply to Milkfairy]

Thanks Milkfairy that’s really interesting about Microvascular dysfunction.

I have had clear angiograms and therefore on the back of this they have diagnosed Microvascular angina as symptoms stop me from exercising much. Going back to see cardiologist later in March and was wondering if it’s worth pursuing a perfusion MRI?

[Milkfairy Heart Star in reply to Billyjean123]

Hi Billyjean123

Here's the very latest article from the research team in Glasgow who with my specialist are about to start a trial into a possible treatment for MVA.

heart.bmj.com/content/106/5...

ncbi.nlm.nih.gov/pmc/articl...

clinicaltrials.gov/ct2/show...

Ask your Cardiologist to get in touch with the researchers for advice.

[Billyjean123 in reply to Milkfairy]

Thanks Milkfairy that’s really helpful. I’m looked after by Kings and it looks like they might already know about it which is great. I am already taking Ranolazine and Isosorbide Mononitrate which unfortunately doesn’t work so really need to find an alternative. Onwards and upwards 😊

[Milkfairy Heart Star in reply to Billyjean123]

Kings as well as St Thomas's are knowledgeable about MVA.

My Cardiologist prof is based there.

Ranolazine is a bit like marmite it works for half of patients does nothing or makes things worse for the other half.

Isosorbide mononitrate tends to be effective for coronary artery vasospasms but less effective for spasms in the microvessels.

There are other options.

We need as patients our own individual treatment plan as we all seem to have our own version of MVA or VSA.

I hope they find the best treatment for you soon.

[Smileyian in reply to Milkfairy]

Milkfairy I wonder if I might disturb you from Singapore. I have read with interest all of your posts sharing your own various cardiac angina varieties with interest. I also researched the Japanese connection to vasospasms and they indeed have much expertise in this field as you alluded in a recent post. I wonder if you or milkfairy or indeed anyone else address a question for me. I am unclear after all the usual tests whether I have CA Spasms or St. Angina. I certainly get pain on exercise above a certain effort incl stairs and hills. I hv joined a fantastic Singapore Heart Foundation program and had minor pain on a rowing machine. However I am extremely surprised that by allowing myself to get emotionally het up, the pain endured is longer and stronger than exercise induced. If I get emotional, angry or anxious, I am subject to my worst angina symptoms. Relieved promptly with GTN . Does this emotion angina resonate with either of you please.

[Milkfairy Heart Star in reply to Smileyian]

Hi Smileyian

Emotional and mental stress are major stressors for me.

The cold the other.

I was retired early from a physically and emotionally demanding profession for this reason.

I can't read sad or upsetting news. Watch a sad film.

I get my pain at rest. However emotional and mental stores will trigger a really bad episode of angina. Most of my hospital admissions are associated with a series of accumulative stressful events.

I manage my stress with Tai Chi, yoga and meditation.

Have I learned to chill completely No! Have learned to respond rather than react No!

It's work in progress😊

[Smileyian in reply to Milkfairy]

Wow that was quick Milkfairy ! I'm thousands of miles away and 7 hours ahead of you. Such is the speed of communicating these days. Tks so much for your comments and advice which are gratefully received. Very interesting re the sad book or film. I am like that when I hear about cruelty or abuse of children or indeed animals. I can actually feel my emotions rising and I think the complex hormones and adrenaline explode through the body and cause chest pain. I also had stressful jobs in education and as a diplomat but at 76 I am well retired and can't blame work. One thing did strike me in that I have a low resting pulse rate of between 44 and 50 and did wonder if the heart muscle was not getting sufficient oxygenated blood due to this. Even with quite strenuous exercise (in heart rehab gym) my HR is only mid 60's. However this may not be relevant but will ask the Snr Cardiologist next month. You seem to be in great demand on this channel - so hope you intend to stay tuned hahaha.

[HectorsDad]

I’m also diagnosed with MVA. GTN helps me when it hits hard, but not much use if I’m trying to do stuff. Ranolazine helps me a lot, and currently trying another drug to see if it helps.

I find breathing techniques help a lot- I learned this when Alexander technique was trendy in the 80s, but there is a book ‘Mindfulness for Health’ (with downloadable tracks) that is good if you are starting from scratch.

Milkfairy is the expert ( thank you milkfairy).

[Milkfairy Heart Star in reply to HectorsDad]

Great suggestion HectorsDad

I found the book and attending a 8 week Breathworks course on living with chronic ill health very helpful

Mark Williams is fantastic too and his meditations are on Spotify

Mindfulness: A Practical Guide to Finding Peace in a Frantic World (Includes Free CD with Guided Meditations) amazon.co.uk/dp/074995308X/...

Mindfulness for Health: A practical guide to relieving pain, reducing stress and restoring wellbeing amazon.co.uk/dp/074995924X/...

Other booksellers available 😁

[Jeanieintheblue in reply to HectorsDad]

Thank you

[Jeanieintheblue in reply to HectorsDad]

Thank you, it sounds like breathing techniques may help, I'll look into finding one that helps me. I also have obstructive sleep apnea and use a CPAP machine each night, as well as being an insulin injecting diabetic, which both put additional pressure on my heart and I do struggle with calming my breathing down at times.

[Sparkeybigshot1]

Ranolazine, Nicorandil and Isosorbide were the cocktail the took the pain away for me.

Hope you feel better soon.

[Jeanieintheblue in reply to Sparkeybigshot1]

I've just started on Oxinorm to help with the pain as the Orimorph was making me too woozy. Hopefully it's just a temporary measure until something more is sorted after my MRI?