Exercise and micro vascular angina - British Heart Fou...

British Heart Foundation

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Exercise and micro vascular angina

gasp1 profile image
14 Replies

After 3 years of test I have been Diagnosed with the above conditions prior to this I was very active sound triathlons marathons etc on a regular basis. I have been told to start to start to exercise again but haven’t been any guidance on what I can or should do I am petrified of going out jogging in fear that I will collapse can anyone please recommend and guidance or exercise programme that they have used as I really want to get back doing thing I know I won’t get back to what I was doing before but something has to me better than nothing just don’t know what it how much todo and

Anxiety is stopping me 😬 many thanks in advance

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gasp1
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14 Replies
Jo31uk profile image
Jo31uk

Hi, I am still under investigation but sounds similar. Used to run marathons and then started to feel out of breath with awful chest pains. Was almost fobbed off that if I used to be able to exercise then there was nothing wrong with me. Had CT which showed I had a squashed right artery. How did you get your final diagnosis as I'm waiting for stress test but covid is slowing things down. GTN spray helps relieve my symptoms on exercise but no actual diagnosis. Sorry can't help with exercise! I miss it so much.

gasp1 profile image
gasp1 in reply toJo31uk

Hi Jo, I mine started following Ironman race abroad where swim which normally took me around 1:10 mins turned into 1:50 and could not get my breath I went from having asthma to copd and after varies test with all my stats being normal got diagnosed with micr angina.I still struggle with running and can not get passed 500 meters without having to walk wh in is why I nee the advice. I think my diagnosis came as a result of negating everything else which from what I understand is main way that this is diagnosed as there is not it known about it.

Had my first bike ride the other day for a while had to use my mountain bike rather than road bike as seating position made it a bit easier in getting Breath but still a struggle .

Good luck on your journey 😁

Jo31uk profile image
Jo31uk in reply togasp1

Good luck with the exercise. Take it easy!

Milkfairy profile image
MilkfairyHeart Star

Hello gasp1

Did you have any formal testing such as an angiogram with adenosine and guide wire followed by acetylcholine to assess the function of your coronary blood vessels?

Microvascular dysfunction is the most common type of Microvascular angina and is thought to be due to the very small blood in the heart being unable to dilate or stay dilated in response to extra demands like exercise or stress. This is more common in women.

The other less common type of Microvascular angina is caused by the small vessels going into spasm.

This can also occur in the large coronary arteries this is known as vasospastic angina ( Coronary artery spasm / Prinzmetal angina. )

It is important to know the underlying cause of your non obstructive coronary artery disease NOCAD, the treatment options are different.

Exercise improves the function of the inner lining of your blood vessels.

I have lived with coronary vasospastic angina so vasospasms in my small and large blood vessels for nearly 9 years.

My advice is to start very slowly, don't push through your chest pain.

Use your GTN before you exercise.

Take a very long time to warm up, don't let your heart rate go up too high.

Then cool down slowly don't just stop it start anything.

One weird thing for me is that I will experience most chest pain later at rest in the night if I do too much.

Anticipate 2 steps forward one step back. My exercise capacity changes depending on what time of day it is.

Be proactive and ask your Cardiologist to review your medication frequently if necessary it takes time and patience to find the best combination of medication that will work best for you.

If necessary ask to be referred to a specialist for proper and accurate testing to determine the best treatment options for you.

gasp1 profile image
gasp1 in reply toMilkfairy

Hi, I have had all of that and they said it was narrowing of the small arteries they have given me medication to try and widen them it did work for a whilst but has now seemed to be an issue again. Also got gt spray etc

Need to have a bit more confidence in myself just worried about keeling over when I go out.

I am due back at hospital soon I will review this with doctor everything was a bit rushed when I went last time think they were trying to get rid of the covid back log 😂

Milkfairy profile image
MilkfairyHeart Star in reply togasp1

Microvascular angina is very complex. I suggest you ask the Cardiologist to explain your angiogram results to you in detail. If you were given adenosine they will be able to tell what your coronary flow reserve and index of Microvascular resistance are.

This should be written on your angiogram report.

Ask the Cardiologist give you a copy of your angiogram and to explain this all to you.

I carry my angiogram with acetylcholine results with me all the time. It helps the staff understand my vasospastic angina, I also have an admission protocol to guide the staff too.

So little is known about the conditions that the staff don't always understand how to treat us.

It does take time to trust your body again. Because of the cold which is one of my triggers I always walk my dog with either my son or husband.

I am hoping to start swimming again in April. I used to be able to swim for an hour

No chance now. I'll start with 10 lengths and slowly build up my stamina again.

I also find yoga helps me.

This is the latest information about Ischaemia non obstructive coronary arteries INOCA another term used.

academic.oup.com/eurheartj/...

gasp1 profile image
gasp1 in reply toMilkfairy

I use to open water swim 3 times a week and love it 🤪The angiogram was all clear on main arteries they said they could not check others due to them being micro which is how thay came across diagnosis.

As they say onwards and upwards I have just got my running pants out which for me is a start 🤪

Milkfairy profile image
MilkfairyHeart Star in reply togasp1

Good luck

Take it slowly 😊

I have been suffering from severe chest pain for a couple of months since my ablation. My EP has said there is no reason l should be having these pains but suggested it could be micro vascular angina.My GTN spray never helped so I have been prescribed lsosorbide Mononitrate (20mg) to take but they give me excruciating headaches and don't help with the pain in my chest. Has anyone else have experience of this drug.

Milkfairy profile image
MilkfairyHeart Star in reply to

Hello Cowie

Have you been referred to a Cardiologist who has some expertise in caring for patients with Microvascular and vasospastic angina?

They are complex conditions with different treatments. It's really important get the correct diagnosis as the medication treatment is different for Microvascular dysfunction and vasospastic angina.

Eg beta blockers help Microvascular angina but make vasospasms worse.

There is some evidence to suggest that isosorbide mononitrate is not effective for some people living with Microvascular angina.

Perhaps ask your GP to refer you to the correct specialist.

There is a new patient group formed which you might find helpful

internationalheartspasmsall...

The BHF has some information about Microvascular and vasospastic angina on their website too.

I have taken isosorbide mononitrate extended release tablet for many years. It helps me as I live with coronary vasospasms.

in reply toMilkfairy

Hello Milk Fairy,I have not seen anyone regarding this and have not been diagnosed as having angina. My only contact was via a phone call from my EP's secretary who told me what he had said and his recommendation to take Isosorbide Mononitrate to see if it would help. I was taking sotrolol to treat Afib prior to having a cryoablation and am still taking them as l am still experiencing some Afib symptoms.

Milkfairy profile image
MilkfairyHeart Star in reply to

That is disappointing to hear.It perhaps reflects the EP's lack of knowledge about Microvascular angina.

I suggest you ask your GP to refer you to the Rapid chest pain clinic.

You are experiencing severe chest pain and the cause needs to be properly investigated.

in reply toMilkfairy

Thanks for your advice. I will try and speak to my GP again, although to be honest he is at a loss to the cause of my problem and also prescribed me with some additional pain killers.

Milkfairy profile image
MilkfairyHeart Star in reply to

Could you send the BHF information on the website about Microvascular and vasospastic angina to your GP?

Sometimes it is just lack of knowledge and you need sometimes to help your GP to gain the knowledge!

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