I wondered if anyone has any similar experiences that could help advise me. Following what seems to be angina symptoms developing over the last year and escalating rapidly over the last week resulting in an A+E admission on Wednesday with chest pain on rest I was admitted to cardiology. I had an angiogram yesterday afternoon which showed clear arteries and it has been suggested I have micro vessel angina. However there doesn’t seem to be any real intent to do further tests to diagnose this more conclusively or to rule out other forms of angina that don’t result from blocked arteries such as the spasm type etc. I am quite certain the pain is cardiac and the angiogram confirmed this for me because when they inserted the die I had a higher than moderate chest pain as it went in which was exactly the same pain I have been getting - albeit a stronger version. I really want to be taken seriously and have the right diagnosis and treatment but feel like I am being expected to skip home happily knowing my arteries are clear. (I am of course happy about this but it doesn’t change the fact that I have felt quite unwell of late and the symptoms got so bad I could hardly do anything pre admission). I am also concerned that as I am being sent home on only the same meds I came in on but a slightly higher dose will my symptoms be controlled? I don’t want to be going through a lengthy process taking years of appointments and lack of symptom control as I need to get back my fitness levels to look after my children!
Any advice would be appreciated thanks x
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Natwoo
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There are quite a few members of the forum who live with microvascular dysfunction or Vasospastic angina. I am sure they will be along to share their experiences with you too.
Microvascular and Vasospastic angina are often overlooked and under recognised as causes of angina.
Non obstructive coronary artery disease is just as serious a heart condition as obstructive coronary artery disease.
It is good to see your microvascular angina has been recognised and is being treated.
Unfortunately few Cardiologists have much expertise in caring for patients like us.
My coronary vasospastic angina was diagnosed during an angiogram using acetylcholine which induced the vasospasms in my coronary arteries and small vessels in 2014. I had 2 years previously been admitted to hospital with a suspected heart attack.
This type of testing is only available in a few centres in the UK.
Microvascular dysfunction a cause of Microvascular angina can be diagnosed during a routine angiogram using adenosine and a guide wire.
If your Coronary Flow Reserve is less than 2.5 that usually suggests the problem is microvascular dysfunction.
There is a research study taking place into a possible new drug treatment for MVA and I suggest you ask your Cardiologist or GP to refer you to one of the centres listed as taking part in the study in the link below.
Thank you -although I’m not sure I feel that micro vascular angina has been formally recognised really - it was more a casual inference from the doc who did the angiogram but it’s not mentioned anywhere in my discharge summary. I asked to speak to a doc before discharge today and posed my concerns and questions about other possible conditions causing angina that aren’t caused by blocked coronary arteries such as micro vascular angina or artery spasm angina and he suggested my pain is not cardiac - as did a nurse this morning. I asked whether there is any intention to do tests to confirm micro vascular angina and he told me there are no tests to diagnose this - which contradicts your knowledge and personal experience! I have been advised to carry on with the diltiazam ( I felt like saying why if you’re suggesting it’s not cardiac as I have perfect blood pressure so it can’t be for that!) and see the consultant as an out patient in a couple of months. The only other test that I am on the waiting list for is an echocardiogram which was agreed a few weeks ago. I honestly can’t see how it’s not cardiac if invading my heart in the angiogram triggered the exact same pain and if gran spray alleviates the symptoms. I really don’t want to be going through a long drawn out process for years of it not being taking seriously!
Ask to speak to the nurse in charge and Consultant. Raise your concerns about the lack of knowledge about microvascular angina and vasospastic angina amongst the staff.
Refer them to the BHF information on the BHF website about MVA and vasospastic angina.
Thank you - I am now in the discharge lounge waiting to be collected to go home. I guess I will just have to wait for my out patient appointment to discuss next steps. In the meantime I am not sure what I can or can’t do - do I push through chest pain as there’s no blocked arteries or is it just as serious? Am I at just as much risk as with blocked arteries for having a hear attack? The pain is there at a very mild level most of the time even at rest - is this ok to just live with? I did Ask to speak to the cardia rehab nurse to go through how to manage this etc but was told she only sees patients whose angiograms show blocked arteries!
Thanks so much for your advice - much more than I got from the hospital! Sorry to ask more questions - but a couple of things thing I don’t quite understand is 1 - whether I am at risk of an acute coronary event such as heart attack given that my arteries aren’t blocked and if so how do I identify the risk and need to go to a+ e given that there is a low level chest pain around most of the time? 2) they advised me the gtn spray is only symptom control so only needs to be taken as a symptom relief if the pain is such that it’s not tolerable and that it doesn’t actually prevent an acute heart incidence such as Heart attack - is this right and should I therefore consider my pain as a symptom to be either lived with or dealt with via gtn just as you would a headache which I often ignore and push through or take paracetamol. As opposed to thinking my chest pain is getting worse I had better get to A+ e in case I’m having a heart attack! They did tell me I could go back to a+ e if I was concerned but that they wouldn’t do an angiogram next time cos now they know my arteries are fine?
If you live with Microvascular dysfunction or vasospastic angina you are more likely to experience a Major Adverse Cardiac Event, MACE than someone with unobstructed coronary arteries and no symptoms of angina.
In the past and it is still a belief amongst some Cardiologists that Microvascular dysfunction and vasospastic angina are harmless conditions.
The evidence and research says otherwise.
A risk is not your destiny.
These conditions can be managed and you risks reduced.
Through a heart healthy diet, exercise, weight control, good management of diabetes and blood pressure.
Seeking out a Cardiologist to work with you to prescribe the correct medications is important too.
It's important to know your new normal.
If in doubt ring 111 or 999 and go to A&E.
Take the BHF information with you and a link to the website above.
Then read everything, understand your condition. If you are on Twitter there's loads of information too.
Hello Natwoo, same diagnosis about 4 weeks ago following an angiogram, having done some research little is known about this condition and few tests exist to fully diagnose but apart from the jubilation from medics that my coronary arteries where clear it was bye bye! and keep using my gtn spray for syptom relief not much else to be done. Life style changes for me weight and high blood pressure reduction but I fear there is little else that can be done, it isn't curable which is why sometimes it is referred to as disease x I have since learned not to over exert my heart when walking ie walk more slowly, good luck
Thank you, this is becoming full time job with all the other health conditions I have chasing, querying but never rude, I can't get to see my own cardiologist who has been looking after me for years, Covid has blown apart continuity
A clot in a small vein is still a blockage. Probably reason why they say no tests can be done, is the time it takes to do pressure tests on arteries . Meds are used to keep blockages free, plus diet and exercise. Listen to your body, you need to be aware of your angina, I find if I start rating the pain, then it's time to seek help. But this is just my thoughts, my coping strategy. Take care.
A blood clot is not a permanent blockage like plaque build up, the usual cause of obstructive coronary artery disease.
Blood clots overtime are reabsorbed by the body.
There also medications that can be given to speed this natural process up.
Myocardial infarction non obstructive coronary arteries MINOCA can be caused by Microvascular dysfunction, vasospastic angina, Spontaneous Coronary Artery Dissection and blood clots.
Prof John Beltrame an Australian Cardiologist and his team have researched this type of heart attack.
It's true, I shouldn't have used the word clot. I was just trying to say, in non technical terms that it doesn't matter where a blockage is, it's still something to get help for.
Thanks for all your really useful info. Surprisingly the Cardiac rehab nurse did call me yesterday and was helpful - although she too posed the question maybe it's not Cardiac and could it be psychological? It's all a bit crazy making! I'm starting to wonder myself if its all in my head! I'm taking pain killers cos my arm is soooo sore from the angiogram when I move it in certain positions and I'm nit feeling any chest pain whilst resting and on pain killers. I guess I'll have to see what happens when I get more active. And then I won't be happy if I get pain - and if j don't I won't know if the increase in meds dose is working or if I'm just going mad and it's all been in my head! This is do head scrambling- and I'm usually very level headed and I'm trained counsellor!
I felt I was going mad too until I read in black and white my angiogram with acetylcholine results. I felt gas lighted by Healthcare professionals who treated their assumptions and lack of knowledge about vasospastic angina.
My results read ' Spontaneous and acetylcholine induced coronary vasospasms, ST elevations and depressions with chest pain occurred.'
I carry my test results along with my admission plan with me everywhere.
Thank you - I have done a little bit more in the last hour - only going up and down stairs a few times at more than a gentle speed and felt short of breath and quickened heart beat with very mild chest tightness - so I’m thinking ‘here we go again’. Does spasm angina get triggered by exertion though - or maybe it’s more likely microvessel angina? It’s good to know others feel like they’re going mad when there is actually something wrong with them!
Hi - I am sorry to bother you as I notice that your post was a couple of years ago. Hopefully you are much better now. I just wondered how things progressed for you as I am in the same position now as you were then: I have been discharged from my angiogram with lots of congratulations on my beautifully clear arteries, but am still getting the same chest pains.
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Angina in small arteries
Coronary artery spasms/Prinzmetal's angina 
Any others with microvascular angina?
Coronary artery spasm, did it cause me to have heart attacks?
