Having had a recent A+E admission and an emergency angiogram which showed clear arteries the doc who did the angiogram reported it was prob spasm or microvessel angina and further invasive tests may be required to establish which. I have just this minute come out of a follow up cardiology apt having been told by a registrar that these conditions are now considered as one, both have the same treatment plan and neither cause any problems so I have no need to worry about any heart attack risk. I am on diltiazam and he wants to put me on nitrate too and back on aspirin which I was taken off when discharged following my clear angiogram. This totally contradicts everything I have read about these conditions not being benign and diagnosing which one is important because treatments are different- e.g aspirin can exacerbate spasm angina. Interestingly my symptoms got way worse when aspirin was started and got gradually better when it was stopped! I politely contradicted him and asked why then had the doc who did the angiogram recommended diagnostic tests to establish which it was - he said 'unfortunately he is from the Philippines we never offer these tests in the UK because it makes no difference to the treatment and there's no real risk to health'. He was very dismissive about anything I have read and after going round in circles said he would request an appointment with his consultant but he was very sure they would give the same opinion. Be good to hear whether others think I should just accept this? And do I just take the aspirins and nitrates as well as the diltiazam and hope it gets better not worse?
Microvessal or spasm angina - does Di... - British Heart Fou...
Microvessal or spasm angina - does Diagnosis matter?
Hello,
The Registrar whom you spoke to is very much out of date with his advice.
Microvascular dysfunction and vasospastic angina are types of non obstructive coronary artery disease, NOCAD.
They are not the same and yes there is testing available in the UK to diagnose microvascular dysfunction and vasospastic angina.
The treatment is different too.
I was prescribed beta blockers many years ago when it was assumed I had microvascular dysfunction. I ended up in hospital with unstable angina. Beta blockers can make coronary vasospasms worse.
I had an angiogram with acetylcholine in 2014 which shows all my coronary blood vessels large and small go into transient constrictions.
My diagnosis Coronary vasospastic angina.
I do not have microvascular dysfunction as my coronary flow reserve is above 2.5.
It is now possible to assess the function of the microvessels during an angiogram with adenosine and guide wire to assess the coronary flow reserve, CFR and Index of microvascular resistance.
It is possible to test for microvascular dysfunction during a perfusion MRI.
I suggest you make contact with the Consultant Cardiologist whom the Registrar you saw works for and ask for the registrar to update their knowledge about non obstructive coronary artery disease NOCAD.
There are 2 studies taking place into microvascular angina.
The PRIZE trial and another at St Thomas's Hospital London.
I suggest you ask the Consultant Cardiologist to refer you to one of the centres carrying out the research for further advice if necessary.
For details see this website which lists the latest research and gives lots of information about NOCAD.
internationalheartspasmsall...
Hello - thank you so much for your reply - once again you have reassured me that what I expect in the way of diagnosis and treatment is reasonable. I thought I had gone to my appointment armed and confident with my knowledge and able to challenge if I needed to- however I now wish I had gone in even more prepared with actual research references as he was so dismissive of me. To be honest though I suspect he would have been that dismissive no matter how I challenged him - I really feel he did not like me questioning his authority! I will now email his consultant as you suggest and it will be easier for me in an email to make a clear case for the need for better diagnosis and copy and paste or include any links to the research and evidence you have pointed me towards to back up my request for further diagnostic testing. I have already decided that if I don’t get anywhere with his consultant I will find a private consultant for an initial consultation to discuss his further with a doctor who has more specialist knowledge of these conditions.
Can I ask - is your role with the BHF simply as a patient/service user? It’s just you seem so knowledgable and very responsive to a range of posts! Does this patient forum provide a way to contact each other individually if I had any further concerns or questions or is it only an option to post to the group? Thank you so much
I am a patient who has lived with vasospastic angina for 9 years. I have like many living with microvascular or vasospastic angina, been dismissed and even been told my symptoms were in my head!
It took me a while to have my diagnosis confirmed and find a Cardiologist to help support me.
I have sent you a personal message.
I would not be surprised if there is a reluctance to do extensive diagnostic procedures mainly because of cost. I suspect that there are many more people who have these sorts of conditions than NICE would be happy to fund. There is also the case of lack of knowledge and available resources (mainly cardiologists).What that may boil down to is an individual patient's ability and willingness to pursue a diagnosis and the appropriate treatment.
Your comment suggests that patients living with microvascular dysfunction and vasospastic angina are not worthy of appropriate investigations and treatment?
National Institute of Clinical Excellence NICE doesn't fund treatment, it provides guidelines of treatment.
Women are more likely to be effected by Ischaemia non obstructive coronary artery disease INOCA. Microvascular and vasospastic angina are types of INOCA.
The lack of appropriate timely diagnosis of INOCA is thought to be contributing to the rise in deaths from heart disease in younger women.
Also the development of heart failure, strokes and other major adverse cardiac events is increased in this group of patients.
The cost of not diagnosing and treating INOCA is much greater than the test required.
Lack of knowledge and willingness of Cardiologists to learn the appropriate skills is a barrier. Though there is a growing interest by Interventional Cardiologists in this area of Cardiology.
For more evidence see The Lancet Women and Cardiovascular Disease Commission report published in May 2021.
thelancet.com/commissions/w...
Prof Angela Maas' book A Woman's Heart explains the difference between men and women's heart disease. Prof Maas highlights INOCA as a major problem.
The tests required to assess the function of the microvascular vessels is easily incorporated into a standard angiogram.
I'm sure you are correct. I am living with one of these conditions, and the cardiologists "think" it might be microvascular angina but show no interest in a proper diagnosis. I know that I should pursue the matter, but it's hard enough to even get a phone call with my assigned cardiologist, let alone a proper diagnosis. I had an angiogram in June, (I had to push for it). They told me that it would not change my treatment, so they probably suspected that the coronary arteries were clear, which they were. The guy said after the angiogram that I probably had MV angina, and should take Ranolazine.
I am sorry you are facing inappropriate indifference.
In my experience it takes an engaged, astute and patient Cardiologist to care for patients with microvascular and / or vasospastic angina.
All with a bucket full of compassion.
I am not sure many Cardiologists understand how living with chronic angina pain and the uncertainty of a diagnosis has a profound negative impact on person's quality of life.
Attitudes and knowledge are improving.
There is a trial taking place into a possible treatment for Microvascular angina. There are several trial centres and it might be worth contacting the centre nearest you to find a Cardiologist to help.
clinicaltrials.gov/ct2/show...
Hi Milkfairy, I think part of the problem is covid. Cardiologists are still pretty busy either still treating seriously ill patients, or dealing with the backlog. Also, they are not all created equal. My assigned cardiologist has 18 months experience . He's a nice guy, but pretty much a hands on techie. I know what I need to do, it's summoning up the will to do it. After a year of what seems like fighting the system, I need to gird my loins for another go.
Does not do my mental state or that of my wife any good at all.
Inwardly screaming with you!
Where in the UK are you based?
I'm in Surrey, weybridge
This is some newly published research that suggests that microvascular angina is certainly not a benign condition.
Hi Natwoo,
I have microvascular dysfunction (no vasospasms, thankfully) diagnosed during my angiogram when the cardiologist measured the flow and pressure in my heart. My angina only comes on when I exercise and I manage it with GTN spray. I take felopdipine and rosuvastatin.
As soon as the cardiologist diagnosed this, he stopped the aspirin immediately and told me not to take any anti-inflammatory. No aspirin, no ibuprofen, so I'm surprised you've been put back on aspirin. Even my GP stressed that I must not use anti-inflammatories when I recently had sciatica.
Definitely reach out to Milkfairy. She is fab at providing information on this seemingly misunderstood issue.
Thank you - yes whether to re start the aspirin is a dilemma for me right now - I’ve certainly lost faith in the registrar completely after yesterday’s appointment. I will be writing to his consultant.
If you can exercise to a high heart rate without problems does this exclude the diagnosis or is this an intermittent problem?
Hi no I can’t exercise to a high level at all - I have been getting breathlessness and chest tightness - albeit not severe pain - easily triggered by things running up and down stairs at home, walking football in our very small garden with my 7 year old, rushing around from A to B as opposed to walking more slowly etc. So not much exercise at all for a relatively fit non smoking normal weight healthy 49 year old!
It depends whether your microvascular angina is caused by an inability of your small blood vessels to dilate in response to exercise ( microvascular dysfunction). Or due to temporary transient constrictions of the small blood vessels ( microvascular vasospasms), coronary arteries (vasospastic angina).
Patients living with coronary vasospasms tend to experience their angina at rest later in response to exercise.
Patients living with microvascular dysfunction causing microvascular angina, tend to experience angina when they exercise.
The symptoms tend to be consistent, however everyone is different.
The time of day, temperature and other factions can effect the way the blood vessels function and a person's ability to exercise.
Hi Natwoo! I'm just chiming in to support what others are saying here. I'm so sorry you had a rough time with the doctor. Feeling dismissed or unheard is such a demoralizing thing. I'm glad to hear you're not just accepting what that doctor said.
I'm in the U.S. so my experience is likely different, but my path to diagnosis with microvascular disease was pretty straightforward. I was already seeing a cardiologist because I have high cholesterol and a family history of early onset heart disease. I started having some left-sided chest pain/tightness radiating to my jaw, arm and upper back while I was jogging. I didn't think much of it because I was 39 at the time and have back issues -- I thought it was probably something muscular or spine related. I mentioned the discomfort in an offhanded way to my cardiologist and he immediately sent me for a stress test and echo.
My stress test was abnormal so my cardiologist suspected microvascular disease and sent me for a cardiac MRI stress test. That was also abnormal in a pattern typical for microvascular disease. Just to be safe, my doctor then sent me for a CT angiogram to make sure I didn't have any large artery blockages. That was all clear and at that point, he made the microvascular disease diagnosis.
None of these test were invasive at all! The only negative was the dose of radiation from the CT angiogram. I live in a big city and am fortunate to have access to a large university hospital system. I think like others have suggested, getting to a place where research is being conducted is hugely beneficial. There's so much new research on microvascular angina and the old "it's harmless" stance just isn't true. My cardiologist has been so helpful in working with me on treatment and also helping me learn how to exercise while managing the pain.
Hang in there and keep pushing for a diagnosis and proper treatment. I'm really fortunate in that my doctor listened to me, took my chest tightness seriously and knew about microvascular angina and current research. But I have felt dismissed by another doctor for a separate issue and I know how damaging and frustrating that feels. Good luck!
It's such a nightmare when they don't all sing from the same hymn sheet. I think I've been lucky with the treatment I've had since 2007. PFO closure after a mini stroke, followed by a diagnosis of Microvascular angina the same year, and then another angiogram a few years ago which yet again was ok. The pains were getting worse and worse in between appointments, then last October I was referred for another dobutamine stress test which was abnormal. Within a week I had a letter saying I needed another angiogram with a view to checking for a blockage and treating during it. I had it last Wednesday, after being asked on Tuesday to go in the next day. Luckily it wasn't a blockage, but I was diagnosed with Vasospastic angina, too. The hospital have been amazing, and so kind. I can't believe how quickly it all happened! I also take aspirin (which I have to do since the implant was put in to close the hole).
Anyway (after my rambling)...Don't give up, and keep pushing them. You might just find that one doctor who wants the best for you, and who takes you seriously (because some do brush it off, or treat it like it's nothing).
Take care
Hello,
Welcome to the forum.
Sorry to hear you have joined our non obstructive coronary artery disease club.
There are a few of us on the forum living with microvascular dysfunction or vasospastic angina.
I was first diagnosed incorrectly 9 years ago with microvascular dysfunction then vasospastic angina after an angiogram with acetylcholine in 2014.
There are a couple of other support groups which you may find helpful.
internationalheartspasmsall...
As well as the Vasospastic angina information on the BHF website.
Thanks for your reply. It helps to know I'm not on my own! Thanks for the info, too 😀
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