Microvascular Angina

[GreyDoor1]

Can I ask all of you lovely women suffering from this or maybe suffering from this if any of you suffered extreme hot flushes & insomnia before taking your first event? Also where any of you prescribed Clonidine for hot flushes and Zopliclone for insomnia? I feel for me Menopause maybe the Culprit! Also the drugs given. I question Clonidine and Zopliclone??

[Hidden]

Hello I can’t help with your query but I’m very interested of the interaction of menopause and heart issues. I’m 51 and it didnt’t occur to me Till yesterday whether some of what I feel is menopause or heart meds related - forgetting simple words, forgetting mid sentence, brain fog (can’t remember much of what I did days earlier). Don’t mean to hijack, but Very interested to see what others respond to your post. But no hot flushes. But bad sleep definitely. And I am still processing what is actually up with me although someone on here said to consider with cardiologist micro vascular angina. Feels like a double whammy heart disease and menopause. So complex so confusing. Take care

[Tannigirl in reply to Hidden]

Hello fishface101, I’m still waiting for a diagnosis of microvascular/vasospastic angina but I restarted HRT a month ago. I’m 68 years old and the symptoms you have I had! I’m now sleeping better and the brain fog is so much better too! Also my angina episodes seem to be shorter and I have more ‘good’ days now. I know HRT doesn’t help everyone with heart problems but I’m convinced it’s helping me. I’m hoping to continue with HRT after the 3 months trial. Take care

[Hidden in reply to Tannigirl]

That’s good to know that there may be something to help. And thanks for the sanity check that they are real symptoms. Hope all goes well with diagnosis and continues to go well with HRT. This can all be very isolating as we process and work through things whether it be heart issues or menopause. ☺️

[Milkfairy Heart Star in reply to Tannigirl]

Have you seen a Menopause specialist who understands heart disease?

I have a confirmed diagnosis of vasospastic angina and have been told very clearly that HRT is not recommended for any woman over 60 years of age with heart disease.

[Tannigirl in reply to Milkfairy]

Hello Milkfairy unfortunately I don’t have a menopause specialist in my GP practice but I had contacted the cardiologist who specialises in microvascular and vasospastic angina and she thought HRT was worth trying.

Do you know why HRT is not recommended for over 60’s?

I know your extensive knowledge of NOCAD and INOCA is invaluable and you may have found information during research that I didn’t find.

[Milkfairy Heart Star in reply to Tannigirl]

The problem is there is so much conflicting advice and mixed messages about using HRT if you have heart disease.

The European Society of Cardiology, in their guidelines for chronic coronary syndromes ( stable angina) suggests that HRT is not recommended for women over 60 years.

See section 3.3.5

academic.oup.com/eurheartj/...

The Lancet Women and Cardiovascular Disease Commission report also was cautious. Low doses for short periods.

Then quality of life needs to considered too. For some women the increased risks are acceptable for an improvement in the quality of their lives.

For angina non obstructive coronary artery disease, ANOCA, I have seen HRT being recommended to women who have hot flushes and other symptoms affecting the quality of their lives.

There have been conflicting research findings too.

It's a minefield. We really need some good quality research!

[Tannigirl in reply to Milkfairy]

Yes, it’s certainly a minefield with conflicting information.

I’ll be in touch with my cardiologist before the trial period ends and hopefully there will be a little clarity on HRT and heart disease 🤞

[Hidden]

Hi Greydoor1

Im 52, think a few years of stress contributed towards my problem. So insomnia was an issue for a long time. I was struggling to support my parents who both have Alzheimer’s. Long story but the nervous breakdown came before the chest pain. I don’t think my age is helping. I’m not overweight but I’ve always been overly out of breath in the past when walking hills, exercising. Went for several asthma tests and a chest X-ray years ago.

A couple of years ago I started experiencing chest pain during exercise. Then overnight as well. My build up is just a feeling of discomfort around my stomach/chest. I call it niggles. I do get the odd almost stitch/sharper niggles in my chest or left hand side of my chest. But that’s a weird one, only seems to happen if I’m fighting something, like a cold, or more recently Covid. Luckily Meds are helping control all this and there’s been no trip to A&E since last May. Confirmed diagnosis wasn’t until January this year. Still haven’t had my consultation with Cardiologist yet. Very grateful to the BHF and this forum. As all my answers to questions have been given here. I still have a few more and will be following that appointment up soon.

[Milkfairy Heart Star]

Hello GreyDoor1

I have lived with vasospastic angina for nearly 10 years, another type of non obstructive coronary artery disease, NOCAD.

Along with Microvascular angina, vasospastic angina can be difficult to diagnose and treat.

I didn't experience any extreme hot flushes or insomnia before my diagnosis.

How has your Microvascular angina been diagnosed?

Are you seeing a Cardiologist who understands NOCAD?

If so perhaps discuss with them your current medication to ensure your symptoms are being managed the best they can be.

I sleep poorly because I experience most of my chest pain at night which is typical of vasospastic angina.

I will sometimes wake up sweating too.

I don't take sleeping tablets or other strong opiate based medication as you can become addicted to them.

Who has prescribed the Zoplicone and Clonidine?

Zoplicone is recommended to be used for short periods only.

Clonidine is sometimes used to treat hot flushes.

I suggest you ask to be referred to a Menopause specialist who has some understanding of heart disease.

In some cases Hormone Replacement Therapy (HRT) is prescribed, as this seems to be the most effective way of treating the extreme symptoms of the menopause.

I no longer work, I took ill health retirement. The lack of sleep is exhausting at times. I manage by pacing my activities and resting in the afternoons.

I also experience the brain fog, feeling my head is full of cotton wool and forgetting things.

Microvascular and vasospastic angina are complex heart conditions for sure.

The menopause just seems to complicate things even more!

[WIgranny]

Hi, my symptoms definitely started as I began to be perimenapausal. I'm still not formally diagnosed as don't have classical angina and cardiologist not convinced it's MVA. I have hot flushes which come and go in severity, currently bad but not sure if linked to meds to

[Milkfairy Heart Star in reply to WIgranny]

Hello WIgranny

It took me a while to get my diagnosis of vasospastic angina.

I had an angiogram with acetylcholine in 2014, 2 years after I was admitted to hospital with a suspected heart attack.

I have chest pain at rest and can exercise.

I suggest you get in contact with the team at St Thomas's hospital in London who are carrying out research into how to diagnose microvascular angina.

isrctn.com/ISRCTN94728379

Also ask your Cardiologist to read this article.

internationalheartspasmsall...

[WIgranny in reply to Milkfairy]

Thanks. I've had a second opinion at the other local hospital last year and he refused to send me for angiogram as invasive! Had a stress MRI which showed no abnormalities in September but am still waiting a follow up appointment!!

[Milkfairy Heart Star in reply to WIgranny]

Where in the UK are you based?

[WIgranny in reply to Milkfairy]

Hi I'm based in Suffolk. First seen at West Suffolk in late 2018 and discharged after normal ETT.

Plodded along until I read something about angiogram with acetylcholine and so asked GP to refer to Ipswich for second opinion last yearSaw registrar last summer not totally dismisive but refused to refer for angiogram. Started amilodipine and had stress MRI in Chelmsford. Still awaiting follow up but had copy of letter saying no abnormalities on MRI

[Milkfairy Heart Star in reply to WIgranny]

I have sent you a message.

It sounds as though you were seen by someone who has unfortunately little understanding of microvascular or vasospastic angina.

You may need to travel.

[Finnbert in reply to WIgranny]

Are you able to be referred to the Norfolk and Norwich University Hospital? I spent two weeks in James Paget Hospital where Consultants from NNUH work. I had my angiogram at NNUH and after that was diagnosed with microvascular angina. However I am still considering as to whether or not to be referred to Professor Kaski at St Thomas in Tooting. I was taken to Ipswich hospital having lost consciousness with friends eating out a restaurant nearby. I asked the staff in A&E if they had heard of microvascular angina and not one of them had! I wish you well and thank you Milkfairy for your advice and will look into the trial.

[Milkfairy Heart Star in reply to Finnbert]

Prof Juan Carlos Kaski has retired. ( He was based at St George's hospital in Tooting)

There is a Cardiologist at Royal Papworth who is knowledgeable. I will message his name, as we aren't allowed to name individual doctors on the forum.

I would definitely recommend getting in touch with the St Thomas's team where they are undertaking the research. I posted the link above.

I suggest you printout the information from the BHF website and hand a copy to the A&E and other staff you encounter.

bhf.org.uk/informationsuppo...

I also ask the staff to look at the International Heart Spasms Alliance website too.

internationalheartspasmsall...

The staff's comments, ' I now understand your condition better and why you need IV GTN'

Sometimes as patients with less well known heart conditions we need to help medics to up date their knowledge .

[Tannigirl]

Hello Greydoor1, I’m still waiting to be tested for microvascular angina and although I am post menopausal I was experiencing insomnia and brain fog but no hot flushes. I asked my cardiologist if HRT would help with my angina clusters and she agreed it was worth trying. I’ve been on Estradot patches (HRT) now for a month and I sleep much better and I can hold a conversation without losing too many words, sometimes! Shorter clusters of angina too. Take care.

[KingfisherBlues]

Hi. I'm 50 and peri-menopausal with angina type pain with even very moderate exertion, a positive stress-echo and a negative angiogram after which I was told by the cardiologist (who I only spoke to twice on the phone) that they wouldn't investigate further. I suspect I might have microvascular angina, but whilst my GP said she re-referred me when I told her my chest pain is starting at lower thresholds now, I haven't heard anything from cardiology for a year or so and I haven't pushed it as I feel generally well and feel a bit silly. I have very recently started on a very low dose of HRT and noticed in the last couple of days that my chest pain seems to be noticeably lessened. But it's too early to say if this is really the case. I found it interesting.

[Milkfairy Heart Star in reply to KingfisherBlues]

There is a growing awareness that microvascular and vasospastic angina are not benign conditions. The Cardiologist's statement is incorrect. Ischaemia/angina non obstructive coronary arteries INOCA/ANOCA can be diagnosed by a specialised angiogram when how the blood vessels function are assessed.

Microvascular and vasospastic angina can and should be further investigated.

It is possible to have angina even a heart attack without obstructed coronary arteries. So it's important to have the appropriate testing, diagnosis and preventative treatment.

There are mixed reviews about whether HRT is appropriate for patients with microvascular or vasospastic angina.

Men also have microvascular or vasospastic angina.

I live with transient contrictions of my coronary arteries and small blood vessels, vasospastic angina. My coronary arteries are unobstructed.

Microvascular angina is thought to be an inability of the small blood vessels to dilate or stay dilated in response to exercise.

MVA is more common that vasospastic angina.

There is a research study iCorMicA taking place with more centres all over the country enrolling patients.

clinicaltrials.gov/ct2/show...

Perhaps ask your GP to refer you to a team taking part in this study.

Where in the UK are you based?

[KingfisherBlues in reply to Milkfairy]

Thank you for your reply. I'm in South Wales.

[Milkfairy Heart Star in reply to KingfisherBlues]

There is a Cardiologist in Cardiff who is interested in Microvascular and vasospastic angina.

I suggest you contact the Research team carrying out the iCorMicA study and ask if there is a centre taking part in the study in south Wales.

In my nearly 11 years of experience of living with vasospastic angina you sometimes have to be proactive in finding a specialist.