For over two years, Symptoms of chest pain ( well it’s more heaviness, pressure or tightness) not associated particularly with exercise often 4-6am and at rest, breathlessness and debilitating fatigue. 12 months ago had successful ablation procedure for atrial flutter arrhythmia but symptoms persisted (sometime better sometimes worse) diagnosed with atrial ectopic beats, Adizem helped at first now struggling again, had ct scan which showed no blockages and cardiology dept just want to discharge me. Finally booked private appointment with cardiologist for second opinion, who made me feel human again, and not like some ungrateful malingerer, and he has booked mri scan in 8 weeks time to look for Microvascular disease or inflammation that could cause my symptoms. Has anyone any experience of this being diagnosed by mri?
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Sue2022
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There are two types of angina non obstructive coronary arteries ANOCA, also referred to as Non obstructive coronary artery disease, NOCAD. Microvascular and vasospastic angina.
I suggest you ask your cardiologist consider this as a possible cause of your symptoms before discharging you. Unfortunately microvascular and vasospastic angina are often overlooked, unrecognised, under diagnosed and under treated.
Microvascular angina tends to cause chest pain, or other symptoms such as breathlessness and tightness on exercise.
While Vasospastic angina usually causes chest pain, at rest and in the night, typically between midnight and 6 am.
Microvascular dysfunction causing microvascular angina can be detected by the newer generation cardiac MRI machine usually based in a heart centre of excellence.
The MRI can also look for myocarditis and other inflammatory conditions of the heart.
Vasospastic angina is confirmed by an angiogram using a chemical to provoke the vasospasms. This is how my vasospastic angina was diagnosed.
The BHF website has this information about microvascular and vasospastic angina.
I suggest you have a look at this link to a study being carried out at St Thomas' hospital in London. The study is researching possible ways of diagnosing ANOCA conditions.
You can contact the researcher directly, their contact details are given at the end of the document.
There are quite a few members on the forum who live with either microvascular or vasospastic angina. I am sure they will be along to share their experiences with you too.
Thank you so much for your helpful information- very interesting that my chest pain is often very uncomfortable between 3am-6am !! I will check out the ‘links’ you have suggested. Thanks again
Great posting, thank you, Milkfairy. 30 months on from my first and 9 months on from my second NSTEMI heart attacks I have finally been diagnosed as having microvascular angina. I have suspected this and your helpful postings and 'signposting' to helpful resources have been invaluable. I am going on to a nitrate medication in tablet form shortly. Your postings show the real benefits of being a poster and postee - a real win/win all round. I'll report back on how I get on with the additional medication.
Context: still quite fit 62 year old male; cycle 35 miles in one go at speed of 10mph; walk regularly 4 miles daily when not cycling; gym user (very light weights, cross trainer); no prior or existing blood pressure, BMI, or cholestorol issues.
MEDICATION: Atorvastatin (80mg), felodopine, aspirin, ramipril (10mg), and recently more frequent use of GTN spray.
Yes that's the drug that the consultant has recommended to the GP, starting with a 30mg dose and then moving up to 60mg. Mind you the wheels have turned very slowly on this from my phone conversation with the consultant on 3 March!!! I will report back; best wishes, John
Now moved onto the 60mg dosage, and it is working fine. Not had any angina since taking it and it has given me loads more confidence. Still keep GTN to hand though. Headache to start with on low dose for a couple of days, but drink plenty of since on your advice. This week I've cycled 35 miles in one go with some friends, and done a Galloway walk/jog of 6km with my recently retired wife. Happy days.
I have found that it's pretty difficult to get your regular NHS cardiologist interested in diagnosing MVD or vasospastic angina. In my case, 2 different cardiologists thought it "probably was" MVD. Neither hospital wanted to do the tests which would have confirmed their opinion.I suspect that the reason might be that there appears to be no medication which is guaranteed to provide symptomatic relief.
For what it's worth they prescribed Ranolazine as an anti anginal. I have just started taking it and await the result.
It's also because many Cardiologists don't have the knowledge, skills or confidence to carry out the tests or care for us as a group of patients.
I was assumed to have Microvascular dysfunction, prescribed beta blockers and ended up in CCU as a result. Beta blockers are contraindicated if you live with vasospastic angina.
There is a growing interest. The president of the British Cardiovascular Interventional Society is certainly pushing the agenda for Angina non obstructive coronary arteries, ANOCA.
This document was published last week. Soon there will be no excuse not to properly investigate for ANOCA.
Hi Sue2022. I'm a 41-year-old woman with microvascular disease, which usually feels like chest pressure, heaviness or fullness, most often when I'm exercising, but also sometimes at rest. I'm in the U.S., but my path to diagnosis was an abnormal exercise stress test and echocardiogram, followed by a cardiac MRI with a stress component, which showed a circumferential perfusion defect at the base of my heart. At that point, my cardiologist suspected microvascular dysfunction, but sent me for a CT angiogram to rule out any coronary blockages. I recently had cardiac SPECT imaging in a different hospital (I passed out at home, ugh, so they ran some tests) and that also showed a perfusion defect, though in a different region of my heart. My cardiologist said he isn't sure exactly what to make of that, but he thinks it can be chalked up to the microvascular disease and differences in the testing modalities.
I'm glad you found a physician who is taking your symptoms seriously and doing some further investigating! I hope you get answers and find a treatment that provides relief.
Hi Sue. Milk fairy’s advice is excellent and helped me start my journey here too. I will add that while Adizem is in the list of medications prescribed for these conditions, it doesn’t work for everyone (including me)! and a combination of other medications instead of Adizem has worked better although my issues and triggers aren’t fully resolved. I haven’t yet overcome unavoidable stress triggers or the cold and damp of British winters… but can exercise lightly again. Adizem was very heavy on my chest. We stopped it and the weight on my chest was gone and I breathe better, but still have regular winter spasms on my other meds. It is an ongoing process of treatment and trials but it does get better.
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