just to talk about symptoms of micro vascular angina ,how people cope with them ,
What they have and how were they diagnosed, it does seem you have to keep on as if your main arteries are fine they say nothing is wrong with your heart ,but you still have all these symptoms .
Hello hyundiblue,
I live with both microvascular and vasospastic angina.
My angina is due to the transient constrictions of my coronary blood vessels, coronary vasospasms.
Most microvascular angina is though to be due to the inability of the small blood vessels to dilate in response to extra demands like exercise. Known as microvascular dysfunction.
Since I was first diagnosed by a specialised angiogram 10 years ago, the knowledge of these types of angina non obstructive coronary arteries, ANOCA has increased.
It can, unfortunately still be difficult to get a diagnosis, as sadly, microvascular and vasospastic angina are still often overlooked, undiagnosed and under treated.
MVA can be diagnosed by a perfusion MRI or by an invasive angiogram using adenosine and guide wires to assess how the blood flows through the small blood vessels.
Acetylcholine is then used to see how the blood vessels respond. Normal blood vessels should dilate. If the coronary arteries constrict then vasospastic angina is diagnosed.
The BHF has this information about microvascular and vasospastic angina.
bhf.org.uk/informationsuppo...
bhf.org.uk/informationsuppo...
You may find this website helpful too. It was was written by 4 patients with over 50 years of experience living with microvascular and vasospastic angina.
internationalheartspasmsall...
I suggest you keep a log of your symptoms and see if you can spot any possible triggers of your symptoms.
My triggers are the cold, mental, emotional and physical stress.
Caffeine and adrenaline.
I can usually exercise, however I experience my chest pain at rest especially during the night.
There are quite a few of us 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.
Hi hyundiblue70
I have vasospastic angina (VA) as a result of a congenital heart defect known as a myocardial bridge (MB).
My symptoms are primarily chest pain, back pain, arm pain, and sometimes jaw pain. I also suffer with palpitations and adrenaline. My pain is mainly there on rest however, I do also experience this on movement, with or without exercise.
My VA and MB was diagnosed through an angiogram whilst on holiday abroad as it triggered an NSTEMI. Whether a stress agent was used to diagnose the spasms, i.e. acetylcholine or otherwise, I do not know.
As Milkfairy has mentioned, microvascular angina is related to the smaller blood vessels in the heart muscle. I recently underwent a CMR with perfusion using adenosine and I believe this will either rule out, or rule in microvascular angina for myself as well, in addition to the level of ischemia (damage) to my heart from the NSTEMI.
Usually, symptoms can be managed with medication. You don’t seem to mention if you are on any. So far, I have not found any medication to be particularly useful for me.
My triggers are also similar to Milkfairy’s, with the cold and emotional stress being a few.
Unfortunately, I don’t think it’s possible to completely eliminate all the symptoms of microvascular angina or VA which is probably why you’re still experiencing some.
You’ve been provided with some good links. In addition to this, you can also directly speak to a cardiac nurse if you had any more questions and they are lovely. I’ve provided the link below just in case.
bhf.org.uk/informationsuppo...
It is also a good idea to speak to your cardiologist about any ongoing or persisting symptoms.
Have cardiologists recommended any medications for when the pains occur?
Other than GTN spray, (which does not seem to do anything for), I have had no other recommendation. There are various pain management strategies such as mindfulness, but they don’t really help when the pain is occurring.
Has anyone found a medication that helps?
An accurate diagnosis is the start.Many people have a presumed diagnosis and are given the incorrect treatment.
There is still a belief amongst some Cardiologists that the treatment options for microvascular angina are the same for vasospastic angina.
Beta blockers can help microvascular angina but can make coronary vasospasms worse.
There is evidence that nitrates don't work well for those living with microvascular dysfunction.
Managing your triggers is essential.
I have struggled during this cold winter and ended up in hospital for 12 days in February .
I use other strategies; mindfulness meditation, breathing and relaxation techniques, Transcutaneous electrical nerve stimulation TENS machine, hot water bottles.
I manage my stress with Tai Chi, yoga and walking my dog everyday.
I pace my activities.
On the horizon is the research into Zibotentan, a possible new treatment.
Various other studies are taking place in different countries.
More centres are carrying out the appropriate testing during an angiogram to assess the function of the coronary blood vessels.
Many patients with appropriate treatment do have fewer symptoms and are able to live well with microvascular or vasospastic angina.
There is sadly a group of us who don't seem to respond well to their medication. I don't.
Hi, 9 years ago I developed unexplained chest pain. I had a CT coronary angiogram done which was completely normal. My pains continued so I had an angiogram done that came back as normal. I was puzzled that nothing had been found. I had been using a GTN spray which mostly helped my symptoms. No one mentioned to me about Microvascular angina in fact I wasn't aware of it myself at the time. I was backwards and forwards to my GP he was trying all kinds of medication both for the chest pain and arrhythmia problems. Then 3 years later the chest pain became worse and after describing the pain to him he said that he thinks this is Microvascular disease and this is angina. Even I thought it was angina just no blockages that could be seen. At last I thought I have an answer. He wrote back to my cardiologist who put me on medication that can be used in the treatment of Microvascular angina and he wanted to see how I responded to it. There was a significant improvement. Cold weather still affected me but I was doing really well on the medication. 4 years ago I had a pacemaker. But in 2021 the angina worsened. Since then I have been sent to hospital twice to check that I have not had a heart attack. My Cardiologist added more medication to my list of drugs to take which have helped. The last time I was at the hospital another cardiologist came to see me and I was told I had a chronic condition and that the disease had now progressed so it was affecting me at rest which made sense. I am aware of the tests that can be done and the different trials as well. Since I was getting worse I asked my cardiologist to refer me for a MRI stress perfusion. My request went down like a lead balloon. He was not happy. He said it was totally unnecessary, you have Microvascular angina. I am aware that an MRI cannot fully rule out MVA. Anyway he did reluctantly refer me to another hospital outside of the area where I live. After all that they could not do it they don't have the diagnostic tools locally to diagnose Microvascular ischaemia and besides with the pacemaker in situ it will limit diagnostic quality. I still suffer more when the weather is cold, I have to wear extra layers and I have had to slow down but generally I am not doing as well as I used to so another visit to the GP is probably on the cards! I think Milkfairy is lucky to have such a good understanding cardiologist which is more than I can say about mine.
I am really sorry you are not able to access the support and care that you need.Where in the UK are you?
Are you prepared to travel?
My Cardiologist is a Prof of Interventional Cardiology at a large London hospital. It took me sometime to find him.
He has actually seen me twice during a severe prolonged episode of coronary vasospasms.
My vasospastic angina is not well controlled by medication and I am admitted to hospital with treatment with IV GTN and morphine, once or twice a year.
I have a confirmed diagnosis following a angiogram with acetylcholine which induced my coronary vasospasms.
I also have an admission plan which guides the staff how to care for me.
Unfortunately there is still a belief amongst some Cardiologists that microvascular angina is a benign nuisance of a heart condition......
Hi Milkfairy, Thanks for your reply. I know you are knowledgeable about this as I have been reading your posts for a while. I have done endless research into MVA and have read up on coronary vasospasms. I live in the far south west and to travel to London is not an option for me unfortunately. But If I'm right the tests that can be done in the Cath lab are going to be rolled out to other hospitals in due course.
There are more hospitals taking part in the iCorMicA study which involves invasive testing for microvascular dysfunction and vasospastic angina.
I am aware that Royal Bournemouth Hospital is taking part in the trial.
There is a Cardiologist at Derriford Hospital who has an interest in non obstructive coronary artery disease.
Hopefully a hospital near you will opt to take part in the research.
Roll on the warm weather 🌞
I am in many many layers too!
The cold certainly contributed to my latest admission.
I hope you can find a Cardiologist who listens and supports you better.
Hi, thanks. That is very useful. You mention that there is a cardiologist who has an interest in this type of problem at Derriford Hospital. I know we cannot mention names on here but how can I find out his name?
I will send you a message.
Hi. Being new to all this I’d like to ask a similar question. I was diagnosed around 6 weeks ago. I was taken to hospital with a tight chest, breathlessness and complete lack of energy. The angiogram showed no blockages etc and was told my heart is fine. I was sent home with a cocktail of drugs but with no follow up (subsequently arrange a visit with my GP) or any idea of what to expect. To be honest this has come as a big shock to me so any advice from anyone will be gratefully accepted.
Have a look at the links I gave above.
I suggest you ask to be referred to a Cardiologist who understands microvascular and vasospastic angina.
that’s what happened to me ,but now have had PET scan waiting for results
Here is some information about how microvascular dysfunction and vasospastic angina are best diagnosed.
Below is a link to the recommended pathway, developed by the joint BHF and National Institute of Healthcare Research, NIHR working party to diagnose angina non obstructive coronary arteries ANOCA.
I suggest you ask your Cardiologist are they aware of these documents.
internationalheartspasmsall...
internationalheartspasmsall...
Morning everyone.I'm still waiting for a diagnosis. I've been having chest pain and a funny feeling in my neck for over a year. A couple of trips to A&E. Ecg was clear, bloods clear. High blood pressure. Was referred to cardiologist and given a gtn spray.
Few months later had a heart scan and that was clear so he referred me back to gp. She said that's good that the scan was clear but I said it's not good that I'm still getting these pains, always at rest. Sometimes it wakes me up. I told my gp that i emailed British heart foundation and they told me to query microvascular and vasospasm which I did but my gp dismissed that so I came on here for advise which was very helpful. Anyway a couple of days later she rung me and said she is writing to the cardiologist so she must have done a some research on it. I did say to her if everything is fine why do I have to use the gtn spray 🤔. So I'm hoping I hear from him soon. It's quite scary waking up at 2am with chest pains. I suffer with palpitations also and sometimes it feels like I miss a beat.
Hi hyundiblue70
I have microvascular angina and spasm . I had a cardiac MRI to diagnose and my angiogram was normal except for spasms.
I find I really have to pace myself. I have to have days of complete rest to really recharge my batteries . I cant excercise without getting chest pain later. I dont drink coffee or smoke . And still I get chest pains out of the blue ,sometimes in the middle of the night . Other times I have just done too much and my heart is not happy.
I am sitting here right now with chest pain wondering whether to go to my voluntry work or not and how much rest will I need until I feel better. Its hard to estimate sometimes and difficult to manage. I take gtn spray , isosorbate mononitrate and diltaizem. I am right now drinking an infusion that contains magnesium it seems to help a bit.
Hi there, I don't have the vasospastic angina but I have been diagnosed with microvascular angina following an angiogram that measures flow rates within the heart. I get the angina on exercise, especially any uphill walking. I'm on monomil which is the tablet form of the GTN and it helped reduce the frequency of the attacks but I still use my GTN on occasions. I'm also on felodipine, rosuvastatin and I've just started on losartin, so now I rattle when I walk uphill. I did have to give up my beloved running as the angina was not receding with the GTN unfortunately. I hope you get a proper diagnosis as I think its very important with the choice of medications you get. Before my diagnosis, I was on aspirin. The moment I got the diagnosis I was told to not take aspirin or ibuprofen.
I was diagnosed with heart disease initially after an angiogram showed blockages and I have 3 stents in one artery my symptoms were breathlessness a heavy tightness in my chest and upper back and feeling of exhaustion also an uneven pulse rate with palpitations. Since having the stents my symptoms of tightness and breathlessness continued and became more frequent.
I was then given a presumed diagnosis of microvascular disease but most of the information I learned was from my own research and from this site milkfairy being very supportive and informative.
I was eventually prescribed a calcium channel blocker and taken off the beta blocker and my symptoms reduced dramatically so I have presumed that I have the vasospasms.
I am usually very well now and can exercise and lead a normal life. I get episodes of chest tightness with breathlessness and exhaustion occasionally when it’s very cold and after stressful times allways at rest but it’s very few and far between now and well controlled with the medication.
My symptoms with microvasular angina are shortness of breath(SOB) on exercise. We go dancing each week and we have had to stop doing the faster dances and do the slower ones (waltz,rumba) Some weeks can be harder than others. Can't walk up hills without using the GTN. Gardening I am learning to pace myself.
Cold and stress are triggers.
Also finding walking brings on SOB if cold and talking at the same time.
I struggle with SOB and pain and generally feeling unwell if watching some programmes on TV (Happy Valley,Line of Duty) Possibly should just stick to Disney😂
I am struggling to come to terms with the condition despite compared with others I don't feel I am that bad as never been to A+E however it has still impacted on my life.
I am trying very hard to pace myself and not do to much. I am trying part time work so only work 3 days at the moment. I have also started tai chi.
The diagnosis was important as I had been told nothing was wrong with my heart. So changed hospital to find someone who was aware of the condition. Made the difference because I was believed and didn't feel like I was going mad.
"The diagnosis was important as I had been told nothing was wrong with my heart. So changed hospital to find someone who was aware of the condition. Made the difference because I was believed and didn't feel like I was going mad."
I think many of us living with microvascular or vasospastic angina have had the similar thoughts.
Being believed is so important.
I use the spoon theory to manage my pacing.
it’s not so much the chest arm neck pains ,it’s the days after feeling so week and very achy
Micro Vascular Angina, 
MICRO VASCULAR ANGINA 
micro-vascular angina pain
Micro vascular angina
micro vascular angina 
