Microvascular Angina

[Justdoit2015]

Hello . I have recently been diagnosed with Microvascular Angina , following an Angiogram last week, that showed my major arteries are unobstructed.

I had a Myocardial Perfusion Scan some months ago , that showed a moderate Ischemia under stress , and a CT Coronary Scan which showed a high calcium count . That is why I was put forward for an angiogram and angioplasty as they were all prepared to stent me , and were surprised to see no obstructions.

I have had chest pains for almost 6 years and no one took me seriously, as following GP , A&E visits my ECGs and blood works, never indicated a problem ; and my Cholesterol is very low , and blood pressure controlled , unless stressed , then it spikes very high .

I am writing this post to ask for advice from others with this condition, as I know there are sub types , such as Microvascular artery spasm , which I believe I suffer from , but I don’t believe the diagnostic test was done during my angiogram.

My Angina is not triggered by physical exertion unless extreme . I was running 7k a year or so ago , and swimming a mile without issue . My Angina is triggered by stress , and the cold affects my breathing.

I believe it is coronary artery spasm finally as , when I was referred to the chest pain clinic last May , I was given beta blockers and all hell broke loose with allergic reactions, but also , suddenly my chest pains became a lot worse , and I had to be taken off them . I believe beta blockers are contradicted in Coronoary Artery Spasm .

I was prescribed last May : Asprin , Lorsortan , Avorstatin, Ivabradine and have just come off Clopidogrel . I have been prescribed a type of daily nitrate , but not yet received it . Are people on a similar combination? I believe Calcium Channel Blockers may also help ?

Sorry for the long post . Here in Deepest Cornwall , I sometimes feel we get less medical expertise than in other parts of the UK , so wanted to ask .

Thank you for your help

[Milkfairy Heart Star]

Hello,

Welcome to the forum.

I have lived with vasospastic angina for over 10 years.

I was originally suspected of having a heart attack however because my coronary arteries are unblocked, I was incorrectly told I couldn't have a heart attack or angina.

I was told perhaps I was anxious and prescribed beta blockers and landed up in coronary care as a result.

My vasospastic angina was confirmed by an angiogram with acetylcholine which induced my coronary vasospasms in 2014.

Microvascular angina is thought to be due to the small blood vessels of the heart not working properly. They cannot dilate or stay dilated in response to extra demands like exercise.

This is known as microvascular dysfunction.

Vasospastic angina is when the coronary arteries constrict in transient constrictions, coronary vasospasms.

You can also have vasospasms in the small blood vessels too.

The symptoms can overlap so it's important to have a functional angiogram when they assess how the blood vessels of the heart are working.

I experience most of my chestpain at rest, especially in the night.

I am on high doses of Diltiazem, nicorandil, Isosorbide mononitrate and GTN patches.

I am also on a statin and antiplatelet.

My triggers are the cold, emotional, mental and physical stress. I tend to experience my chestpain later in response to exercise.

The umbrella term for Microvascular angina and vasospastic angina is ischaemia/ angina non obstructive coronary arteries INOCA / ANOCA.

The BHF has this information about microvascular and vasospastic angina.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

You might find this website helpful. It was written by four patients with over 50 years combined experience of living with microvascular and vasospastic angina.

They are actively working with world expert researchers into these conditions.

internationalheartspasmsall...

It can take time to find the best combination of medication that will work best for you as an individual.

There are several other forum members who live with either microvascular or vasospastic angina. Hopefully they will be along to share their experiences with you.

[Justdoit2015 in reply to Milkfairy]

Hello Milkfairy , thank you for your detailed reply . Vasospastic angina is the term i was looking for . Strangely, a lot of my chest pain has always felt like something was constricting or going into spasm , just for a second at a time then stopping , then starting . I have never had the typical elephant on your chest pain . At the chest pain clinic last May, I was listed as low priority as the pain I suffered was described as Atypical .

It is interesting what you say about delayed pain with respect to exercise. A few years back when I was starting to exercise , I would be fine , but fours later would suddenly become breathless. I also get my pain at rest , during the night or early in the morning, waking me up . Although the pain is painful , I have had it on and off for a few years and know it will pass , so I remain calm . Me getting stressed will just make it worse .

Do you know any good consultants whose name you can share over private message? I aim to pay for a private consultation so they can review my tests and provide a plan of action .

Thank you for the list of medications you provided, that will be a useful template for my GP. Also , it is very interesting that we had such negative responses to the Beta Blockers .

I am actually quite positive about the whole diagnosis. I will now be on the radar and have some validation that the pain and fatigue I suffer from, as not just in my head , and I will get some medication to alleviate the symptoms

Thank you for now

Benjamin

[Milkfairy Heart Star in reply to Justdoit2015]

Vasospastic angina is usually outside the sphere of practice most GPs.

Are you still seeing a Cardiologist locally?

Each of us seem to have our own version of the condition so it's important to be reviewed by a knowledgeable Cardiologist who can treat you as an individual.

What works for me may not work for you.

Having chest pain at rest is a very common symptom of vasospastic angina.

Using the term atypical isn't helpful for those of us living with vasospastic angina.

It took me a while to find my Cardiologist who is very supportive. I am unfortunately severely effected and don't respond well to my medication.

I end up in hospital about once or twice a year for treatment with IV GTN to calm my unruly coronary vasospasms.

I will message you.

[Tos92]

Hi Justdoit2015

I have coronary artery spasms, also known as vasospastic angina as a result of a congenital heart defect which I have in the form of myocardial bridging. I’m sorry to hear that you may have this also.

I can empathise with the late diagnosis. I had chest pain for 1.5 years with frequent trips to A&E which was mostly put down to anxiety. It wasn’t until a spasm triggered a heart attack last year in the form of a MINOCA (myocardial infarction in non-obstructed arteries) that I was diagnosed.

An angiogram with acetylcholine can usually confirm a case of vasospastic angina. My myocardial bridging was seen spasming on my angiogram and this is how I was diagnosed.

My triggers are also the same as yours, with stress, the cold, strong emotions, and some types of physical exertion causing me angina and spasms. I also didn’t get on well with a beta blocker which I was prescribed with last year.

I am on calcium channel blockers and aspirin. I also have a GTN spray which I use only in moments of intense pain. However, calcium channel blockers are usually the first line of treatment for coronary artery spasms.

There are a few other members with microvascular angina and/or vasospastic angina so I hope they will share their experiences with you too.

All the best.

Tos

[Justdoit2015 in reply to Tos92]

Hello Tos, thank you for your kind reply . I can emphasise with you regarding your trips to A&E and being told your pain is just Anxiety. That happened to me a lot . As my pain was not brought on my standard exertion , I thought maybe they are right , and powered through the pain for a number of years .

It seems you MilkFairy and I , have had very similar experiences to Beta Blockers. It was this point that really focused my attention to vasospastic angina. My chest pain disappeared when I was taken off beta blockers . I was on the lowest dose of Bisporol for a week , but was only taking a 1/4 of one tablet a day and slowly moving towards getting to 1 tablet, when I had allergic reactions and chest pain , so I consider myself lucky I did not just drop a tablet a day as planned.

I am going to ask for calcium channel blockers , and will introduce them into my body slowly if I am prescribed them .

I too have a GTN spray which I have never used . I have been given it in hospital. Since a lot of the time my pain comes in waves of chest pain for 1 second, then fine , then chest pain for 1 second then gone , I have never used it . It is almost like someone is pinching an artery for a second , then letting go . It is quite hard to explain

I aim to get a private consultation with a specialist so my case can be reviewed and a treatment plan made .

Thank you again for your reply.

Benjamin

[Crystal614]

Hi, I have MVA, I have had it for over 9 years. Like you and many others when the chest pain first started, I felt that the Cardiologists didn't take it seriously. I had a CT coronary angiogram which was clear, my chest pain continued so they decided to do an angiogram still nothing. Chest pain still persisted, eventually with the help of my GP he contacted the Cardiologist again and I was prescribed Trimetazidine this drug completely turned things around. I have now had more medication added, I take Isosorbide mononitrate and I also use Nitrate patches as well. I was on a calcium channel blocker but that has been stopped for now due to low BP. I have had high BP for many years. It is interesting what you say and Milkfairy about beta blockers. When I was on a higher dose it made the angina much worse. I have mentioned this to the cardiologist so now I am on a tiny dose, I need to take a beta blocker as I take Flecainide for SVT. I also have a pacemaker. The cold affects me badly and I have been struggling with exercise, my cardiologist told me not to push myself to the point where I am getting chest pain. I also suffer with terrible fatigue as well. Milkfairy has given you some good information. All the best to you.

[Justdoit2015 in reply to Crystal614]

Thank you for your kind message Crystal . I am off to bed now , but will reply to your post in full , tomorrow. Benjamin

[Justdoit2015 in reply to Crystal614]

Thank you for your reply and for the medication names you provided. I am sorry it affects you that much . It was the fatigue that really got me a year or so okay , and it nearly broke me trying to push through it and carry on as normal . Ivabradine had the most dramatic improvement for me , I was prescribed it when I had adverse reactions to Bisporol Fumerate . I am waiting for my medication to be prescribed , but in a way , I am a lot calmer , now I understand the mechanism of my pain and how I can avoid it . Thank you fir your reply .

[Shellac]

Hi I got mircovascular angina and coronary artery disease, excellent group on Facebook mircovascular angina/coronary spasms, I'm on a mixture of medications. If you go on Inoca website it brings up names of cardiologists who specialise in Inoca❤️

[Milkfairy Heart Star in reply to Shellac]

There is also a long established Facebook group listed in the BHF website.

.bhf.org.uk/informationsuppo...

Prinzmetal Angina/ CAS group

It was patients from this group that created the International Heart Spasms Alliance.

The group is listed on Heart Research UK website.

heartresearch.org.uk/nocad-...

[Justdoit2015 in reply to Shellac]

Thank you for your reply . I will check that website, as I am not on FB . I will endeavour or get a private review of my results in the coming months.

[dunestar]

Hello Justdoit 2015. Your story is a bit similar to mine. I had a stress echo which showed "fairly global ischaemia". I was convinced I was headed for multi bypass surgery but the angiogram came back all clear apart from a mild blockage in one artery. I was diagnosed with microvascular angina. I also sought out the opinion of an expert because I didn't have the opportunity to talk to anyone after the angiogram. An expert will be able to assess all the possibilities. I wouldn't take your adverse reaction to beta blockers as definitive for vasospastic angina . I was put on bisoprolol after my stress echo and I hated it as it did all sorts of weird things to my heart. It was a wonderful day when the cardiologist said I could stop taking them. I have microvascular angina but not vasospastic angina.

[Justdoit2015 in reply to dunestar]

Thank you for your reply . I am not the only one that did not get the opportunity to speak to anyone after my angiogram then . I tried but the consultant stated he was only being paid to do my angiogram, and I needed to make an appointment with Outpatients Cardiology if I have questions . I am enquiring about that now . Thank you for your advice about Beta Blockers . Yes , it could indeed be a red herring. My issue at present , is that I am not overtly keen to undergo another angioplasty with pressure tests for a more specific diagnosis, albeit , I will defer to whoever I gain a private appointment with . Thank you for your reply . Benjamin

[Milkfairy Heart Star in reply to dunestar]

Beta blockers are advised to be used with caution by the National Institute of Clinical Excellence NICE in patients with vasospastic angina.

cks.nice.org.uk/topics/angi...

The underlying causes of microvascular and vasospastic are different.

We are all different and respond to medications differently. Our blood vessels don't aways behave as they should!

[dunestar]

Thanks. I totally agree with you about swerving angios if at all possible.

[treemarks57]

Hi im only on asprin, atrovastin, and nabivolo I have a gtn spray aswell only to use if I need to.I was on ivabradine but I was taken off them a few months ago as they were causing me to have bad palpitations and chest pain.