Microvascular angina

[Acapella]

Following a diagnosis last year of microvascular angina, I have been seeing another cardiologist who recently carried out an angioplasty on a blocked diagonal coronary artery. This made no difference to my symptoms. I saw him yesterday and had another treadmill test and performed well with little discomfort. The cardiologist thinks I am now fit and should be able to do anything, and that the treadmill test proves there is nothing wrong with the oxygen flow to my heart. He doesn't really believe that microvascular angina exists. However today my chest is really sore and I'm feeling very tired which is typical of the delayed reaction that I've been experiencing following activity. I'm feeling very confused. Is it possible to perform well on a treadmill yet still suffer from symptoms of microvascular angina?

[Milkfairy Heart Star]

Hello,

I am sorry to hear about your confusing situation.

I live with vasospastic angina another type of ischaemia/ angina non obstructive coronary arteries INOCA/ANOCA.

My coronary arteries go into transient constrictions causing a lack of blood supply to my heart.

My coronary arteries are unblocked. However some people can have vasospasms around the area of a stent.

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

I can exercise.

I sailed through my stress echo last year.

Then, I experienced chest pain later, especially over the next few days.

This delayed response to exercise is a common symptom of vasospastic angina.

People with microvascular angina tend to experience chest pain on exertion.

In the 11 years of living with vasospastic angina, I have met a few Cardiologists who have tried to dispute my diagnosis even though I have had a specialised angiogram confirming my coronary vasospasms.

The Cardiologist's attitude perhaps reflects their lack of knowledge about microvascular and vasospastic angina.

There is certainly lots of research to say that INOCA not only exists, it also has a negative impact on a person's quality of life and increases the risks of a heart attack, stroke, heart failure and major adverse cardiac events.

I suggest you ask for a second opinion from a more knowledgeable Cardiologist.

The BHF has this information.

bhf.org.uk/informationsuppo...

bhf.org.uk/informationsuppo...

[Acapella in reply to Milkfairy]

Thanks for taking the time to reply to my post. I will seek a second opinion as you suggest.

[Wooodsie in reply to Milkfairy]

Hi Milkfairy, I knew you would pick this one up, and so knowledgeable too, you really are a star 😊👏👏👏

[Milkfairy Heart Star in reply to Wooodsie]

Ah thanks for your kind words 😊

[Hel52 in reply to Milkfairy]

Hi bless sorrry your going through so much definitely get a second opinion you certainly shouldn’t be suffering like this sadly some consultants fob us off your health is so important.

I have just being diagnosed with angina I am off the the rapid chest pain clinic on Friday feeling really anxious due too so many time of being fob off with negative doctors I kept going eventually it’s take 12 year to get this far with my chest pains.

Big hugs please keep instant on a second opinion.

Hel52

[Milkfairy Heart Star in reply to Hel52]

Hello I had quite a struggle to get my vasospastic angina diagnosed over 10 years ago.

You may find the information I posted in my reply to Acapella helpful.

[Dollywow1999 in reply to Milkfairy]

Is vasospastic feel like heart skipping beats and just like all out of sorts and my heart rate is 43 or 45 during this 4 to 6 minutes episode

[Milkfairy Heart Star in reply to Dollywow1999]

Hello,

Vasospastic angina is notoriously painful, with long episodes of chest pain and other symptoms of angina, mainly at rest.

When my coronary vasospasms are really bad it feels like being in labour in my heart to me.

Have you discussed your symptoms with your GP?

[theonethatgotaway1 in reply to Milkfairy]

Wow that is scary! That's some serious pain then. I get chest pains but would say it's more sharp stab or dull ache but probably less painful than a stitch but they do worry me a lot when it occurs.

[Milkfairy Heart Star in reply to theonethatgotaway1]

I am as my Cardiologist says unusually severely affected. That's me though.

If you are worried and unsettled by your symptoms it's important to discuss this with your GP.

[Hel52 in reply to Milkfairy]

Thank you 😊

[mathematics]

Same thing is happening to my husband he gets chest pain which was attributed to Microvascular angina but when he had a test, which was an injection as not able to do treadmill, although he was getting chest pain and said he was to the person doing this test apparently nothing was showing up so they have now said he does not get angina even though he gets chest pain on exertion and especially when he has to reach up with his arms. He has had 2 heart attacks and has stents and was re-stented just over a year ago. It is frustrating also he had a recent ecg, which showed up changes from his old ecg but no one seems to be following it up.

[Milkfairy Heart Star in reply to mathematics]

Unfortunately microvascular angina is often overlooked as it is not well understood by many Cardiologists or other Cardiology staff. To diagnose microvascular or vasospastic angina requires a very specialised angiogram where they assess whether the blood vessels work properly.

I suggest you ask your husband's Cardiology team to consider whether microvascular angina is a possible cause of your husband's ongoing chest pain.

[mathematics in reply to Milkfairy]

Thank you we will try and inquire.

[Poppy451]

I have been diagnosed with microvascular angina and spasm angina. The microvascular was detected by cardiac MRI where they saw a perfusion deficit. I also get spasms but when they did the provocation angiogram ,they gave me nitroglycerin before the acetylcholine so although I did spasm it was not the full 80%. So it was rather bogus test. Anyway I get chest pain mostly after excretion . If I am already in pain then excretion will make it worse. But for example if I go swimming when I feel well (and go a bit fast) then I get the chest pain hour/s later.

[OscarRomeo]

I have the same as Milkfairy non obstructive microvascular and vasospastic angina. Took forever to diagnose, and extremely frustrating as I'm a fitness freak and struggled to exercise. I'm now on Isosorbide mononitrate 10mg twice a day, which pretty much controls my symptoms up to 90% and allows me to freedom to exercise.

Hope you get yours sorted out soon.

[Milkfairy Heart Star in reply to OscarRomeo]

It's great to hear that you have responded so well to your medication.

[Acapella in reply to Milkfairy]

I was on Amlodopine, Nicorandil (twice a day), Isosorbide Mononitrate and Ramipril, none of which made much difference. The latest cardiologist that I've seen stopped all of these and left me on basic aspirin, statin and betablocker. He doesn't believe in Microvascular disease so will not refer me for an Cardio MRI. In the meantime I suffer from bouts of chest pain, chest tightness, burning sensation down my left arm, and tightness/hoarseness if I sing or speak too much.

[Milkfairy Heart Star in reply to Acapella]

I am really sorry to hear this.I suggest you keep a log of your symptoms and go back to your GP and discuss with them that your symptoms have got worse since stopping the medications.

Perhaps also ask to be referred to another Cardiologist for a second opinion.

It took me awhile to get my diagnosis sometimes you need to be persistent.

[Crystal614]

Hi, I started to experience chest pains on exercise back in 2014. I had a CT coronary angiogram done which was normal and eventually went on to have an angiogram which again was normal. I had no further help from my cardiologist at the time so I saw my GP numerous times with ongoing chest pain. He put me on Isosorbide Mononitrate which improved things and also prescribed a GTN spray. Eventually some time later my GP wrote back to cardiology about his concerns that this was Microvascular disease. My cardiologist put me on a drug called Trimetazidine what a vast improvement it made to the angina. The last 18 months or so has seen worsening chest pain which was happening mainly during exercise or after. I asked for a treadmill test but was told a stress MRI would be better so I was referred to another hospital outside of the area where I live but they declined to do the scan one of the reasons is because I have a pacemaker and this will limit diagnostic image quality. I was seen twice in the emergency department in March on my second visit chest pain started after exercise GTN relieved the pain but it kept coming back. I rang 111 and they arranged for an ambulance (the Paramedics were lovely) and I was taken to A & E. I was told there that this is MVA. My Troponin was slightly raised. Since then I have had several conversations with the cardiologist and I have been told it is Microvascular angina. As well as Trimetazidine I also take Isosorbide Mononitrate extended release and I use a GTN patch which I suspect will need to be increased to a higher dose when the weather gets colder! I take a tiny dose of a beta blocker, I have to take it because of taking Flecainide, higher dose can make the intensity of the pain worse, possibly there may be spasms in the small vessels. The information that Milkfairy has given is good advice . Its just a pity its such hard work to get diagnosed.

[MustyK]

Hi

There has been good comments already, especially by Milkfairy.

Initially, I was diagnosed with left bundle branch block. Up to that point I never had any angina pain. Subsequently I started experiencing angina pain mostly in the early hours of the morning (catching a flight). It was only when I had an MRI that the cardiologist explained the issue with very small arteries (contracting, hence MVA). So in my case it was the MRI scan that led the cardiologist to come to the conclusion. I should explain that several months before the MRI scan, I had an angiogram which showed no blocked arteries, I also had the usual treadmill and I came out good. I should also explain I ended up seeing three different cardiologist before the diagnosis settled on MVA. Hope that helps