I was clinically diagnosed with coronary microvascular angina / disorder by my cardiologist a few days ago. I had a HA in August & he placed a stent in a blockage. Since then I've had difficult episodes of angina where I've ended up in a&e.
I was given ranolazine diagnostically 3 weeks on and then after a few days off - I ended up in a&e again with a terrible angina episode. I've been back on it for 2 weeks and been ok so far, just niggles.
I have so many questions!
1/ Should my clinical diagnosis of MVA/D be tested for medical confirmation? Cardiologist was so confident in his clinical diagnosis that he doesn't see the point in medically testing for it. That doesn't feel right to me - should I trust him or should I push for testing?
2/ What should I expect to happen across the next 10 years - is it progressive?
3/ Is it possible that it will get better as I heal from my NSTEMI HA/Stent?
4/ Will I be on ranolazine for the rest of my life? What are the implications of this on my organs, especially alongside my heart meds?
5/ Does it always lead to vascular dementia?
6/ Should I find a cardiologist that specialises in MVD/A? My cardiologist didn't give me much information and I couldn't process it at the time to ask these questions.
7/ Once I'm the other side of menopause will this get better or worse or stay the same?
8/ How can I prevent or minimise the lightheadedness and exhaustion after an episode?
There's more questions but I'm already going on.
Thanks for your time.
Written by
bee_bear
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Microvascular angina along with vasospastic angina are types of ischaemia/ angina non obstructive coronary arteries INOCA/ANOCA.
Microvascular angina is thought to be caused by the small blood vessels in the heart not working properly, microvascular dysfunction. The small blood vessels are unable to dilate or stay dilated in response to extra demands like exercise.
Vasospastic angina is due to the transient constrictions of the coronary arteries, some people have vasospasms in the small blood vessels.
I was, 11 years ago assumed to gave microvascular angina. However after an angiogram with acetylcholine I was found to have Vasospastic angina.
The symptoms of microvascular and vasospastic angina can overlap. The treatment options are different.
I was prescribed beta blockers which I found out later are contraindicated if you live with coronary vasospasms. I found put the hard way after a hospital admission due to unstable angina.
There are further tests that you can be offered to confirm your diagnosis.
A perfusion MRI for microvascular dysfunction.
A functional angiogram to test how your blood vessels are working by using adenosine and guide wires to make measurement of how the blood flows in the small blood vessels.
Then in a few centres a chemical acetylcholine can be injected into the coronary arteries to see what happens.
If the coronary arteries constrict, then vasospastic angina is diagnosed
There is a study taking place in several centres in the UK, to diagnose microvascular dysfunction.
There is this website and patient group created by 4 patients who have over 50 years combined experience of living with microvascular and vasospastic angina. They are supported by 30 world expert Cardiologists and are actively working with researchers into these types of angina.
There are quite a few other forum members who live with either microvascular or vasospastic angina and hopefully they will be along to share their experiences with you too.
I can't tell you with certainty what the future holds for you. However there now is much more information available about how to treat us as patients.
I have a wonderful supportive Cardiologist, whom I see every 4 months, as unfortunately my vasospastic angina is resistant to treatment. I can email him when necessary when my symptoms are becoming unstable and I need admitting.
No problem, when I was first diagnosed there was very little information about microvascular or vasospastic angina available. I felt very alone and bewildered at first.
The BHF information about vasospastic angina includes a link to a Facebook support group whose founders created the website I gave the link to.
Excellent info from MilkFairy as ever. Let me echo the advice to sit down with your cardiologist - or at least your GP, they really should be able to answer your questions.
I also have microvascular angina for which I take Ranolazine, Diltiaziem but the two medicines that really help with the attack are : Monomil XL (Isosorbide Mononitrate) which is slow release to help the blood vessels relax and dilate, and a GTN spray which I take in case of an agina attack. For me these two are absolutely vital without which I would have constant regular chest pain
I have vasospastic angina I haven’t had a specific test it’s a presumed diagnosis based on my symptoms improving with a change in medication. I’ve found it difficult to find a doctor and cardiologist with enough knowledge and experience in this particular type of angina.
I have 3 stents in my LAD but was lucky to have these before a heart attack
However after having the stents I continued with angina symptoms and was in and out of A & E for a year and the diagnosis of microvascular angina was given eventually. I have seen 3 different cardiologists none were experts in microvascular angina however since being prescribed calcium channel blockers and being taken off beta blockers I have improved and now get only very occasional symptoms I also take ranolazine.
I’m under the care of my GP now and feel fine most of the time.
It’s difficult to get all the answers as few medics understand microvascular and vasospastic angina.
I gained knowledge and support from this site and from milk fairy who has given you lots of information.
It takes time to come to terms with but I’m able to lead a normal life and manage the symptoms effectively.
Hi, I have Microvascular angina. I've not had the specific tests done, I had a CT angiogram done and an angiogram as well both results were normal. I had endless visits to the GP with ongoing chest pain. Some 3 years later my cardiologist tried me on a drug called Trimetazidine it made a vast improvement to the pain. I have been told that I have Microvascular angina. I have had this problem for almost 10 years. I now have other medication added which includes Isosorbide Mononitrate and I also use a Nitrate patch. Things will get better with the right support and medication.
Hi we sound very similar, I had my HT in May 22 and a quadruple CABG shortly after. I kept getting angina pain and have had test after test, two of my grafts have collapsed but that’s not causing the problem.
They now think it’s MVD/A and I was put on Ranolazine 375mg twice a day which definitely helped but I was still using my GTN 5 times a week. At my last appointment the decision was made to up this to 500mg twice a day. I’m now only using GTN once or twice a week, so I think it’s working but at what price to the rest of my body?
Sounds very similar to me, I am a 45 year old female. I had a HA in September, with 1 stent fitted and a balloon. After several trips to a and e, they are saying it could be angina
Trying to get the pain managed and get back to work, but I have had no tests to confirm this.
After another night in hospital last week, the cardiologist called me for a review and has organised a MRI stress test.
Each time I've been discharged from A&E the discharge notes say unstable angina & then go on to say either ?microvascular angina or ?coronary artery spasm. The '?' means it's a theory not a clinical diagnosis. So it's great that they'll be doing the MRI stress test, I see it as the first step toward a clinical diagnosis and getting the best treatment plan.
Have you talked this through with your GP/cardiac nurse? Mine have been great and over the past few months have sent letters to the cardiologist to get some progress on diagnosis & to improve symptoms I've had.
Thank you bee bear, my GP has been very good, changing medication and seeing if that works. I am still off sick from work, and waiting for the stress echo and the cardiology clinic. I hope you get some answers soon. All the best.
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