PET scan microvascular disease

[Heartmum56]

Just seen a private cardiologist regarding ongoing chest pain following NSTEMI 6 months ago. Successful stent and no other main artery blockages. Now considering microvascular angina. Anyone know anything about PET scans for that? Sounds expensive and wondering if NHS do this?

[Tos92]

I’m sorry to hear you might have microvascular angina and I am also sorry to hear about your NSTEMI. I have something called vasospastic angina where my coronary arteries go into spasm, limiting the blood flow to my heart. I had a heart attack last year as a result of one of my arteries, also known as a myocardial bridge spasming.

I am not sure on the methods of testing for microvascular angina however, an MRI stress test seems to be a common one to test for this type of angina, followed by a stress echo, and acetylcholine provocation during an angiogram.

bhf.org.uk/informationsuppo...

There is some good information on microvascular angina and testing on the below website. There is also a list of INOCA (ischaemia in non-obstructed coronary arteries) specialists on this site under the patients section who have knowledge of, and treat microvascular angina, dysfunction, and coronary artery spasms.

inocainternational.com

PET scans are available on the NHS however, I would think that your cardiologist would have to refer you for one through the NHS. You would be right in saying that if you had it done privately, it would be expensive. I have had a handful of cardiac tests done privately, and some of the fees were almost eye-watering. If you have health insurance however, this might help with the expenses.

I also find from a Facebook group that I am on for microvascular angina and coronary artery spasms, some patients choose to pay for the initial consultation privately and then get referred for scans and testing that way on the NHS when the consultant can see that there is a genuine problem. I have attached the group below in case you are interested.

facebook.com/groups/2879606...

There are other forum members that have microvascular angina and have been tested for it. I hope they come by to share their experiences.

All the best.

Tos

[Milkfairy Heart Star]

Hello Heartmum56

I am sorry to hear you are still experiencing on going chest pain following your heart attack.

The possible causes of your ongoing symptoms could be microvascular or vasospastic angina.

These types of angina are often overlooked, go under diagnosed and treated.

The umbrella term for microvascular angina along with vasospastic angina is Ischaemia/ angina non obstructive coronary arteries INOCA/ANOCA.

I was 11 years ago admitted to hospital with a suspected heart attack.

I was incorrectly presumed to have microvascular angina at first. MVA is more common than vasospastic angina.

Microvascular angina is thought to be caused by the inability of the smallest blood vessels of the heart being able to dilate or stay dilated in response to extra demands like exercise, microvascular dysfunction.

A stress echocardiogram can in some cases assess how your heart responses to exercise.

A perfusion MRI can diagnose microvascular dysfunction in some cases.

My small blood vessels can dilate. I can exercise, however I experience my chest pain at rest later, especially during the night.

The definitive way to diagnose microvascular or vasospastic angina is with an invasive functional angiogram.

A chemical adenosine is used along with guide wires to make measurements of how the blood flows through the small arteries.

This is how microvascular angina can be diagnosed.

A different chemical acetylcholine is then injected into the coronary arteries. Normal functioning coronary blood vessels should dilate in response.

If they constrict, accompanied by ECG changes and the person feels their usual chest pain, vasospastic angina can be diagnosed.

You can have vasospasms in your small and large blood vessels.

I had this type of angiogram about 10 years ago to confirm my diagnosis of vasospastic angina.

I technically also have microvascular angina because both my microvessels and coronary arteries go into transient contrictions, vasospasms.

Unfortunately there are only a few centres carrying out this type of testing in the UK.

There is however a study taking place that is aiming to diagnose microvascular angina.

There are about 25 centres in the UK taking part in the study.

Perhaps ask your Cardiologist to get in contact with the research team carrying out the trial?

This could be a way of identifying a NHS Cardiologist with some knowledge of microvascular and vasospastic angina and obtaining your care through the NHS.

clinicaltrials.gov/study/NC...

I have received all my care through the NHS including the following tests, perfusion MRIs, angiograms, stress echoes and holter tests.

I have been reviewed by some of the world leading experts into ANOCA/ INOCA. I have not been offered a PET scan though.

This is a link to a consensus document produced by a group of world experts in this field of cardiology of how microvascular and vasospastic angina can be diagnosed and treated.

internationalheartspasmsall...

Where in the UK are you based?

[Heartmum56 in reply to Milkfairy]

Thank you so much Milkfairy . This is all hugely helpful. I'm not sure my cardiologist is an expert in this but he seemed to suggest I would go to Oxford for the PET scan. I am in Buckinghamshire.

My pain is unrelated to exertion (so I don't think a stress echocardiogram is much use to me?) and does not affect me at night either (so not vasospastic I think?) It seems to be related to stress during the day. Does that make sense from what you have picked up on your journey with all this? This article seems to describe me best: heart.org/en/health-topics/...

What I can't quite work out from all my reading ( and I can't fond the relevant bit now!) is if there are in fact two sorts of microvascular angina one caused by spasm and one by dilation issues, and if so whether this PET scan can detect either. Do you know? I am looking for whatever is the best non invasive test.

[Milkfairy Heart Star in reply to Heartmum56]

The link is to the American Heart Association website and the understanding of microvascular and vasospastic angina have certainly greatly increased over the years.

The WISE study in the US was started many years ago.

Yes, there are thought to be two causes of microvascular angina.

One type of microvascular angina, is as you say due to dilatation problems. The inability of the small blood vessels to dilate or stay dilated in response to exercise, microvascular dysfunction.

The other due to vasospasms in the small vessels.

internationalheartspasmsall...

Microvascular angina can be diagnosed by a perfusion MRI and a PET scan.

Coronary vasospasms either in the small vessels can be only be confirmed by an invasive functional angiogram.

The Coronary Vasomotor Disorder International Study Group COVADIS, are trying to unify the terminology and testing protocols.

The BHF and The National Institute of Healthcare Research NIHR have produced these guidelines about testing.

internationalheartspasmsall...

Here's the BHF information about vasospastic angina.

bhf.org.uk/informationsuppo...

Another useful resource is this website that was created by four patients with over 50 years experience of living with microvascular and vasospastic angina. The group is supported by world expert Cardiologists.

internationalheartspasmsall...

The symptoms of microvascular angina can overlap the symptoms of vasospastic angina.

I experience breathlessness and chest pain on exertion as well pain at rest during my unstable phases.

I suggest you keep a log of your symptoms and see if you can spot your triggers for your symptoms.

Mine are the cold, emotional, mental and physical stress.

We're asked not to name individual doctors on the forum. I'll message you some names of some Cardiologists who maybe able to help you.

[Suzyh]

I had that done when I continued getting chest pains after stent put in on nhs

[Heartmum56 in reply to Suzyh]

Ah that's good to know. Where did you have it done and did you have to fight for it? GP seems reluctant to refer.

[roughquest]

You can have a PET scan on the NHS because I did 3 days ago here!

rbhh-specialistcare.co.uk/i...

Some perculiar diet and fasting requirements prior to the tracer injection and scan but nothing to fret about 👍

[Poppy451]

I am not sure if a PET scan is the same as a myocardial perfusion scan . This is where they scan you ,then maybe you have to eat something, then they inject you with radioactive tracer and then scan you again to look at the perfusion of blood in the heart. I did this but could not continue with the test because I had a very bad reaction to the radioactive tracer. Another test is a cardiac MRI with gadolinium I think . This is what eventually diagnosed me with micro vascular angina.