Coronary reactivity test (Microvascular dysfunction?)

[Ignacio182]

Hello everyone,

I had a NSTEMI a couple of months ago and after going through the Cath lab and outruling main artery blockage, I was requested and MRI.

Even though the MRI showed a

Left 57% ventricular ejection fraction

Right 68% ventricular EF.

They found hipokinesis in the mid inferior left ventricle and Myocardial enhancement level 1.

Overall the heart is functioning, but they have to discover what is wrong.

My cardiologist ordered a CRT to check endotelial function and check if there is microvascular thing going on.

I am located in Miami and have not found a hospital to make this exam,

Any help from someone that has been through this same situation?

Regards!

[Milkfairy Heart Star]

Hello,

We are asked not to name individual doctors or hospitals on the forum.

However, I suggest you have a look at this article which is written by an experienced Cardiologist knowledgeable about ischaemia/ angina non obstructive coronary artery disease, INOCA/ANOCA.

INOCA/ ANOCA is an umbrella term for microvascular angina and vasospastic angina.

He is based in Florida.

sciencedirect.com/science/a...

Here in the UK microvascular dysfunction and coronary vasospasms are diagnosed by a functional angiogram.

The US uses terms such as endothelial dysfunction slightly differently to the UK.

I was diagnosed with vasospastic angina following a functional angiogram many years ago.

I notice you also live with antiphospholipid syndrome which is associated with microvascular angina.

aps-support.org.uk/about-ap....

[Ignacio182 in reply to Milkfairy]

Thanks Milkfairy, Can you share your experience throughout these years? Do you feel any symptoms? I do not have chest pain, but mild shortness of breath after exercise.

Thanks!

[Milkfairy Heart Star in reply to Ignacio182]

I have just added to my original reply to you concerning antiphospholipid syndrome.

I experience lots of chest pain mainly at rest which wakes me at night. I unfortunately don't respond well to my medication.

You might find this website helpful.

internationalheartspasmsall...

[1a2b3 in reply to Milkfairy]

Milkfairy, I find your reply very interesting. For four years , I experienced mild chest pain when doing any type of brisk, extended walking. In 2019 this happened for the first time which I reported to my family doctor I was referred to a cardiologist and did a contrast dye stress test followed by a nuclear CT both showed no blockages, heart healthy, lungs healthy. These symptoms continued for four years, in which time I always brought up to my family doctor that I was still experiencing the symptoms. . I would go back to the cardiologist who, because of my clear testing, said it was likely muscular. Fast forward to one month ago, April 2024. I have a repeat nuclear CT done and I’m found to have a 90% blockage in my LAD . After reading your post and looking up ANOCA/INOCA , I believe that is what I was experiencing. Very frustrating. Had this been detected four years ago , would I have avoided a 90% blockage requiring a stent? This is a question. I will be asking my cardiologist on my visit… Even after having the stent, I am still experiencing pain when exercising.

[Milkfairy Heart Star in reply to 1a2b3]

I am sorry to read about your experience. Some people do have both obstructive and non obstructive coronary artery disease at the sametime.

Once the obstructive disease is treated by a stent it can reveal INOCA/ ANOCA conditions such as microvascular or vasospastic angina.

There is also an unconscious bias in cardiology about women and heart disease.

You might find these links interesting.

bhf.org.uk/informationsuppo...

academic.oup.com/eurheartj/...

[1a2b3 in reply to Milkfairy]

There is so much to learn and try to understand. I also have positive LP(a) which I was only tested for this year . I listened to a podcast recommended by another member which was very informative .

Thank you for replying and I will check your recommendations out.

I am in Canada … how do you find out if you have INOCA/ANOCA ?

[Milkfairy Heart Star in reply to 1a2b3]

INOCA/ANOCA is an umbrella term for microvascular and vasospastic. The tests are slightly different.

Microvascular angina is caused by microvascular dysfunction. The smaller blood vessels in the heart don't work properly, they fail to dilate or stay dilated when extra demands on the heart are made by exercise.

Whilst Vasospastic is due to the coronary arteries going into transient constrictions, coronary vasospasms.

Invasive testing for INOCA/ANOCA

[Milkfairy Heart Star in reply to Milkfairy]

Microvascular angina can be diagnosed by none invasive testing.

Vasospastic angina is diagnosed using acetylcholine.

None invasive testing

[1a2b3 in reply to Milkfairy]

Thank you ! You are so knowledgeable, I am so glad I found this forum. There is so much to know and learn .

[Ignacio182]

I am gonna check if possible to do that test and get the diagnosis.

[Milkfairy Heart Star in reply to Ignacio182]

Good luck!

[fishonabike]

i have no direct experience of microvascular issues but the is a US network which has a list of doctors and clinics which offer relevant treatment:microvascularnetwork.com/

[Hatchjd]

I was diagnosed as NSTEMI in 2019 even though I did not have raised enzymes just a short episode of jaw aching. Retired RN so I decided it needed investigating.

i had 80% and 90% blockages and received 2 stents. The day after the angio and stents I had an echo that showed 46% left ventricular stunning - hypokinesis due to ischemia.

Fortunately this improved as a repeat echo 18months later ( following covid lockdown) I had normal LV function and EF of 65%

My note was mainly to say it can improve, hopefully they will get to the root of the problem.

[Ignacio182 in reply to Hatchjd]

Thanks for your answer!

How did you managed diet and exercise?

[Hatchjd in reply to Ignacio182]

I did walk every day, gradually building the distance and speed until I averaged 3 miles a day. Initially I could barely walk the length of my street and it probably took a year to feel "normal"

In my case, ischemia caused myocardial stunning and ventricle hypokinesis. The stents likely improved the blood flow and the muscle recovered.

[Ignacio182 in reply to Hatchjd]

Your words encourage me to take it slowly. I feel short of breath during the day, normal during walks and strength exercise.

Thanks again