Microvascular angina

[Anginalady]

Hi, I've recently been diagnosed with microvascular angina and awaiting an angiogram for further invasive testing to identify the cause. Anyone else out there managing this type of angina, any pointers for coping, long term prognosis, changes to medication appreciated.

[Milkfairy Heart Star]

Hello,

Welcome to the forum.

I have lived with vasospastic since 2012.

I have transient constrictions in my microvessels and coronary arteries, coronary vasospasms. I experience most of my chest pain at rest especially during the night.

My vasospastic angina was confirmed by a functional angiogram when chemicals were injected into my coronary arteries to see how they responded and how the blood flowed through my small blood vessels.

Vasospastic angina and microvascular angina are types of angina/ ischaemia non obstructive coronary arteries ANOCA/INOCA.

The only treatment option is by medication. It can take time to find the best combination of medication to help treat your symptoms.

With medication and adopting a heart healthy diet and life style the prognosis of the condition is improved.

Microvascular is a long term chronic condition which can effect the quality of your life.

Coming to terms with any long term condition can take time.

Another more common cause of microvascular angina is when the smallest blood vessels fail to dilate or stay dilated in response to exercise, microvascular dysfunction.

People with microvascular angina tend to experience their symptoms such as breathlessness and chest pain when they exercise.

It can help to keep a diary to see if you can spot the triggers for your angina.

Common triggers are the cold, emotional, mental and physical stress.

I manage my stress by practising yoga, Tai Chi, and walking my dog everyday

The BHF has this information about microvascular angina.

bhf.org.uk/informationsuppo...

You may find this website helpful too. It gives lots of information as well as the latest research.

internationalheartspasmsall...

There are several members on the forum who live with microvascular or vasospastic angina who hopefully will be along to share their experiences with you too.

[Anginalady in reply to Milkfairy]

hi Milkfairy

Thank you for your reply, I’ve read so much over the past few weeks, so many acronyms to remember!!

Looking at posts on this site there seem to be so many different combinations of drugs. I’m clearly at the start of my journey, can I ask if your symptoms have deteriorated since 2012? Or have you just adjusted your medication over time to manage it?

I’m on Bisoprolol, Atorvastatin and aspirin, with a GTN spray, it’s hard to come to terms with the fact that I’ll be taking these forever.

My trigger is exertion, 10 minutes into a brisk walk or half way through housework will cause the chest pain and breathlessness for me. No problems at rest.

Thank you for the links, most helpful. Keep well.

[Milkfairy Heart Star in reply to Anginalady]

What helps is having the correct diagnosis. The symptoms of microvascular and vasospastic angina can overlap.

Do you know whether you'll be having a functional angiogram when adenosine and acetylcholine are used to see how the blood vessels respond?

This is the most accurate way to confirm a diagnosis of microvascular or vasospastic angina.

The treatment for microvascular and vasospastic angina are different.

I was presumed to have microvascular angina originally. Vasospastic angina is much rarer.

I was even prescribed beta blockers which can help if you have microvascular angina. Beta blockers can make coronary vasospasms worse which I found out the hard way as I ended up in hospital with unstable angina when I was prescribed beta blockers.

Some people do well on treatment, some stay the same others get worse overtime.

My vasospastic angina is stubbornly resistant to treatment. I have overtime learned to walk a tight rope by being aware of my triggers and pacing my activities.

I end up in hospital about twice a year with unstableangina.

This however is my story and doesn't mean it will be your experience. I am unlucky, my very experienced Cardiologist says he's never encountered someone as profoundly affected as I am.

I see my Cardiologist about 3 times a year and he regularly comes to see me on the ward when I am admitted.

I am also aware of people who with the right medication are able to run, exercise and lead the life they did previously before their diagnosis.

I hope with time you'll find a manageable equilibrium.

It took me sometime to get used to taking my medication. Over the years I have probably been prescribed every combination of medication available.

I now take very high doses of Diltiazem, nicorandil, Isosorbide mononitrate, GTN patches, clopidogrel, rosuvastatin, Lansoprazole and use oxygen at night.

My Cardiologist wants to add Ivabradine to slow my heartrate.

This illustration is from a recent article about the management of microvascular and vasospastic which are referred to by the umbrella term, ischaemia non obstructive coronary arteries INOCA.

I hope it helps clarify the possible treatment options.

Whilst the information on the BHF is good, it is becoming outdated much of the microvascular angina information being produced nearly 10 years ago.

sciencedirect.com/science/a...

Suggested management of microvascular and vasospastic angina

[Anginalady in reply to Milkfairy]

Thank you so much for your sharing your experience, yes it is the functional angiogram with adenosine and acetylcholine that I’m waiting for.

After my previous angiogram (2019) when all was clear, I was just taken off all medication because they said my heart was fine and I didn’t need it. Strangely, I believe the angiogram did something as my chest pain stopped, doctors seem to brush this comment aside, but I would say I had 4 years with no chest pain or breathing difficulties and it gradually started up again after that.

Hopefully the functional angiogram will give a clearer picture.

I hope they find a combination of drugs that works for you soon.

Thank you again for the links, take care

[Crystal614]

Hi, I have been diagnosed with MVA. I have had it for 10 years. I have not had the more invasive testing done. I recently had a change in medication, I now take Diltiazem, beta blockers have been stopped. I also take Monomil XL, my GTN patch has been increased to 10mg. I have been taking Trimetazidine since 2017 and I have found this drug to be very beneficial, this drug can only be prescribed by a cardiologist. Since this change in medication I am now doing much better. I have learnt to pace myself, I go for slow walks, I enjoy gardening but I don't over do it, I do a little at a time. I wrap up with extra layers in the winter as the cold can effect me more.

[Anginalady in reply to Crystal614]

Hi Crystal614,

Thank you for your reply. Can I ask, do you have regular checkups with a cardiologist? How often do they monitor you or do you just get to see them when you have a change in symptoms?

I’ve not heard of some of your medication, more research to do! Glad to hear you’re doing better. Keep well.

[Crystal614]

Hi, I actually have an appointment with a cardiologist in a few days time, its a follow up appointment from my hospital admission in April. Usually I have an open appointment so if I have any problems I either contact the secretary and request an appointment or the GP will contact cardiology for me. But due to the complex problems I have with pacemaker/electrical issues another hospital is involved with this now. Should be interesting! All the best to you. Hope you get sorted soon.