I am 67 and was hospitalised in May this year following very high blood pressure, chest tightness, breathlessness , extreme fatigue and light headedness etc. I am very lucky that in crisis I was admitted to the cardiology ward for treatment as bloods showed I had increasing levels of the enzymes indicating a heart attack was likely. I was diagnosed with micro vascular disease. I have been struggling with this for way over 10 years, with the issues gradually worsening, happening during physical exertion and at rest (sleeping and sitting). It's definitely reassuring to have a diagnosis at last but I'm still frightened, struggling and not able to do much at all.
For a while I've been on and off water tablets for leg and ankle swelling. Hospital tests showed this isn't heart related so the GP diagnosed 'elastic veins' and recommends elastic stockings to prevent fluid pooling at feet/ankles. As the hospital described micro vascular angina to me as issues with the veins preventing blood flow to the heart, does anyone know if there is any connection between 'elastic veins' and microvascular angina?
I have also just been tested for Alpha-1 antitrypsin deficiency AATD, following the recommendation of my brother's cardiologist, as my brother has recently tested positively. I'm waiting for the actual result but the GP has said my alpha 1 antitrypsin levels are very low, indicating deficiency and the test has gone to the genetics lab. I've read that AAT deficiency can affect the collagen and elastin in veins and I'm wondering if this can be connected to micro vascular angina, but I'm probably confusing the terms elastic and elastin and jumping to links that aren't there. Am I clutching at straws looking for reasons and help?
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How has your microvascular angina been diagnosed ?
Microvascular angina is thought to be due to the inability of the small blood vessels ( tiny arteries) of the heart not working properly.
The microvessels either fail to dilate or stay dilated in response to extra demands like exercise. This leads to a lack of blood supply to the heart and a person will feel the symptoms of angina including breathlessness on exertion.
Microvascular angina along with vasospastic angina are types of ischaemia/ angina non obstructive coronary arteries INOCA/ANOCA.
Vasospastic angina is thought to be due the to the inner lining of the blood vessels of the heart, not working properly, endothelial dysfunction and hyperactivity of the smooth muscle in the artery walls.
This causes coronary vasospasms which usually occur in the coronary arteries but can occur in the microvessels too. The person tends to experience their chest pain at rest, especially during the night.
This is the type of angina I live with.
Microvascular and vasospastic angina are a disorder of the large and smallest arteries of the heart.
The BHF has this information about microvascular angina.
The consultant diagnosed microvascular angina after tests in hospital showed restricted blood flow to the heart. They expected to insert stents but discovered the arteries are clear. On discharge the consultant said there is another test which can be done to find out more which we will discuss in the follow-up appointment, which isn't until February 2025 due to waiting lists. I can contact directly for an earlier appointment if things deteriorate before then. I contacted 111 last week after 4 days of increasing intensity of symptoms which my medication and spray didn't help at all. On that day it kicked off at 4am and didn't ease until 2am the next day whilst in A&E. I was told it's unstable micro vascular angina, but nothing else. I have researched it including BHF info and found your posts very helpful too, but really am struggling the the daily variability of it, as many people seem to be.
Thanks for the link to newcastle hospitals for AATD, I've been researching that for a few months following my brother's diagnosis. There is also a helpful information and support site for AATD alpha1.org.uk/
Most sites/research don't have much on any coronary links with AATD but there are a few new papers published in recent years that are doing that. I was just wondering if the 'elasticity' of veins could be impacted, but with no medical knowledge whatsoever I think I'm probably needlessly clutching at straws.
I will certainly follow your advice to call the BHF helpline.
It may help to keep a log of your symptoms and see if you can spot any triggers.
Mine are the cold, sudden drop in air pressure, emotional, mental and physical stress.
It can take trial and error to find the best combination of medication that will work best for you. I suggest you ask for an earlier appointment, you could request a cancellation.
It's important to have an accurate diagnosis to be able to be offered the appropriate treatment.
The most accurate way to confirm a diagnosis of vasospastic or microvascular angina is by a functional angiogram. The way the blood flows through the small vessels is measured followed by an assessment for vasospastic angina in this type of angiogram.
Living with microvascular and vasospastic angina can feel like walking on a tight rope. I will be hit by chest pain out of nowhere for no rhyme or reason.
This website created by 4 patients has lots of information.
Thanks again for your help. I need to record triggers as my memory is not good and I probably forget as much as I remember. I have been worried about asking again for an earlier appointment, as so many people are desperately waiting to see cardiologists and people I talk to seem to think that angina is easy to live with. I see your point about getting the right diagnosis to be able to know which meds to try, so I will try again and see what happens. Thanks for your info and support, I'll follow everything up.
microvascular angina usually affects the tiny arteries and arteries have a layer of muscle in their walls which allows them to contract and relax
your "elastic veins" are veins which do not have a layer of muscle, so they don't contract and relax
both are vessels and part of your vasculature and all include collagen in their structure
I'm not sure how AATD defficiency affects your situation but suspect that knowledge in this area is developing - you could be right about there being links but may struggle with medics who know little about either issue😒
what concerns me is that you don't seem to have much by way of helpful treatment for your pain - you may need to push your GP habit to get something done while you wait for the tests to confirm your diagnosis
on the other issue: veins rely on valves and pressure from surrounding tissues to move blood back toward the heart - if these start to fail you can get symptoms like your swelling legs - you might want to look for info on venous insufficiency
Another really helpful reply, thank you. I have an appointment booked with my GP to discuss this and how the medication is working after blood tests. The appointment was delayed while waiting for one of the tests. I've had a text message to say the appointment will now be a telephone call at the end of august. That suggests to me that the doctor considers no adverse effects seen in the bloods after using the new medication. I have rung to try and change the appointment, as I need to talk about how I am on the meds and would prefer to see the doctor, but it's classed as non urgent so that's it. I've taken on board suggestions from here and will note everything down that I want to say. It's such a lot to take in, and I really appreciate the help here, thank you.
Thanks Qualipop, you're so right, and I'm glad I joined the forum. With the best will in the world and knowing how busy doctors are, I'm already learning that! There's definitely more specialised help and information here. Thank you.
JUst remember that the members on here are not medical professionals b ut they do have he experience. It appears that an awful lot of cardiologists and many more GP s, know very little about your condition
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