Hi there, I am a 66 year old female....In March I received results of nuclear stress test and nuclear CT which revealed a blockage in my LAD. I had been experiencing chest pain when starting on my outdoor walk each day, lasting about 5 minutes. This started back in December 2019, which I reported to my family doctor and March 2020, just before lockdown, I had my first nuclear CT. Results came back with no blockages or significant buildup. I had been put on a statin prior to this test as a precaution along with low dose aspirin. With these, results I was told I could discontinue as not needed.
I continued to have the pains and 2 more times back to cardiogist and in March 2024 CT was repeated and showed a significant blockage. April 2024 I had an angiogram/angioplasty with a stent placed in my LAD, which was 90% blocked. I began clopidogrel and low dose aspirin along with the statins , which I had been put back on . I assumed ,and hoped that the pain would be gone, but alas, that did not happen.
I requested a female cardiolgist, as I felt I wasn't being heard by my male cardiologist and he wasn't really trying to figure out what was going on . I mentioned stable angina, or perhaps microvascular disease and he said could be but no real way to diagnose except except by using nitro spray. If it provided relief, then that was likely what I had. Nitro did not help . One week ago I saw my new cardiologist. She was a bit perplexed as to why the pain hasn't gone away, if even for a short period after the stent was inserted. If it had subsided, then she would have thought restenosis had perhaps occurred. She has put me on a beta blocker to see if that helps, stating that it could be Sydrome X aka Microvascular Disesase. I have been on the beta blocker one week, very low dose to start, but no change. I see her in 6 weeks but will likely call earlier as I am concerned that I am still having pain.
I am curious to see if any members here have experienced similar symptoms, have microvascular and had success with Beta Blockers....or have any other suggestions as to what may be going on.
This has been a very frustrating 4 years, and to say I am worried and anxious would be an understatement .
thank you....any input would be appreciated.
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I’m sorry to hear about your struggle with your health over the last 4 years.
Microvascular angina (MVA) tends to be an under-recognised and under-diagnosed condition historically, but improvements in its diagnosis are being made and there is an increase in the number of people being diagnosed with it. MVA can occur during movement or exercise, and also at rest. It is thought that the smaller blood vessels are unable to stay effectively dilated in response to activity and therefore, this causes angina which is the pain and discomfort you feel in your chest. It can also be experienced at rest.
The nitro spray, also known as the GTN spray can be a hit and miss. It is not necessarily a diagnostic tool or medicine in determining whether someone has MVA or not though if it helps, it may be an indication and can help with a diagnosis further down the line.
Beta-blockers seem to be more effective in those with MVA as opposed to another type of angina which I have called coronary artery spasms (CAS) or vasospastic angina (VSA). Beta-blockers may make VSA worse in some patients as it can cause vasoconstriction. I am personally on a beta-blocker which is a Bystolic but this is to treat a high heart rate and not my spasms. I have seem to done ok on the beta-blocker so far and have not noticed a significant difference in the increase of my spasms.
My triggers for spasms are the cold weather, very hot weather, stress, emotion, and a lack of sleep. Certain types of pollutants and smells also trigger it, as well as certain types of food. My pain can be felt either in the left or right hand side of my chest, and spreads to my arms, upper back and jaw.
Some of the tests available for diagnosing MVA is a stress MRI using adenosine or having an angiogram with acetylcholine. The below link has some more information on this. You may benefit from speaking to your cardiologist about these tests to see if they will refer you for one if there are no improvement in your symptoms, though you may find that it is a bit of a struggle in the beginning for them to execute further testing. Therefore, advocation will become very important.
There is also a network of cardiologists who specialise in INOCA/ANOCA conditions (ischaemia/angina in non-obstructed coronary arteries) and you may find that if you have no luck with your current cardiologist, you could receive the right support from a specialist. The link below shows where a specialist near to you might be available.
Failing that, I have some names of specialists based in Canada therefore, if you require any further assistance please let me know and I can PM you the details as we cannot mention physician names/details on this forum.
Alternatively, there is more information on the below link. There is also a lovely patient support group on Facebook, amongst others, which is dedicated to bringing awareness and increasing research in these rarer types of angina (VSA and MVA) which you might benefit from joining if you wish to. Sometimes it helps to know we are not alone in these conditions as often it can feel like a battle in trying to get diagnosed.
Thank you so much for your detailed reply. I love this site and am so happy to have found it . I will definitely look at the sites you have provided. You have suggested lots of possibilities to explore . As mentioned I have just started seeing a new cardiologist and I am hopeful that she is going to get to the bottom of this. She comes highly recommended seems to be committed to figuring this out. Starting on the beta blocker was step one . Is the angiogram that you suggested different than me standard one that is usually done is diagnostic tool?
A standard angiogram and a specialised angiogram using acetylcholine are two different types of angiograms. A standard angiogram can detect blockages for example, but may not be able to effectively detect spasms in the micro vessels and coronary arteries. As a result, a chemical called acetylcholine is administered during the angiogram. If the micro-vessels fail to dilate adequately during the administration of the acetylcholine, it is indicative of microvascular angina. Similarly, in the case of VSA, the administration of acetylcholine can provoke spasms if the endothelium becomes hyperactive, causing transient constrictions of the coronary arteries. The spasm can lead to temporary narrowing of the artery during the angiogram which causes angina or chest pain and therefore, indicative of VSA.
This type of angiogram is not widely available however, with the right support from your physician and a referral to a hospital or centre that provides these types of angiograms, you may be able to have access to one if your cardiologist thinks it is required.
I have microvascular angina and I find that often it is after exercise that I am unwell. Yesterday I was full of energy and went on a brisk quite long ( for me) walk. Today I am paying for it and feel terrible. Chest pain since the early morning.
Sometimes the symptoms of spasm angina and microvascular angina overlap. I had a angiogram test with acetylcholine but I think it was bogus because they injected nitroglycerin before the acetylcholine so I only spammed 50% . I also had the cardiac MRI which showed endocardial perfusion deficit so have been diagnosed with microvascular angina.
Thank you for your reply… I have only ever experienced the pain while walking outdoors. Temperature or weather conditions such as wind or cold have never affected me . Last evening. I had the pain during my walk which subsided after about 5 minutes but about an hour later, while watching TV, I had pain on my left side only which lasted about an hour . My blood pressure was fine, but my heart rate was 56 which for me is quite low. I’m finding since I’ve been on the beta blocker, I can’t get past 90 when I go for a walk. I will check in with my cardiologist office this morning. I suspect there will be more invasive testing to come .
Also I was wondering if something might have gone wrong when they inserted the stent so that it is not working properly? Could you get another CT scan perhaps to check? I don't want to worry you further.
Hi again, since the beginning, when my symptoms did not go away or sub slide at all, I was concerned that perhaps there was an issue with the stent. The cardiologist suggested that if I had had some relief after the angioplasty , and then the pain started up again, that could be restenosis, but since I had no relief at all, she’s unsure and basically will start at 0 again with me. It’s a bit of a mystery yet to be solved . In my original post a few months back, I mentioned that I had to keep insisting to my doctor that something wasn’t right, and she would send me back to the cardiologist who would tell me that there was nothing in the reports and it’s likely muscular … then later mentioned it could possibly be microvascular, but no suggestions made on how to diagnose , just increased my statins… and finally three months after having the stent put in a he gave me GNT spray. At this point I requested a new cardiologist . So I know that I have to keep pushing this. I know my body and I know it’s not normal to feel the way I’m feeling.
I have lived with vasospastic angina for over a decade.
My vasospastic angina was confirmed with a functional angiogram using acetylcholine.
I had spontaneous and acetylcholine induced coronary vasospasms. Also, during a functional angiogram adenosine and other techniques are used to assess how the blood flows through the microvessels. This is how microvascular angina is diagnosed.
Vasospastic angina is caused by transient constrictions of the coronary arteries. The classic symptom is chest pain at rest
Microvascular angina is caused by microvascular dysfunction. The usual cause is the inability of the small vessels to dilate or stay dilated in response to extra demands like exercise. You can also have vasospasms in the microvessels too.
The symptoms of microvascular angina tend to be breathlessness and chest pain with exercise.
The term cardiac syndrome X is a term that was used on the past. It's no longer used by the latest cardiology experts and in current guidelines.
The European Society of Cardiology 2024 guidelines in the management of chronic coronary syndromes uses the terms
Angina/ ischaemia non obstructive coronary arteries, microvascular and vasospastic angina.
I suggest you share these guidelines with your Cardiologist. It gives the latest evidence based recommendations on the diagnosis and treatment of microvascular and vasospastic angina.
The BHF has just updated their information about angina. They have listed this support group as a resource for people living with microvascular and vasospastic angina.
We all respond to medication differently and how a person does or doesn't respond to their medication isn't necessarily the best way to make a diagnose.
It can take trial and error to find the best combination of medication that will work best for you as an individual.
It may help to keep a diary of yur symptoms and see if you can identify your personal triggers.
Mine are the cold, emotional, mental and physical stress. A sudden drop in air pressure and over tiredness.
Sometimes a person can have both obstructive coronary artery disease and microvascular or vasospastic angina at the sametime.
The stent may open up the blocked coronary artery to reveal microvascular dysfunction.
Sometimes you do need to be persistent to get an accurate diagnosis. However you lnow your body best.
I hope you are able to work with your new Cardiologist to get the help you need.
Thank you for your thorough reply. I have never had pain at rest , only with brisk walking, which usually subsides on its own in about 5 minutes . I appreciate the links and will give them a read
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