Does anyone have any experience with microvascular angina. My cardiologist suspects I have it and has booked me in for an angiogram.Can anyone tell me what symptoms they were having if they've got it.
Micro vascular angina : Does anyone... - British Heart Fou...
Micro vascular angina
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Fifimyangel
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MilkfairyHeart Star
Hello,
Over 10 years ago I was admitted to hospital with a suspected heart attack.
I was presumed to have microvascular angina. I had a functional angiogram using a chemical, acetylcholine which showed that I have transient constrictions of my microvessels and coronary arteries, coronary vasospasms.
I have vasospastic angina along with microvascular angina.
I experience my chest pain and other symptoms at rest, especially during the night. I also feel as though my bra is too tight, chest pressure and tightness.
Microvascular angina can also be due to microvascular dysfunction. The small blood vessels of the heart don't work properly. The microvessels don't dilate or stay dilated in response to exercise and other extra demands.
The symptoms of microvascular angina tend to be breathlessness and chest pain on exertion. Microvascular angina is more common in women.
Microvascular and vasospastic angina are types of angina/ ischaemia non obstructive coronary arteries ANOCA/INOCA.
Up until recently microvascular and vasospastic angina were largely under recognised and diagnosed.
The BHF has some further information in their ' Understanding Angina ' booklet
bhf.org.uk/informationsuppo...
At the end of the booklet there is a link to a website for people living with microvascular and vasospastic.
The BHF also has this information about microvascular angina.
bhf.org.uk/informationsuppo...
There are are quite a few forum members who live with microvascular and/or vasospastic angina who hopefully will be along to share their experiences with you too.
Has your Cardiologist said whether you will be having a functional angiogram where how your blood vessels work will be assessed?
Thankyou x
Hi Milkfairy, I very much have same symptoms and diagnosis. I find your posts most informative and helpful while following you regularly. Would you feel comfortable sharing what medications you are on? I am learning there may be a difference between treatment in USA and UK especially concerning beta blockers. Just as an aside, my term for the bra is the "too tight bra syndrome" lol. Thank you!
Hello,
My understanding from being in contact with people from the US living with microvascular and vasospastic angina is that the US uses slightly different terminology and testing techniques.
The term Angina/ Ischaemia non obstructive coronary arteries ANOCA/INOCA is now being used more widely.
In the US ' endothelial dysfunction' is given as a diagnosis and beta blockers recommended.
While in the UK, Europe and Australia beta blockers are given only to treat microvascular dysfunction not vasospastic angina even though endothelial dysfunction is thought to be present along with hyperactivity of the smooth muscle in the artery walls as a cause of coronary vasospasms.
Beta blockers can make coronary vasospasms worse. The patient information leaflets of beta blockers actually say beta blockers are contraindicated for people with vasospastic angina.
Cardiologists in Europe and Australia tend to follow the recommendations of the European Society of Cardiology which is the largest and probably most influential professional organisation.
The ESC has just recently published their latest guidelines which I suggest are a good resource for evidence based treatment guidelines for ANOCA.
See section 5.2.
academic.oup.com/eurheartj/...
We are all individuals and respond to our medication differently. I don't respond particularly well to my medication which means I end up in hospital about twice a year.
So what works for one person won't necessarily work for another.
I am on very high doses of a calcium channel blocker, nicorandil ( not available in the US) isosorbide mononitrate, nitrate patches, clopidogrel, rosuvastatin, lansoprazole, oxygen and a low dose of ivabradine ( which is not recommended if you take Diltiazem).
I was in hospital on continuous cardiac monitoring and my Cardiologist did a trial ivabradine. The conclusion the benefits of the Ivabradine out weighed the risks.
Medication is only part of the management of vasospastic angina.
You may find the information from this website helpful.
internationalheartspasmsall...
Medication to treat angina.
Hi. Thats helpful, Likewise I've had the angiogram test and my heart went into block so my beta blockers (bisoprolol) I was currently on were stopped immediately. Confirmed I have vasospastic angina and coronary artery spasm. I'm now currently taking Invabradine and Verapamil and slow release nitrates twice day. I get the heavy or tight chest feeling daily but not as severe, I just know it's there.
I'm currently waiting on MRI as they ASD I have may also be causing some of my issues.
It's nice to know im.not alone with these symptoms as sometimes I think it really gets to my head.
All the best fifimyangel with the tests.
When I was first diagnosed there were no support groups. It was so isolating. I found going to a Pain Management Programme helpful where I met other people living with pain in their lives.
Life with vasospastic angina can feel like learning to walk on a tight rope.
The psychological impact of living with the uncertainty and unpredictability of vasospastic angina is challenging!
Have you been prescribed an antiplatelet or anticoagulant because of your atrial septal defect?
I am prescribed clopidogrel as my coronary vasospasms are so frequent.
I hope your coronary vasospasms remain well managed and Good luck with your MRI.
Hi, I’m newly diagnosed with vasospastic angina after my angiogram on Monday. I had the angio as my cardiologist also thought I may have microvascular angina as we knew my large arteries were clear.
My symptoms were chest tightness and my arrhythmias were being aggravated by it. It wasn’t terribly painful for me and I understand many get a lot of pressure and or pain - thankfully I don’t. I do get a lot of pin point pain on the left underside of my breast and occasional the right top side and it will be interesting to see if my new medications which are designed to help stop the pressure, also make the pin point pain disappear. It’s a bit like a stitch type pain but only for very short periods here and there and never when I’m exercising - only at rest! The same with the chest pressure
The angio was an interesting procedure and I felt what many must feel during a heart attack. The arteries spasmed before they injected me with anything and this time I felt chest tightness and pain up into my jaw. Then when they injected the stuff to provoke my arteries the pressure on my chest became incredibly intense! I could barely speak to let them know.
My vasospastic angina is apparently not connected to my current cardiac issues and is another issue on top. The cardiologist who performed the angio said it was much more common in women over 40 and I suspect it’s potentially linked to hormones in some cases. I hope your angio goes well.
Thankyou
Interestingly the latest research suggests that men and women are affected equally by vasospastic angina while microvascular angina disproportionately affects women.
Though some women do have more symptoms at different stages of their menstural cycle.
Beta blockers are usually contraindicated when you have vasospastic angina as they can make coronary vasospasms worse.
I ended up in hospital when prescribed beta blockers many years ago when I was assumed to have microvascular angina.
You may find this recent article helpful. It was co authored by an expert patient and two world leading experts into vasospastic angina. One of whom is based in Australia and is the co founder of COVADIS Coronary Vasomotor Disorder International Study Group.
Chest pain and breathlessness on that is climbing stairs and hills. I'm Ok on medication unless I do the above.
Thankyou
Chest pain on exertion - mostly when walking up hill although it can vary. Sometimes I can do a short sharp uphill walk and get nothing, other times a slight slope can cause pain.
I'm on Atorvastatin 20 mg and Zemtard (300 mcg). After getting a second opinion a very good cardiologist told me that "anecdotally" his patients benefit from the max dose of Zemtard and I've been taking that for 2 - 3 years now. I sometimes wonder what would happen if I stopped taking the Zemtard altogether.........
Thankyou
Being a calcium channel blocker it also helps reduce blood pressure. Did you have high blood pressure previously as well. It may be covering a dual role.
Yes, my blood pressure is a bit on the high side. I'm sure the medics are happy to see me on it.
I’ve been monitoring my blood pressure after having being started on a new drug this week for my vasospastic angina. I’m normally hypertensive and am on candesartan to control it, but it’s been noticeably lower this week. I started to read up on my figures and have discovered what I used to think of as low bp is now normal and within range. I hadn’t know that the guidelines for high and low had changed so much. I’ve never really had cause to even look at the low before! Always learning. 
Ennasti
Which medication has your Cardiologist prescribed for you?My Cardiologist is very concerned if my blood pressure goes too high or low.
Any changes in heart rate or blood pressure can reduce the amount of blood that goes to your heart and trigger coronary vasospasms.
Does your Interventional Cardiologist have a good understanding of vasospastic angina?
The maximum dose of Diltiazem required for people living with microvascular and vasospastic angina can need to be much much higher.
I am on 360mgs of Diltiazem twice a day.
I am 420mgs a day 240mgs morning 180mgs evening for vasospasms.
I hope your coronary vasospasms are well managed.
I was last in hospital July this year. I wouldn't get in the bed when they moved me to a two bed room after A&E as I felt all I needed was my medication tweeked and I was going to be kept in a bed that could be used for someone who needed it.I had my first heart attack and stent fitted August 2022 Takosubo October 2022 day after covid injection second heart attack July 2023 given more blood thinners November 2023 after another episode which as well as all the other past admissions to hospital with feeling I had very bad indigestion I had an angiogram with Acetylcholine done. This is when they found very quickly I was suffering from prinzmental angina (vasospasms) medication upped after find. So when I had an episode this year in July and had waited in ambulance outside A&E for 6 hours had an episode in there and another just after I was sent up to two people one room ward I had decided when I seen doctor I would enquire about tweeking my meds. Oh and while I was in A&E had seen a cardiologist who said I had had a mild heart attack and would need an angiogram. I told him I had had five angiograms and didn't think I could take anymore due to nerve damaged caused previously. I told him I suffered from vasospasms he asked in not a good manner how I knew that. So I went into great detail how it was done. He obviously didn't read my discharge notes that I always take to hospital with me as my procedure and found vasospasms were done at the British Heart Institute Hospital which are run by a different Trust and don't seem to appear on each others records . Which I find weird as I always thought NHS was NHS. Anyway sorry for long story but thought would only make sense with a background story for the conclusion which is it took a while for a lovely cardiologist to come see me who was bit concerned I wasn't in bed but after I explained all of the above he agreed with me about tweeking meds and after a while waiting for discharge letter I went home and fingers crossed all ticking along nicely since 😊
Hope I haven't jinxed it now lol. I do apologise for long story but also as has been said on here many times you know your body and you have a right to ask about meds.
It is unfortunate that there is no joined up communication through the NHS.
When my vasospastic angina was confirmed over 10 years ago by a functional angiogram with acetylcholine, even fewer Cardiologists had any understanding of coronary vasospasms.
I have put in place several things to help me avoid going into hospital.
My GP practice will do my ECG and troponin blood levels. There is an alert on my records to notify the staff to do this.
I have a supportive Cardiologist whom I email if my vasospastic angina becomes unstable.
I carry a copy of my angiogram results with me at all times along with my Admission Plan which was written by my Cardiologist, Pain Team, ward staff and by myself.
I still need to be admitted to hospital about twice a year for treatment with IV GTN to calm my unruly coronary vasospasms.
I will occasionally encounter a numpty Cardiologist, who I just ask to read my careplan and tell them to speak to my Prof.
I have this written in my care plan
'Acknowledge Mrs ******* expertise in her own condition '
We do indeed know our bodies best
I hope your coronary vasospasms continue to stay well managed.
Thank you. Hoping you stay stable too.How did you get a care plan put in place? Would be good if I could as repeating everything to every person that approaches you while you are in agony and breathless is exhausting.
Thank you.
NHS England support the use of careplans for people living with long term conditions.
england.nhs.uk/personalised...
I asked my Cardiologist for a careplan, he agreed I needed one.
My Cardiologist has seen me during a severe, prolonged episode of coronary vasospasms, so understood how difficult it is for me to communicate my needs when I am in pain.
My Careplan has just been updated and is uploaded onto my electronic patient records system of the hospital.
This recent article has also been uploaded into my records by my Cardiologist.
I also carry a paper copy to give to staff.
Last time I was in hospital many of the staff read this paper and said how helpful it was.
journals.sagepub.com/doi/10...
Thank you so informative. I will look into this. Have a nice day and keep well.
I was told that the max is 300. That's obviously not the case!
My Cardiologist said the maximum dose, used in Japan where vasospastic angina is more common, is a whopping daily total dose of 960mgs!
I am now doing better since I had a change of medication. But I had chest pain and breathlessness on exertion, walking up hills, stairs as well. Sometimes pain would start immediately after exercise. Cold weather is a big trigger for me. Not looking forward to the winter, but it will be interesting to see how I do with the change of medication. I have had to slow down and pace myself.
Thankyou
My symptoms are most prominent with emotional stress, which is when my blood pressure rises too. Also get breathless when walking on any sort of gradient of a slope or hill but ok with household stairs. Can walk on straight road for miles if have to. And when there is an attack at home the bra has to come off for some relief. Ranolazine and isosabride seems to help, but who knows, as there is no follow up angiogram since 5 years ago
Milkfairy is extremely knowledgeable and we all benefit from her sharing the info. In many ways the info is much richer, useful and practical than what we get from the clinicians
I too have microvascular angina, it took a while before it was "diagnosed". I take monomil XL 60mg (isosorbide, calcium channel blockers : Diltiazem 60mg and Ranolazine 375mg (which is often referred as a top med). For my high BP I take Losartan 50mg. Plus the usual add-ons : Altorvastating and Aspirin. I also carry a GTN spray which I sometimes use
As many have already, meds are very much a personal prescription: what works for me may not work for many others. In my case, my MVA seems to be stable in general
Hope that helps
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