Breathlessness / Microvascular dysfunction

[Ignacio182]

Hi everyone,

I wanted to share my journey with microvascular dysfunction which led to a MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) despite having a normal ejection fraction (59%).

I experience chest pain, breathlessness, and fatigue, often triggered by stress or exertion. After tests ruled out major coronary blockages, I was diagnosed with microvascular dysfunction and started on:

- Atorvastatin: For cholesterol and vessel inflammation.

- Ramipril: To lower blood pressure.

- Clopidogrel: To prevent clotting.

- Metoprolol: To reduce heart strain.

- Dapagliflozin: For added heart protection.. as an Echo found that I have slight HFpEF in a couple of arteries.

While these help, I still struggle with occasional chest discomfort, fatigue, and shortness of breath, especially during stressful times.

I play padel tenis twice a week,

Do light exercise like walking.

-Stress management through breathing exercises and mindfulness.

- Symptom tracking to identify triggers.

Looking for Advice

1. Have you managed microvascular dysfunction or MINOCA? Any tips to reduce symptoms?

2. Are there other medications (e.g., ranolazine, ivabradine) or therapies you’ve found helpful?

3. How do you handle the emotional toll of a heart condition with “normal” test results?

I’d love to hear your insights and experiences. Managing the dyspnea can be hard at times..

Thanks for reading,

[Milkfairy Heart Star]

Hello

Living with angina/ ischaemia non obstructive coronary arteries ANOCA/INOCA is challenging!

Is your microvascular dysfunction caused by the inability of your small blood vessels to dilate or is it due to microvessels vasospasms?

I live with vasospastic angina, I have transient constrictions of my coronary arteries and microvascular vasospasms.

I was diagnosed by an angiogram using acetylcholine.

Microvascular and vasospastic angina are complex conditions and the psychological fall out can be profound.

Over the years I have come to a place of acceptance. However I need to work on this just like I need to exercise.

It's tough because at first nobody believed me. I was told incorrectly I couldn't have angina or a heart attack because my coronary arteries are unblocked.

My functional angiogram says otherwise.

I do have dynamic ECG changes during my severe episodes of chest pain which were ignored at first.

I have a good Cardiologist who co designed my Admission Plan with the ward nurses, pain team and myself.

I have been supported by a Clinical Psychologist too.

I practice Tai Chi, yoga and Mindfulness meditation which I find helpful.

I get breathlessness or a feeling that someone has put my chest in a vice and I just can't breathe in when my vasospastic angina is unstable.

I find this symptom one of the most difficult to manage.

It feels like drowning on dry land.

I concentrate on my breathing and use visualisations to try and keep calm as possible.

I listen to music.

I found this free app helpful, which has lots of stratergies to manage your breathing and relaxation techniques.

insighttimer.com/

I can recommend Vidyamala Burch's books, in particular

'Living Well with Pain and Illness'

I also use a transcutaneous electrical nerve stimulation, TENS machine.

I used a TENS machine as well as breathing and relaxation techniques during labour.

All these techniques help turn the volume down on my symptoms.

When I run out of coping strategies, I contact my Cardiologist and I go into hospital.

We're all individuals and respond differently to medications so it can take a while to find the best combination of medication that will work best for you.

The University of Adelaide and a patient group has collaborated to produce a survey to find put more about the experiences of people living with microvascular and vasospastic angina.

You might like to take part?

You'll find more information in this post.

healthunlocked.com/bhf/post....

[Ignacio182 in reply to Milkfairy]

Thanks MilkFairy, for your detailed response and for sharing your journey. It's inspiring to see how you've worked toward acceptance despite the challenges of vasospastic angina.

In my case, my microvascular dysfunction is likely due to Triple Positive Antiphospholipid Syndrome (APS), which is quite rare but explains the clotting tendencies and the vessel issues I’ve been experiencing.

A bit about me: I’m a musician (drums are my passion), an entrepreneur, and blessed with an incredibly supportive wife and three amazing kids. Life has thrown me challenges, but one thing that keeps me going is competing in padel tournaments—and even winning some! It gives me a huge sense of accomplishment despite all the burdens.

I really appreciate your recommendations—I'll look into the app and Vidyamala Burch's books. The TENS machine is also an interesting idea. If you have any insights on managing fatigue or mental resilience, I’d love to hear them.

Sending strength your way, and thanks again for your thoughtful response

[Milkfairy Heart Star in reply to Ignacio182]

Thank you for your kind words.

You asked me:

'If you have any insights on managing fatigue or mental resilience'

This is work in progress for me.

Life living with vasospastic angina is like walking on a tight rope. I know that at some stage I'll fall off but I have built a net of resilience below to catch me.

I did fall though a big hole in the net when I was a few years into my ' journey '. I was diagnosed with PTSD.

I attended a Pain Management Programme. It helped me to build my tool kit of resources.

One is to pace my activities. I found the Spoon Theory an approach that works for me.

I looked at how people living with chronic pain or other long term conditions like multiple sclerosis managed their symptoms.

mssociety.org.uk/support-an....

I walk my dog everyday out in the nature reserve near where I live.

I volunteer, helping others helps me.

I have my family to support me.

I am mindful.

Keep playing your drums and competing in competitions. It's important to have joy in your life.

My walking buddy.