Hi I had an angiogram a week ago with dye and was told by the registrar dr that my main coronary arteries were unobstructed. I then asked if that mean’t that I hadn’t had a heart attack and she said we are still treating as a mild heart attack as we are unable to see if smaller arteries are affected. I had raised troponins and chest pain, nausea and sweating but for a few years now when walking in the cold or wind, sometimes too many stairs and even sitting getting stressed brings on severe pain in my chest across my shoulder blades in my back and pains down the inside of my arms and breathless and have to stop what I am doing. Could this be microvascular angina as it has been mentioned a few times to me and if so why did they not look for it when I had my angiogram.
Microvascular Angina: Hi I had an... - British Heart Fou...
Microvascular Angina
Hello,
Microvascular and vasospastic angina are types of angina/ ischaemia non obstructive coronary arteries ANOCA/INOCA.
You can have a heart attack without obstructed coronary arteries, a Myocardial infarction non obstructive coronary arteries MINOCA.
Microvascular angina is thought to be due to the small vessels of the heart not working properly. The microvessels are unable to dilate or stay dilated in response to extra demands like exercise.
The common symptoms are chest pain on exertion and breathlessness.
Vasospastic angina is caused by transient constrictions of the large blood vessels in the heart, coronary artery vasospasms. You can also have vasospasms in the small vessels.
The common symptom of vasospastic angina is chest at rest, especially during the night. Coronary vasospasms are notoriously prolonged and more painful that other types of angina.
As ANOCA is caused by the blood vessels not working properly, a rountine angiogram cannot ' look' for microvascular or vasospastic angina.
A specialised functional angiogram is the best way to detect ANOCA.
A chemical adenosine and guidewires are used to measure how the blood flows through the small vessels. From these measurements microvascular dysfunction, microvascular angina can be diagnosed.
Another chemical acetylcholine can then be used. Normal functioning coronary arteries should dilate in response to acetylcholine. If the blood vessels constrict, accompanied by chest pain and ECG changes. Coronary vasospasms, vasospastic angina is diagnosed.
I live with vasospastic angina my coronary and microvessels go into transient spasms.
The BHF has this information about microvascular and vasospastic angina.
bhf.org.uk/informationsuppo...
bhf.org.uk/informationsuppo...
The BHF ' Understanding Angina ' booklet lists this website created by four patients as a resource for people living with microvascular and vasospastic angina.
bhf.org.uk/informationsuppo...
internationalheartspasmsall...
Thanks for the info I will have a look. I think they only used the standard dye and I know they only looked at my main arteries. They are now just leaving me on dual platelet therapy for 3 months along with doubling my statin and added a beta blocker along side my other bp tablets. I don’t know where to go with this as it’s clearly got worse over the last couple of years.
I suggest you keep a diary of your symptoms. Ask to be seen by a Cardiologist who understands microvascular and vasospastic angina, who can offer you further testing.
The research has shown that having the correct diagnosis means a person is prescribed the appropriate medication.
It can take time to find the best combination of medication that will work best for you as an individual.
I was presumed to have microvascular angina, prescribed beta blockers and ended up in hospital with unstable angina.
I later learned that beta blockers can make coronary vasospasms worse.
You may find you will need to be persistent.
I have recently been diagnosed with microvascular angina. The angiogram was completely clear in 2019, and it took other tests to confirm it. Being given a gtn spray to help when the attacks come and Ranolazine which has really helped. Keep pressing for further tests if you don’t think the current treatment you’re on is helping.
It’s a fairly new identified problem so don’t give up.
Hi there … what tests were done to diagnose Microvascular ? I live in Canada and they don’t seem to have any further tests . I was prescribed bisoprolol which didn’t help and made me feel miserable . I have had the standard angiogram followed by angioplasty, pain still presents during exercise. Thank you …
Functional angiograms are performed in Canada to diagnose microvascular and vasospastic angina. A perfusion MRI can diagnose microvascular dysfunction in some cases.
Angioplasty is a stent which cannot treat microvascular or vasospastic angina.
There are several centres of excellence providing care for patients with angina non obstructive coronary arteries in Canada.
I believe I have provided this information to you before, but I suggest you contact this organisation further support.
Thank you… Yes, you have provided the information before and I am aware that a stent does not correct microvascular. This has been an ongoing journey. I have just had a repeat angiogram done at the end of November and I’m still searching for answers or a correct diagnosis . I will speak with my cardiologist
I had an US cardiac echo trans thoracic and CT coronary angiogram. Hope you get the help you need.
It also is fairly newly diagnosed in women . There’s a book about women’s hearts that was advertised on this site, which is very helpful.
Microvascular angina was first described by Harvey Kemp, a US Cardiologist in 1973.
My vasospastic angina was confirmed by an functional angiogram with acetylcholine in 2014.
The knowledge has been around about vasospastic angina for over 60 years.
There has thankfully been an explosion of research into angina/ ischaemia non obstructive coronary arteries ANOCA/INOCA since my diagnosis.
Prof Angela Maas, now retired wrote ' A Women's Heart '
Did you see my post about the patient survey being carried out for people living with microvascular and vasospastic angina?
healthunlocked.com/bhf/post....
I think there were some statistics showing that about 40% of angina is micro-vascular in origin. Milkfairy will know!
An interesting question. There are various estimates about how common microvascular angina is. MVA is probably under diagnosed, however this is changing as there is now greater awareness of microvascular and vasospastic angina
The problem is that many people have a presumed diagnosis rather than a confirmed diagnosis following an invasive functional angiogram.
I have been told vasospastic angina is rare, making up 2% of angina cases.
I am not sure it is rare, rather underdiagnosed.
Someone needs to do an audit and create a register of patients with microvascular and vasospastic angina.
I keep being told it’s likely not Microvascular but this is only from a repeat :standard angiogram . I have been told it is likely muscular … which I don’t believe as it happens every single time I get on the treadmill, for the past five years, and no other time. The uncertainty is very unsettling. I would like to know one way or the other. I am considering paying for a private.PET scan as I don’t know what else to do , I am in Canada
Have you tried contacting the Canadian Women's Heart Health Alliance? They may be able to help you find a Cardiologist to help you.
Alternatively if you are on Facebook, you could join this international group which is listed in the BHF website as a resource.
yes. I understand you !I live in Montréal and have been struggling to get answers for a few years now . There is only one interventional cardiologist who does these functional angiograms and I did not have it as I did not tolerate the treatment meds . Also some meds are not allowed here like Nicoraldil. Every time I see the cardio I am given another prescription ! It is very difficult. Now I was prescribed Ivabradine . I am very sensitive to meds so my situation is even worse . Good luck and you can contact me for more info at any time .
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