Microvascular Angina symptoms?

[Eglatine]

Hello, I am so happy to find this forum!

I have recently been diagnosed with Microvascular Angina and would like to share my experience in the hope that others of you have had similar symptoms and can reassure me of the diagnosis.

About 2 years ago I started getting pains across my back, which then over time started to include my chest. I saw a cardiologist, had a CT Angiogram, which found that I had a calcium score of zero, and was told the pains were most likely muscular, costochondrosis, or gastric. So I was happy to mostly ignore the aches and pains and carry on.

October last year, I had 3 episodes where I felt staggeringly unwell with chest pains, aches, discomfort, that started about an hour after exercise, and the pains/discomfort continued for a few hours, or on the second occasion, about 24 hrs, with breathlessness and extreme exhaustion lasting up to a few days afterwards. (Initially just walking to the bathroom was a breathless struggle.) Even when the chest pains stopped, for a day or so afterwards if I lay on my side and curled my top arm forward it would start to hurt. The third occasion was a few days after the second one, I hadn't really 100% recovered, was still a bit tired and went for a 2hr walk and got very cold. So not heart attack level pains at all, but definite pain or discomfort. And not gastric.

In A&E after episode 3, I had a CT Aortagram, which found I had moderate to severe calcification, despite having normal cholesterol, and never having smoked, and having had a zero calcium score 2 years prior. I then had an Angiogram which found that my Coronary Arteries were clear.

Having had a clear Angiogram and feeling good, it was felt that I could try reducing the Bisoprolol (beta blocker), that I was taking, and continue with Atorvastatin (statin), Asprin, Amlodopine, and Ramiprol. My blood pressure was well controlled with only tiny doses, and my cholesterol fine.

I went from taking 1.25mg bisoprolol, to taking half of 1.25mg bisoprolol every other day, and then ran into trouble on the third 'no tablet' day. I'd had a stressful couple of days, and then decided to spend a couple of hours outdoors in cold weather, sat on a tractor bouncing around the field. I was well wrapped up but my feet were freezing when I came in. An hour after a warm bath, I was feeling dreadful, chest hurting, breathless, exhausted, struggling to walk 10 meters. I restarted the bisoprolol at 1.25mg dose and went to bed. I remained exhausted with a sore, sometimes aching chest, gradually improving over the next 2 days.

Everyone tells me that Angina pain doesn't last this long and it should happen during exercise not afterwards, so please, how does my experience and description match your experience?

Stress, and cold definitely cause me discomfort, especially when combined with exercise, but it also seems to come on after extreme exercise, or even mildly when I'm tired. In worst cases it can go on for hours and leave me totally exhausted and in bed for a couple of days afterwards.

Otherwise I'm fairly fit and active, overweight but have lost a stone since October, good diet, non-smoker, low alcohol, female and 61. I'd be really interested in your thoughts.

Thank you.

[devonian186]

Well done for losing a stone. Does that put you in the "correct" BMI range or is there still more to go?

If you are around the correct weight then that can be discounted as a major contributory problem although having said that the symptoms you describe are quite substantial. Could be withdrawal from bisoprolol but seems unlikely.

Yes, weather conditions can play a big part as can a virus, but I would have thought what you describe warrants a visit to the GP, or at least a phone conversation with them or 111.

[Eglatine in reply to devonian186]

Thank you for responding, I still have more to go to get to my ideal weight but I’m getting there. I have a call scheduled with my GP to discuss adding ranolazine and I think I’ll give it a try.

[Poppy451]

Hi there

I have microvascular angina and my symptoms are similar to you. I get chest pain mostly after excercise ,sometimes halfway through but thats often because I didnt feel well to begin with. I rarely get short of breath. Lack of sleep can bring on chest preassure/ pain on waking but usually gets better if I can get some more sleep. Doing too much in general will make me very exshausted and in pain. And taking days to recover .Then again doing nothing at all I still get the pains.

Have you been diagnosed with microvascular angina? I was diagnosed after having clear angigram and an MRI scan that said I had a perfusion deficit.

[Eglatine in reply to Poppy451]

Hi, yes I’ve been told I have MVA. Sometimes I can walk a couple of miles, but when I get an attack of it, walking to the bathroom is exhausting. I don’t sleep great and think that, plus getting cold, are factors that influence it. What drugs do you take? I’m on bisoprolol, plus statin, aspirin, ramipril and amlopidine. But all really low doses a sky BP and cholesterol are fine. Thank you for taking the time to respond.

[Poppy451 in reply to Eglatine]

I am on diltaizem twice daily and isosorbate mononitrate twice a day too.

[Eglatine in reply to Poppy451]

Thank you Poppy. Sending big hugs having read some of your prior posts, it just seems such a random thing for me, sometimes I can do lots and be fine, other times not. Sleep and stress and cold seem to be factors for me. Visiting A&E is horrible when feeling really unwell, I wish they had small clinics for getting topinen tests done quickly.

[fishonabike]

There are specific tests for the diagnosis of microvascular angina and vascular spasm (another possible diagnosis)

Milkfairy knows a lot about these conditions and will probably respond soon with more helpful information - you could also search in the group for posts on this and ANOCA/INOCA

[Eglatine in reply to fishonabike]

Thank you for responding. I’ll look up INICA and ANOCA as I’ve not heard of that.

[fishonabike in reply to Eglatine]

INOCA means Ischaemia with No Obructed Coronary Arteries, ANOCA is the newer name for it, Angina with No Obructed Coronary Arteries - it is the umbrella term for conditions which cause angina when arteries are not blocked by atheroma/plaque

[Eglatine in reply to fishonabike]

Thank you 🙂, even after reading the explanation from Google I was unclear of the difference between them. So that would be what I have as the angiogram showed the CA were clear. I’m left wondering where the ‘moderate to severe calcium’, is located, I’m guessing it must be in the smaller arteries. I haven’t been prescribed nitrates, except for the GTN spray, just bisoprolol, statins and CCBs at lowest levels. My chest pains are not generally very intense even at their worst, it is the exhaustion at the time and that continues for a few days which is most debilitating. I just don’t understand why the chest discomfort and exhaustion continues for a couple of days after the trigger event, or what to do to prevent episodes, and then recover more quickly.

I realise I am very lucky compared to many using this forum, but I want to be able to walk and cycle and garden extensively without having to worry I’ll end up in bed or A&E. Lots to learn about this and how to manage it! Thank you again for your help.

[Poppy451 in reply to Eglatine]

I have learned that I cant walk very far,like a couple miles is too much ( although I do walk around alot) . I cant swim normally without getting chest pain afterwards. Which is disappointing . I have to pace myself during the week and have rest days in between more active ones . I do yoga and I enjoy that alot.

[Sunshinebrew in reply to Eglatine]

Hello I have symptoms very similar to yours chest pain but also breathlessness and exhaustion which can last a few days your explanation sounded very familiar

I have been told it’s microvascular angina without a specific test but I also have 3 stents in one artery

I take nitrates and CCB dilaziam and also ranalozine

I find the winter months challenging the cold makes the symptoms much worse I get symptoms at rest often in the evening and early morning but in between I am able to exercise and have a normal life

I think in my case it’s vasospastic there’s information on this on BHF website that you may find helpful

It’s difficult to manage sometimes and I find the cold weather doesn’t help and stress is also a factor

I find meditation helps and I enjoy walking my dog and Pilates classes to keep fit when I’m able.

It’s been about 7 years now and I was actually fine for 4 years but the last 2 years I’ve had symptoms again it’s debilitating but can be managed. Ive been referred back to cardiology again.

I wish you well.

[fishonabike in reply to Eglatine]

ANOCA and INOCA are the same thingGTN = Glicryl TriNitrate - it is a nitrate

i hope Milkfairy will be along soon to help, in the meantime you could also check info from the Intenatonal Heart Spasm Alliance and/or INOCA International, both have websites

[Milkfairy Heart Star in reply to fishonabike]

Hello,

It's alittle more complicated.

Not everyone with angina non obstructive coronary arteries has ischaemia, which is why the term ANOCA is being more widely adopted.

I have attached a diagram from the European Society of Cardiology's 2024 Management Guidelines of chronic coronary syndromes, which may help.

I tend to say microvascular or vasospastic angina.

GTN is Glyceryl trinitrate known as nitroglycerin in the US.

GTN is a short acting nitrate usually a spray or tablets that are put under a person's tongue.

https://academic.oup.com/eurheartj/article/45/36/3415/7743115?login=false

[Eglatine in reply to Milkfairy]

Thank you! That helps me to understand better.

[Milkfairy Heart Star in reply to fishonabike]

The BHF 'Understanding Angina' booklet lists the International Heart Spasms Alliance website as a resource for people living with microvascular and vasospastic angina.

bhf.org.uk/informationsuppo...

See page 62

[Eglatine in reply to Milkfairy]

Gosh thank you! That’s a lot of information! It’s amazing that I always get told my symptoms make no sense, when they do clearly do in the context of this. I guess A&E are looking for life critical issues and cardiologists for something they can fix. I’m not sure I’m on the right drugs yet, but I now know more so can ask the right questions. Thank you so much! My cardiologist suggested ranolazine might help and I will ask my gp when I talk with them tomorrow to see if this is in addition to the bisoprolol or instead of.

Thank you again!

[Oldgimmer66]

Hi

I have angina, together with a 50% blockage in the LAD artery. I’m in constant pain, have tight chest, fatigue when I do even minor things, and can’t even drive for more than 15 minutes now. I’ve asked to see a specialist angina cardiologist, so am hoping something can be done.

[Kind51]

Hello Eglatine, Welcome to the forum. I'm sorry to hear about the problems you have been experiencing with chest pain. Congratulations on your weight loss. I have been suffering from Angina (non-obstructed arteries) - possibly Vasospastic Angina and my symptoms are similar to those you describe. I was a healthy, active, non-smoker when I started suffering from what I thought was infrequent indigestion/chest discomfort. The cold weather of winter increased these episodes and they became debilitating. I became so unwell last winter that I could not walk far between the bedroom and the bathroom before becoming out of breath and suffering severe chest discomfort. I suddenly became unable to climb the stairs without chest pain and shortness of breath.

I spent several evenings in A&E last year - at each visit, I underwent a troponin test but my troponin result came back normal every time. A CT scan showed non-obstructed arteries and zero calcification. I have improved after starting angina medication but my episodes of chest pain are ongoing. They can be painful, lengthy and debilitating. I experience good days and bad days. On good days life is more normal - cleaning, cooking etc. (unable to move heavy furniture etc or strenuous gardening). On a very bad day all I can do is sit and rest.

My main triggers for chest pain are cold air and wind. Other triggers for me are lack of sleep, stress and too much caffeine. I take Isosorbide Mononitrate and GTN.

I agree with your suggestion that it would be good if there were small clinics we could go to for Troponin tests.

[Eglatine in reply to Kind51]

Hello and thank you for responding. Gosh that sounds familiar Do you have days of just being exhausted after an episode? And does the GTN spray help you? The spray makes me feel so bad that I wonder how much it helps something that goes on for hours. But I don’t take the slow release nitrate tablets, which may make a difference.

It’s awful hearing that others are also suffering either this, but at the same time reasuring to know that there are others who are coping and to keep pushing the clinicians and not just accept the situation.

Take care.

[Kind51]

Yes I am exhausted after a bad episode. I've had a couple of social events last year which I was looking forward to but had to cancel at the last minute because I was unwell. I hate planning anything too far in advance now because I just don't know how I'm going to be. I find the nitrate spray helps me. Sometimes it helps more than other times and I can't explain why. I hadn't heard about Microvascular Angina/Vasospastic Angina prior to the onset of this illness. When you read other's posts on this forum you realise you are not alone which is reassuring. Some of our stories sound so familiar.

What I would say is that I am learning to prioritise sleep because If I'm lacking sleep I find my symptoms increase. Only a few months before this began I was climbing flights of stairs and walking up a hill in a normal way. So I'm still trying to make sense of it all.

[Eglatine in reply to Kind51]

My experience is that stress, cold, and lack of sleep are all trigger factors for me, especially when combined! Unfortunate for me really because I don’t sleep well and when stressed I head into the garden and attack the shrubbery, this time of year emerging with freezing feet no matter how well wrapped up I am. I go from being able to walk for a couple of hours to struggling to walk to the bathroom! Then it takes days or even a couple of weeks to get back to walking any distance.

Slowly, slowly and hopefully you’ll be climbing hills and stairs again soon! I couldn’t attempt a hill even if I wanted. Luckily I’m in the Cambridgeshire fens so we don’t have hills and get altitude sickness at anything above sea level.

[Kind51]

Hello Eglatine, It has been very cold this week and I have experienced an increase in chest pain. I had a bad episode of pain today whilst shopping at a retail park. One of the shops was freezing cold. I don't know if there was something wrong with the heating but all I could feel was cold air blowing around me. The cold immediately caused increasing chest pain. I knew I had to get into a warmer environment otherwise I felt as though I was going to keel over. I left the store and made my way to another shop nearby where it was lovely and warm. Within 10 mins of being in a warmer environment the chest discomfort started to lessen, my chest was still sore but not as bad. Like yourself, sometimes I can walk about not too bad and other times can't walk far within my own home due to an episode. It's very variable. How are you in milder temperatures? Do you improve or does your chest pain remain problematic? I generally have less severe episodes in the milder weather but problems were ongoing and continued throughout summer. I needed less GTN during the summer but noticed an increase in use during the autumn as the temperatures started to fall.

[Eglatine in reply to Kind51]

I hope that you are feeling better now. Being unwell while out or on holiday is something that really worries me for sure. My consultant said that many people find the cold weather a problem, as you and I seem to do for sure. I’ve yet to find out how hot weather will affect me, although I did find it exhausting when we had some last summer, which I put down to the blood pressure drugs which we nee to me at that time. Looks like we need a steady climate in the low 20’s so I may have to rethink my dream of a Nordic Winter Northern Lights Cruise.

[Kind51 in reply to Eglatine]

Yes, I agree we could do with living in a steady climate. I was much more settled last summer when temps were around low 20s. Last August, during a spell of warm dry weather, I experienced very little/no chest pain and felt back to my normal self but it was unfortunately short-lived!

[Headache1001]

Hi! I’m still in the ‘unknown area’ of what’s wrong following a heart attack in November but also get exhausted, chest pain/ pressure. Can’t find any connection to when this happens! Was absolutely fine last week, then this week have been on the verge of going to A&E most nights. All I can think is that I did more as felt better, but I’m surprised the discomfort can go from nothing to lasting several days? Agree that it would be nice if you could just get troponin level checked!

[Eglatine in reply to Headache1001]

That sounds serious, especially if you already have had a heart attack. You should probably get it checked out!

Take care and I hope you are better soon.

[Kind51 in reply to Headache1001]

Hello Headache1001, I haven't had a heart attack but I do experience angina - chest pain/pressure daily. Cold being my main angina trigger makes the winter weather extremely challenging for me. Please get yourself checked out though. I hope you find out what is causing your continued symptoms.