Chest pain diagnosis

[ludo]

Hi, I have GPA and recently been diagnosed with Microvascular Angina. I hadn't heard of this before and wondering if anyone else has this?

[Brussels]

Hi Ludo,

I was diagnosed with this around 18 months ago after having symptoms for over a year ( I have Behcets). I would recommend the British Heart Foundation Health Unlocked Page, lots of good info about microvascular angina there. Feel free to message me if I can help, have learned a lot since diagnosis!

[ludo in reply to Brussels]

Many thanks for your reply Brussels. I shall look up the site with interest. I know very little about It. My diagnosis is 'probable' microvascular angina and advised by cardiologist to take isosorbide mononitrate MR 30mg to go with Felodipine I'm already taking for hypertension. I'm just concerned about taking extra meds if it's not a definite diagnosis. I was wondering if you wouldn't mind telling me how you were diagnosed.

It's good to know of someone with the condition.

Look forward to hearing from you

Best wishes

[Brussels in reply to ludo]

Hi,

I was diagnosed via a clinical trial. I had a specialist coronary angiogram where they specifically looked for problems in the small blood vessels, most coronary angiograms only look at the large vessels/ arteries. There are 2 main types of microvascular angina, where the small blood vessels don’t dilate and where they go into spasm ( I have the spasm type ) some patients have both. There is increasing evidence that microvascular angina can be caused by auto immune, Rheumatic diseases such as Vasculitis but also RA and Lupus.

Usually the first line treatment is an ACE inhibitor ( eg Ramapril ) or Calcium Channel Blocker such as Amlodipine. Unfortunately, like Vasculitis, it’s important to find a Consultant who understands and has experience in treating it. It took a while to get the medication right for me ( still not quite there yet ) as my BP and pulse are naturally low. I find I get more pain at rest than when I am active, can have bouts of pain lasting days and get short of breath. It has added to my fatigue but I have found cardiac rehab really helpful and since then have completed a 12 week exercise referral programme.

For years Dr’s were very dismissive of microvascular angina but now there is evidence that patient outcomes can be poor if it’s not taken and treated seriously. The fact that it affects more women than men hasn’t helped........

[ludo in reply to Brussels]

That's a great help thank you Brussels. My chest pain is random and usually at rest. A bit like yours. It can last 20-30mins then often leaves me with a discomfort in my chest for sometime after.

It was great that you got on a trial which lead to a diagnosis.

The type of vasculitis I have (GPA) affects the small blood vessels so quite possibly the cause.

The BHF information was very interesting and helpful.

I hope they soon find the right treatment for you.

I really appreciate you replying.

Thank you.

[Brussels in reply to ludo]

Forgot to say that there is increasing evidence that microvascular dysfunction isn’t confined to the heart and can affect other organs as well in people with microvascular angina.

I agree that it makes sense with GPA, my type of Vasculitis called Behcets Disease can affect all of the different sized blood vessels ( I have a mix of large and small vessel involvement ). I had no risk factors for heart disease apart from underlying auto immune disease. I think the link is still poorly recognised and there is a lack of research into microvascular angina unfortunately. The medications used to treat it are the meds used to treat “ conventional “ angina but there is probably a different mechanism responsible.

[ludo in reply to Brussels]

You're right. Sounds like a lot more research is needed. I'm seeing my vasculitis consultant at QE hospital in March. Hes the one that referred me for a heart scan (yet to be reported on) and the cardiologist. It will be interesting to see if he thinks there might be a link,

I shall let you know.