Microvascular angina: what you didn't know

Microvascular angina is intense chest pain, caused by reduced oxygen-rich blood flow. However, it differs from standard anginas in that the blood flow is obstructed within the small blood vessels in the heart’s muscles, rather than the major arteries. In standard angina, chest pain will occur as the heart is under stress when engaging in strenuous activities like running or climbing, but with microvascular angina, the pain is unpredictable and can be triggered even whilst resting or relaxing. If the root of the issue isn’t discovered and the heart continues to not receive sufficient oxygen, it can eventually trigger a heart attack. A leading interventional cardiologist sat down with us to tell us all about this oft-overlooked condition.

Other symptoms that accompany pain that may suggest microvascular angina:

• sweating
• nausea and dizziness
• stomach pain
• troubled breathing
• fatigue

What causes microvascular angina and how is it diagnosed?

Microvascular angina can be caused by the small blood vessels being blocked due to high traces of cholesterol, failing to dilate normally to facilitate blood flow, or going into spasm and constricting, which also reduces the blood flow.
These small blood vessels are tiny, less than a half millimetre wide. The condition can be difficult to diagnose as the smaller blood vessels are not detectable in a standard coronary angiogram. However, there have been advances in the diagnostic technology available, such as in MRI scans, a reactivity test using a drug called acetylcholine that is specifically designed to test microvascular spasms and dysfunction, and sinvasive evaluations of the blood vessel function using guidewires.

Who is at risk for microvascular angina?

Microvascular angina can occur in anyone, but is the most common in post-menopausal women (around the age of 50 and upwards). This is thought to possibly be caused by the lack of oestrogen in their bodies, as oestrogen is important for pain and cholesterol management.

Those who smoke or have diabetes have a higher risk of microvascular angina.

How is microvascular angina treated?

Treatment for microvascular angina is the same as standard anginas.

Patients are encouraged to better their diet, stop smoking, and regularly exercise. It is also important to get enough sleep and to limit stress. If the angina is comorbid with diabetes or high cholesterol, then treating those conditions can also address the microvascular angina simultaneously.

The medications that doctors might prescribe for microvascular angina are beta-blockers, nitrates like nitroglycerin, statins, and calcium channel blockers to improve blood flow in the vessels of the heart. For post-menopausal women, they may be recommended to start hormone replacement therapy (HRT) to supplement their oestrogen levels.

If you are experiencing unexplained chest pain, or have concerns regarding your heart health, consult with a cardiologist via Top Doctors today.