Microvascular Angina

What is microvascular angina?

Microvascular angina (chest pain) is a type of angina that is caused by problems in the smallest blood vessels of the coronary arteries. The coronary arteries, which surround your heart, bring a constant supply of oxygenated blood to the heart. The small vessels (called the coronary microvasculature) are a big part of your heart’s blood supply.

Microvascular angina was previously called cardiac syndrome X. Another name for it is microvascular coronary artery disease.

What is the difference between microvascular angina and typical, or classic, angina?

Typical, or classic, chest pain (angina) usually happens when you exercise or climb stairs or when you’re under stress. The discomfort lessens when you’re resting. This is also true for the type of microvascular angina that’s caused by microvascular angina. However the mechanism is different. In microvascular angina, functional problems with the vessels (known as endothelial dysfunction) cause chest pain. The endothelium is the tissue lining the blood vessels of the heart. In classic angina, the problem is with the large arteries of the heart, the epicardial coronary arteries. When these arteries are narrowed or blocked, it is known as coronary artery disease.

However, angina caused by spasms of the blood vessels can happen while you’re resting and not while you are working hard.

Who does microvascular angina affect?

Microvascular angina is more common in women than in men. Among the women who have microvascular angina, a majority are postmenopausal. Microvascular angina is also more common in people with diabetes or hypertension and those who smoke.

How does this condition affect my body?

Microvascular angina can sometimes cause myocardial ischemia. This means that the heart doesn’t get enough oxygenated blood. If this happens often enough, the heart muscle begins to die.

What are the signs and symptoms of microvascular angina?

The signs and symptoms of microvascular angina may include:

• Discomfort in your chest that can feel like a heaviness, tightness, pressure or squeezing.
• Sweating.
• Nausea and dizziness.
• Stomach pain.
• Difficulty breathing.
• Being very tired (fatigue) and having low energy — although it’s very unusual for this to be the only symptom of microvascular angina.

What causes microvascular angina?

Microvascular angina may be caused by vessels that don’t widen the way that they should. It may also be caused by spasms in the vessels. This is known as primary microvascular angina.

There’s also a type of microvascular angina that is related to other heart diseases, like cardiomyopathy, or autoimmune diseases, such as connective tissue disease. This type is called secondary microvascular angina.

How is microvascular angina diagnosed?

After talking to you about your symptoms and medical history, your provider might decide you have angina. If so, they will order tests that include:

• A stress test.
• An echocardiogram.
• A cardiac catheterization.
• A magnetic resonance imaging (MRI) or positron emission tomography (PET) scan.

These tests are used to diagnose blockages in larger arteries, but the small blood vessels of the coronary microvascular are too small to be seen directly. Instead, your provider looks for indirect evidence of microvascular disease such as reduced blood flow in the heart on MRI or PET. Microvascular disease might show up during stress tests or echocardiograms, but it might be the type that isn’t triggered by exertion.

It hasn’t always been easy to diagnose microvascular angina because it’s difficult to see inside the small blood vessels.

How is microvascular angina treated?

Treating any kind of angina, including microvascular angina, includes lifestyle changes and medications.

Lifestyle changes

These changes include:

• Stopping smoking. This is very important.
• Eating a heart-healthy diet focused on reducing the amount of fat and red meat you eat and increasing your intake of fruits, vegetables and fiber.
• Getting enough exercise.
• Reaching and staying at a healthy weight.
• Getting enough sleep and managing stress.
• Managing other health conditions like high blood pressure, high blood cholesterol and diabetes.

Medications

The usual medicines prescribed for typical angina and microvascular angina are:

• Calcium channel blockers.
• Beta blockers.
• Nitrates like nitroglycerin.

In rare cases, your provider might suggest that you take estrogen.

How can I reduce my risk of developing microvascular angina?

There are risks you can’t prevent, such as being female or having an autoimmune condition. However, you can make choices that may reduce your angina risk, including:

• Stopping smoking. This is the most important thing you can do for your overall health and for your heart’s health in particular.
• Reaching and maintaining a healthy weight.
• Eating a heart-healthy diet by reducing red meat consumption and increasing your intake of fruits, vegetables and fiber.
• Getting enough sleep and enough exercise.
• Learning ways to lower your stress like meditation or yoga.

Keeping your blood sugar levels, blood pressure and cholesterol in check and managing any other health condition.

What can I expect if I have microvascular angina?

Generally, the outlook for someone with microvascular angina is good, but you need to know you have it. Microvascular angina is sometimes not diagnosed correctly, or even at all.

If you do have microvascular coronary artery disease, it’s important that you do what you can to treat it and to improve your health in general. Take your medications. The lack of oxygen to the heart muscle can still result in heart damage significant enough to prove fatal.

When should I contact my healthcare provider about microvascular angina?

If you have any type of chest pain, you should contact your healthcare provider. This is true if you do or don’t already have a diagnosis. It’s also true that you could have microvascular angina and a digestive disorder, so make sure you keep track of your symptoms and when you have them.

A note from Cleveland Clinic

If you have chest pain, especially if it happens while you’re working hard or under stress, see your provider. If you’re diagnosed with microvascular angina, make sure you follow treatment recommendations. Try to make small improvements every day in your lifestyle. Like your small vessels, small improvements are very important.