Microvascular Angina

What is microvascular angina?

Microvascular angina is a type of angina (chest pain) that happens because of problems in the smallest blood vessels that branch off of your coronary arteries. These arteries bring a constant supply of oxygenated blood to your heart. The small vessels (coronary microvasculature) are a big part of your heart’s blood supply.

Like typical or classic angina, microvascular angina pain usually happens when you’re physically active or under stress. The discomfort lessens when you’re resting. But instead of issues with your heart’s large arteries, you have problems with your small blood vessels in microvascular angina. That’s why you may have pain even if testing shows that your large vessels are fine.

It can be frustrating to keep feeling chest pain after imaging doesn’t find a problem. But other tests can check how well your heart is working. This tells your provider about your smaller vessels, too.

Healthcare providers used to call microvascular angina by another name: cardiac syndrome X.

What are the signs of microvascular angina?

Microvascular angina feels like heaviness, tightness, pressure or squeezing in your chest. This can last for at least 15 minutes.

Other signs of microvascular angina may include:

• Sweating
• Nausea and dizziness
• Stomach pain
• Shortness of breath
• Fatigue

What causes this symptom?

Microvascular angina causes include:

• Coronary microvascular disease
• Other heart diseases (like cardiomyopathy)
• Autoimmune diseases (like connective tissue disease)

Healthcare providers use the terms “primary” and “secondary” to describe microvascular angina. Primary microvascular angina comes from vessels that have spasms (tightening) or don’t widen as they should. Spasms can cause pain during rest. Coronary microvascular disease is a primary type.

Providers may use the term “secondary microvascular angina” for angina that happens because of other heart or autoimmune diseases.

Risk factors

There are risks you can’t prevent, like being assigned female at birth (AFAB) or having an autoimmune condition. But you can make choices that may reduce your angina risk, like changing habits as you would when treating this symptom.

Microvascular angina pain is more common in people who:

• Are AFAB and have been through menopause
• Have diabetes
• Have high blood pressure (hypertension)
• Have high cholesterol (hyperlipidemia)
• Use tobacco products

How is microvascular angina treated?

Microvascular angina treatment includes making changes to daily habits at home and taking prescription medications. These are crucial for preventing complications.

Changes to daily habits include:

• Not using tobacco products
• Eating healthy meals that include less fat and red meat and more fruits, vegetables and fiber
• Getting enough physical activity
• Reaching and staying at a weight that’s healthy for you
• Getting enough sleep and managing stress
• Managing other health conditions like high blood pressure, high cholesterol and diabetes

The best medications for microvascular angina are:

• Calcium channel blockers
• Beta-blockers
• Nitrates like nitroglycerin
• Statins
• ACE inhibitors

What are the possible complications or risks of not treating it?

Microvascular angina can be dangerous. It can sometimes cause myocardial ischemia, which means your heart doesn’t get enough oxygenated blood. If this happens often enough, your heart muscle begins to die. The lack of oxygen to your heart muscle can result in heart damage.

When should this symptom be treated by a healthcare provider?

If you have any type of chest pain, you should contact your healthcare provider. This is true even if you don’t have a diagnosis.

A provider can diagnose microvascular angina pain with tests. This type of angina can be difficult to catch because your larger coronary arteries may look OK on imaging. But a stress test can show myocardial ischemia (lack of blood flow to heart muscle). Coronary flow reserve can tell if your heart can keep up with its demand for oxygen.

Your provider may order nuclear scans, MRIs or specific cardiac catheterization testing that looks for coronary microvascular dysfunction.

Can you live a normal life with microvascular angina?

Generally, the outlook for someone with microvascular angina is very good, but you need to know you have it. Some people don’t get a correct diagnosis of microvascular angina.

For 1 in 5 people with this symptom, episodes get worse. They happen more often and last longer, leading to more than one hospital admission.

Researchers don’t have a firm answer about microvascular angina life expectancy. Some say the risk of death is like that of other people the same age who don’t have this symptom. Others disagree. But everyone is different. Medical conditions and daily habits factor into how healthy you are and how long you live.