Microvascular Angina: Symptoms & Treatment

Instructor: Danielle Haak

Danielle has a PhD in Natural Resource Sciences and a MSc in Biological Sciences

Microvascular angina is characterized by pain in the chest due to insufficient delivery of oxygen-rich blood to the heart because of abnormalities in the smallest coronary arteries. This lesson will specifically cover symptoms and treatments for this condition.

What Is Microvascular Angina?

Jodie began experiencing chest pain shortly after her 71 birthday. She had never had heart problems before, so the sudden pain was alarming. In addition to the pain, she was also experiencing difficulties sleeping. After the fourth episode of pain, which lasted almost 40 minutes, she decided to see her doctor, who put her through a series of tests before diagnosing her chest pain as a symptom of coronary microvascular disease (MVD). Specifically, this pain was called microvascular angina. Once she was successfully diagnosed, her doctor prescribed various medications to treat her high blood pressure and symptoms, and he recommended a series of lifestyle changes that could help prevent future episodes of angina. Let's take a closer look at how Jodie's diagnosis relates to microvascular angina.

Angina is chest pain caused by oxygen deficiency of the heart. This usually occurs due to blockages or constrictions in the coronary arteries, the blood vessels responsible for carrying oxygenated blood from the lungs to the heart. These coronary arteries come in a variety of sizes, the smallest of which are called microvascular coronary arteries. This is easy to remember because 'micro' means tiny, and 'vascular' refers to the body's blood vessels. When angina is caused by abnormalities with these small arteries, it's called microvascular angina (or cardiac syndrome X, small artery disease, or non-obstructive coronary heart disease).

Microvascular angina is often caused by coronary microvascular disease (CMD or MVD), which is a type of heart disease that specifically affects these microvascular coronary arteries. With CMD/MVD, the microvascular coronary arteries are narrow or constricted to the point that blood flow to the heart is limited, causing the drop in oxygen supply that leads to chest pain. However, unlike other forms of angina, CMD/MVD is not caused by blockages in the arteries.

Microvascular angina is usually caused by coronary microvascular disease.
coronary arteries

Microvascular angina is more common in women and may be caused by abnormalities in the structure of the arteries (which affects how well they can open or stay opened) or by arterial spasms. The risk factors of developing microvascular angina are similar to other types of cardiovascular disease, including high blood pressure, high levels of bad cholesterol, smoking, diabetes, obesity, poor diet, or lack of exercise.

Symptoms & Treatment Options

Obviously, as the name suggests, the most common symptom of microvascular angina is angina, or chest pain. This pain lasts longer than other forms of angina, often more than 30 minutes at a time, and may be more severe. Patients may also experience difficulty catching their breath, difficulties sleeping (like Jodie), and fatigue or tiredness.

Pain is most often first noticed during regular daily activities, especially during times of emotional stress. Some women may experience pain during exercise, but this is relatively uncommon.

Treating microvascular angina requires identifying the underlying cause to prevent future episodes or pain events. The primary treatment goal is to eliminate pain and prevent future cardiac problems, as microvascular angina may be a precursor to heart attacks or other types of heart disease.

Once the underlying cause is found, medication may be used for both long-term prevention and short-term symptoms. For example, cholesterol medication may be used to lower bad cholesterol levels in the blood, or medication may be administered to treat high blood pressure (hypertension). Nitroglycerin may be prescribed to immediately treat symptoms as they appear, though it isn't meant to be used as a long-term treatment option. Nitroglycerin works by dilating or opening the blood vessels, restoring normal blood flow.

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