Microvascular Angina: Symptoms, Causes, Treatment

What are the symptoms of microvascular angina?

Microvascular angina (MVA) is a condition characterized by chest pain or discomfort that occurs when the small blood vessels in the heart are narrowed or blocked, reducing blood flow to the heart muscle. The symptoms of MVA can be similar to those of classic angina, but they are often more subtle and may not follow a typical pattern. Here are some common symptoms of MVA:

1. Chest pain or discomfort: The most common symptom of MVA is chest pain or discomfort that can feel like tightness, heaviness, or pressure in the chest.
2. Radiating pain: The pain may radiate to the arms, back, neck, jaw, or stomach.
3. Shortness of breath: People with MVA may experience shortness of breath or difficulty breathing, especially during physical activity.
4. Fatigue: Fatigue is a common symptom of MVA, and people may feel tired or exhausted even after resting.
5. Dizziness or lightheadedness: Some people with MVA may experience dizziness or lightheadedness, especially when standing up or changing positions.
6. Cold hands and feet: Cold hands and feet are a common symptom of MVA, as the blood vessels in the extremities are also affected.
7. Numbness or tingling: People with MVA may experience numbness or tingling in their hands and feet.
8. Chest tightness: Chest tightness is another common symptom of MVA, which can feel like a band around the chest.
9. Swollen legs: Swelling in the legs can occur due to fluid buildup caused by poor circulation.

It’s essential to note that these symptoms can be similar to those of classic angina, but they may not always follow a predictable pattern. In some cases, people with MVA may experience no symptoms at all until they develop more severe coronary artery disease.

If you’re experiencing any of these symptoms, it’s crucial to consult a doctor for proper diagnosis and treatment.

What are the causes of microvascular angina?

Microvascular angina (MVA) is a condition where the small blood vessels in the heart, known as the coronary microcirculation, become narrowed or blocked, reducing blood flow to the heart muscle. The causes of MVA are not fully understood, but several factors contribute to its development. Here are some of the main causes of MVA:

1. Atherosclerosis: Atherosclerosis is the buildup of plaque in the coronary arteries, which can narrow or block blood flow to the heart muscle.
2. Coronary artery disease: Coronary artery disease is a condition where the coronary arteries become narrowed or blocked due to a buildup of plaque.
3. High blood pressure: High blood pressure can damage the small blood vessels in the heart, leading to microvascular dysfunction and reduced blood flow.
4. Diabetes: Diabetes can damage the small blood vessels in the heart and increase the risk of microvascular angina.
5. Smoking: Smoking damages the blood vessels and increases the risk of atherosclerosis and coronary artery disease.
6. Obesity: Obesity is a risk factor for developing coronary artery disease and microvascular angina.
7. Physical inactivity: A sedentary lifestyle can increase the risk of coronary artery disease and microvascular angina.
8. Family history: A family history of coronary artery disease or heart attacks increases the risk of developing microvascular angina.
9. Hormonal changes: Hormonal changes during menopause or pregnancy can affect blood flow to the heart muscle and increase the risk of microvascular angina.
10. Other medical conditions: Certain medical conditions, such as hypertension, hyperlipidemia, and kidney disease, can also contribute to the development of microvascular angina.

It’s essential to note that MVA is often underdiagnosed and undertreated, as it may not follow a typical pattern of symptoms like classic angina. If you’re experiencing symptoms that may be related to MVA, consult a doctor for proper diagnosis and treatment.

How is the diagnosis of microvascular angina made?

The diagnosis of microvascular angina (MVA) is often challenging because the symptoms can be subtle and may not follow a typical pattern. A diagnosis of MVA is typically made through a combination of:

1. Medical history: A thorough medical history is taken to identify any underlying conditions that may contribute to the development of MVA.
2. Physical examination: A physical examination is performed to assess the patient’s overall health and identify any signs of coronary artery disease or other conditions that may be contributing to MVA.
3. Electrocardiogram (ECG): An ECG is a non-invasive test that records the electrical activity of the heart. It can help identify any abnormalities in the heart’s electrical activity that may be indicative of MVA.
4. Stress testing: Stress testing, such as a treadmill test or pharmacological stress test, is used to evaluate the heart’s function under physical or pharmacological stress. This can help identify any abnormalities in blood flow to the heart muscle.
5. Echocardiogram: An echocardiogram is a non-invasive test that uses sound waves to create images of the heart. It can help evaluate the heart’s structure and function and identify any signs of coronary artery disease.
6. Cardiac imaging: Cardiac imaging tests, such as coronary computed tomography (CT) angiography or magnetic resonance angiography (MRA), can be used to visualize the coronary arteries and identify any blockages or narrowing.
7. Microvascular function testing: Microvascular function testing, such as handgrip test or cold pressor test, can be used to assess the function of the small blood vessels in the heart.
8. Cardiac catheterization: Cardiac catheterization is a minimally invasive procedure that involves inserting a catheter into the heart through an artery in the leg or arm to visualize the coronary arteries and measure blood flow.

A diagnosis of MVA is typically made when a combination of these tests suggests that:

• The symptoms are consistent with microvascular angina
• There is evidence of small vessel disease on cardiac imaging
• The patient has normal coronary arteries on cardiac catheterization
• The patient has normal left ventricular function and no significant valvular disease

It’s essential to consult a cardiologist or other healthcare provider for proper diagnosis and treatment if you suspect you have microvascular angina or are experiencing symptoms that may be related to the condition.

What is the treatment for microvascular angina?

The treatment for microvascular angina (MVA) typically focuses on managing the underlying causes of the condition and relieving symptoms. The treatment approach may include:

1. Lifestyle modifications: Making lifestyle changes such as quitting smoking, reducing stress, and engaging in regular physical activity can help improve symptoms and reduce the risk of complications.
2. Medications: Medications such as:
   • Nitrates: To relieve chest pain and reduce blood pressure
   • Beta-blockers: To slow down the heart rate and reduce blood pressure
   • Calcium channel blockers: To relax blood vessels and improve blood flow
   • Antiplatelet agents: To prevent blood clots from forming
   • Statins: To lower cholesterol levels
3. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs): To lower blood pressure and reduce the risk of complications
4. Pain management: Medications such as opioids or tricyclic antidepressants may be used to manage chronic pain associated with MVA.
5. Revascularization procedures: In some cases, revascularization procedures such as angioplasty or stenting may be necessary to open up blocked or narrowed coronary arteries.
6. Cardiac rehabilitation: Cardiac rehabilitation programs can help improve exercise tolerance, reduce symptoms, and promote overall health.
7. Nutritional therapy: A healthy diet rich in fruits, vegetables, whole grains, and omega-3 fatty acids can help reduce inflammation and improve cardiovascular health.
8. Supplemental therapies: Some patients may benefit from supplemental therapies such as:
   • Coenzyme Q10 (CoQ10) to improve energy production in the heart
   • L-arginine to improve blood flow
   • Omega-3 fatty acids to reduce inflammation

It’s essential to work with a healthcare provider to develop a personalized treatment plan that addresses the specific needs and symptoms of MVA.

In some cases, MVA may be treated with a combination of medications, lifestyle modifications, and revascularization procedures. It’s crucial to consult a cardiologist or other healthcare provider for proper diagnosis and treatment if you suspect you have microvascular angina or are experiencing symptoms that may be related to the condition.