Microvascular angina: Symptoms, diagnosis, treatment, and prevention

microvascular anginaIndigestion can cause a sense of heaviness or a sharp pain in the chest, but sometimes that twinge can be something more serious, such as microvascular angina. Just what is microvascular angina? Read on and find out what a microvascular angina diagnosis means and how you can treat or prevent it.

Microvascular angina is a concerning source of chest pain because it is commonly misdiagnosed. The reason for this is that unlike some other heart-related issues, it does not show up as a blockage in the large heart arteries during tests. In other words, doctors can miss the underlying cause.


It is worth knowing that this type of chest pain is more common in women than it is in men.

What does microvascular angina mean?

Chest pain can sometimes come about when the oxygen supply to the heart muscle tissue can’t meet the heart’s metabolic demand. This is what is known as angina. In most cases, angina is formed from a blockage in the heart’s arteries due to a build-up of plaque. This build-up limits blood flow to the heart.

This condition can usually be evaluated with stress testing and sometimes an angiogram, which is a special X-ray that allows a doctor to see blockages or narrowing of arteries. When people with chest pain don’t show blockages in their arteries, they could have microvascular angina, which can be caused by problems with the small arteries of the heart that aren’t seen on traditional scans.

It is believed that sometimes, temporary spasms in the larger heart arteries can lead to problems in the smaller arteries. There is also a theory that abnormal functioning of endothelial cells, which are cells that line the inner surface of blood vessels, could be part of the cause. Endothelial cells release chemicals that relax and contract small arteries. This process can become imbalanced in some people due to a number of different underlying reasons, including inflammation.

It is interesting to note that people who have microvascular angina can experience an increased sensitivity to pain due to substances released by the endothelial cells.

According to the American Heart Association, as many as 50 percent of women with angina symptoms don’t have a blocked artery. They may not even have chest pain but may have other symptoms.

Symptoms of microvascular angina

Microvascular angina symptoms include chest pain during physical exertion, signs of reduced blood supply to the heart during a stress test, and normal-looking arteries on an angiography. Many people who have been diagnosed with microvascular angina complain about difficulty sleeping.

Symptoms such as chest pain, shortness of breath, or fatigue often occur during times of mental or emotional stress. This is why sometimes the symptoms can be mistaken for anxiety or panic attacks.

When it comes to chest pain associated with microvascular angina, research shows that episodes of pain tend to last longer than those described in cases of obstructive coronary disease. The average pain period can last anywhere from 10 minutes to 30 minutes.

Is microvascular angina a serious health concern?

Back in 1996, about 900 women enrolled in a landmark study (The Women’s Ischemic Syndrome Evaluation) sponsored by the National Heart, Lung, and Blood Institute. These women had signs and symptoms of heart disease and underwent coronary angiograms.

They were followed for over a decade and their cases have contributed to much of the information we know about microvascular angina today. For instance, thanks to the participation of these women, it was discovered that the heart’s arteries react with abnormal patterns or narrowing and relaxing with angina. The data that was collected also helped researchers conclude that microvascular angina is concerning because even without obvious obstructed arteries, it increases the rate of heart attacks, strokes, heart failure, and death compared to women who don’t have angina. The problem is magnified in those women who have other cardiovascular risk factors, such as high blood pressure, high cholesterol, diabetes, obesity, and smoking. People who suffer from microvascular angina also have a higher hospital readmission rate for chest pain.

While there have been significant improvements in the diagnosing and treatment of women with microvascular angina, it is believed that women are still being underdiagnosed and undertreated.

How to diagnose microvascular angina

It is not unusual for most of us to get a chest twinge or pain from time-to-time. In many cases, it is a simple case of indigestion or a pulled muscle, but you might be wondering how to detect microvascular angina.

Unfortunately, determining the cause of chest pain from just symptoms alone is rarely possible. In most cases, additional assessment is required. In situations where a woman is complaining of chest pain, a doctor will usually classify her symptoms first. The doctor will either conclude she is of low, intermediate, or high risk based on cardiovascular risk factors. Low-risk women normally don’t undergo any further tests; however, low-to-intermediate and intermediate-risk should be further evaluated. This can begin with exercise on a treadmill, which measures a woman’s fitness capacity, while an electrocardiogram measures electric activity of the heart.

Women in the intermediate-to-high-risk category who test with an abnormal ECG need more imaging, such as myocardial perfusion imaging, stress echocardiography, and cardiac MRI or cardiac CT-angiography. High-risk individuals may undergo a traditional coronary angiogram. This may even be accompanied by an invasive test called coronary flow reserve measurement. The coronary flow reserve test measures how much the heart arteries dilate and increase blood flow above the normal volume when a specific drug that relaxes the arteries is administered. To determine the exact cause of the microvascular problem, more testing is required.

How to treat microvascular angina?

Treatment of microvascular angina is not exactly clear-cut. The goals are essentially two-fold – to increase blood flow and reduce workload in the heart, as well as minimize pain.

To date, microvascular angina treatment involves using medications that address the chest pain and prevents plaque build-up in the arteries. Research tells us that responses to such treatments are not the same in men and women. This might be due to the fact that there are differences in the disease mechanisms. Doctors do agree that the important thing to keep in mind when it comes to treating women with microvascular angina is that they are at risk for some of the same outcomes as people with the obstructive coronary disease.

Here’s a look at potential medications involved in the treatment of microvascular angina:

  • Beta blockers: Can improve the heart’s blood flow by reducing workload.
  • Calcium channel blocker: Improves blood flow and decreases blood pressure.
  • Nitro-glycerine: Improves blood flow.
  • Aspirin: Can prevent blood clot formation and decreases inflammation.
  • Statins: Used to lower cholesterol levels and prevent the build-up of cholesterol in the arteries.
  • Angiotensin-converting enzyme inhibitors: Improves the function of the endothelial cells lining the heart’s arteries.

There are some newer treatments under review, including medications that act at the cellular level and electrical nerve stimulation, both of which could potentially improve blood flow.

Preventing microvascular angina

Microvascular angina prevention begins with understanding risk factors. There are many risk factors that can be controlled. Smoking and obesity are some examples of controllable factors.

Lifestyle choices, including a healthy diet and moderate exercise, can help lower your chances of getting microvascular angina. Keeping a close eye on cholesterol levels and sugar levels can be helpful. People should eat a diet that is rich in omega-3 fatty acids, fruits, vegetables and whole grains. Limiting processed foods, as well as foods with saturated fats and high amounts of sodium is advisable. If you smoke – quit. It is also important not to ignore chest pain. Many women with chest pain dismiss it because they associate heart disease with men’s health. They also mistake it for stress or indigestion.

Autoimmune conditions, such as lupus and rheumatoid arthritis, may also increase risk of developing microvascular angina. Young women with lower than normal estrogen levels are also at risk.

Today, women have packed schedules – raising a family, working, meeting social commitments, and participating in community and charity work, but they often forget about taking care of themselves. Taking time out for physical fitness and relaxation programs, such as meditation, can be important to their heart health.

Prognosis of microvascular angina

There is still so much to learn about microvascular angina. Research is ongoing, but in the meantime, many people inquire about microvascular angina prognosis.


With proper treatment, symptoms of microvascular angina can improve but it is important to understand that coronary microvascular dysfunction has been linked to a yearly cardiac event rate of 2.5 percent. People who suffer from microvascular angina do have a 1.5–fold increase in death compared to those without the condition. About 30 percent of patients with microvascular angina undergo repeat coronary angiography. They also seem to have a worse quality of life compared to those who don’t have the condition.

Aside from adhering to a heart-healthy diet and maintaining a regular exercise routine, it is a good idea to know your body mass index (BMI) and know your family history of heart disease. As the saying goes, “knowledge is power,” and should you get chest pain, you will want to be equipped with the right information to decide whether checking in with your family physician or making a sudden trip to your local hospital emergency department is the best course of action.

Related: Unstable angina a common cause of heart attack: Causes, symptoms, treatment, and prevention



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