Do you often feel tightness, heaviness, or aching in your chest? Does this pain increase especially when you are a little tired, when you climb stairs, or when you feel anxious? But then you had an ECG, maybe even an angiogram, but the doctor said that there are no blockages in the large blood vessels of the heart (coronary arteries), and they are perfectly fine. You may be thinking, "Then why on earth do I have this chest pain?" This is actually a problem that many people have. You are not alone. Today we are talking about a type of chest pain that is not easily detected by major tests, but is really there. We call this microvascular angina.
What is Microvascular Angina?
Simply put, this is also angina, which is chest pain caused by not enough oxygenated blood reaching the heart. But here's the difference. In typical angina, the problem is in the main, large blood vessels that supply blood to the heart. They may be blocked by fatty deposits.
But in microvascular angina, the problem isn't in those big blood vessels. It's in the very fine, tiny blood vessels that branch off from those big vessels (coronary microvasculature). Think about it, we have a big pipe that brings water to our house. That's fine. But if the small pipes that go to the little taps and showers inside the house are clogged and rusty, the water won't come out. That's what happens here too. When this small system of vessels that carries oxygen to the heart muscle doesn't work properly, you feel chest pain.
This is why when you look at your large arteries on tests like an angiogram, they look normal. But the pain is really there. In the past, doctors used to call this condition 'Cardiac Syndrome X.'
What are the symptoms of this condition?
These symptoms are very similar to those of regular angina. The pain can last for 15 minutes or more.
| Symptom | Explanation |
|---|---|
| Chest pain or discomfort | A feeling of tightness, pressure, or heaviness in the chest. This usually increases with exertion or stress. |
| Difficulty breathing | Difficulty breathing even with a little exertion, feeling like you're having a stroke. |
| Unusual fatigue | Feeling extremely tired and lacking energy for no reason. |
| Other features | Some people may also experience things like sweating, nausea and dizziness, and stomach pain. |
Why does this happen? What are the causes and risk factors?
There are several reasons for this. Doctors divide it into two categories: primary and secondary.
- Primary causes: The problem here is in the small blood vessels themselves. They either suddenly tighten (spasm), or they don't dilate (open) properly when the body needs more blood. This is called ``Coronary microvascular disease''.
- Secondary causes: This is when the problem with the small blood vessels occurs as a side effect of another medical condition. For example, it can be caused by conditions such as cardiomyopathy, which weakens the heart muscle, or autoimmune diseases, which attack the body's own cells.
Also, some people are at higher risk of developing this condition.
| Risk Factor | Who is most at risk? |
|---|---|
| Being a woman | Women who have gone through menopause are especially at higher risk. |
| Diabetes | Because diabetes can damage blood vessels. |
| High blood pressure (Hypertension) | High blood pressure can damage delicate blood vessels. |
| High cholesterol `(Hyperlipidemia)` | It can affect the function of blood vessels. |
| Use of tobacco products | Smoking is a major cause of narrowing and damage to blood vessels. |
How is this treated?
There are two main ways to manage this condition. Lifestyle changes and medication. Both are equally important.
Lifestyle changes to be made
- If you smoke, quit completely. This is the most important step you can take.
- Adopt a heart-healthy diet. Reduce oil and red meat, and eat more vegetables, fruits, and fiber-rich foods.
- Exercise regularly. Even something as simple as walking for 30 minutes a day can be very beneficial. However, ask your doctor what kind of exercise is right for you.
- Maintain a healthy weight.
- Get good sleep and reduce stress. Things like meditation and yoga can help.
- If you have other diseases like diabetes, high blood pressure, or cholesterol, control them well.
The medicine given by the doctor
Your doctor may prescribe various medications to improve the function of these blood vessels and reduce pain.
- Calcium channel blockers
- Beta-blockers
- Nitrates - for example, nitroglycerin
- Statins - to lower cholesterol
- ACE inhibitors
Most importantly: These medications are prescribed by your doctor after carefully examining your condition. Do not, for any reason, use these medications based on the advice of others or as you see fit.
When to see a doctor? and diagnosis
The simple answer is, if you have any kind of chest pain, you should definitely see a doctor. It could just be gastritis, but it's up to a doctor to determine whether it's a heart problem or not.
Since this condition can be difficult to diagnose, it's important to be clear about your symptoms to your doctor. Don't be afraid to say, "I still have chest pain when I'm stressed," even if tests show no problems with your large arteries.
If the doctor suspects this condition, he may perform several more specialized tests.
- Stress Test: To see if blood flow to the heart decreases when you exercise (Myocardial Ischemia).
- Coronary Flow Reserve (CFR) Test: To measure whether the heart can increase its blood supply to meet its oxygen demand.
- Specialized scans: Nuclear scans, MRI, or specialized cardiac catheterization testing can identify dysfunction in these small vessels.
If left untreated, the constant lack of blood supply to the heart can cause permanent damage to the heart muscle. So don't dismiss this chest pain as just a symptom. It's an important signal from your heart.
Take-Home Message
- Microvascular angina is a type of chest pain that occurs when the large blood vessels in the heart are functioning normally, but due to problems with the functioning of the very small blood vessels.
- Chest pain, shortness of breath, and extreme fatigue are the main symptoms.
- If you continue to have chest pain even though your test results are normal, don't ignore it. Talk to your doctor about it again.
- This is more common in women, people with diabetes, high blood pressure, and high cholesterol.
- With proper diagnosis and treatment (lifestyle changes and medications), this condition can be well managed and a good quality of life can be maintained.
👩🏽⚕️ Additional questions (FAQs)
💬 What are Body Aches?
It's not just the body aches that come after a workout at the gym! 'Body Aches' is a severe symptom that makes you feel like your muscles, joints, and bones (Muscle/Joint pain) are all crushed and crushed all at once, making it unbearable (Dull, widespread ache), and making it impossible to get out of bed. This is often the first warning sign of a big war going on inside your body!
💬 What are the main causes of body aches/pain so bad that you can't get out of bed?
There are 3 main reasons for this: 1) 'Severe viral infections' - Dengue (Dengue - bone marrow failure), COVID-19, or the common flu, when the immune system inside the body fights (Inflammatory response/Cytokines) the whole body becomes inflamed. 2) 'Fibromyalgia' - Pain amplified neurological disease that causes unbearable pain in the joints and muscles throughout life without any disease. 3) Lupus (Lupus / Autoimmune diseases), and Statins (Statins) pills taken for cholesterol, which also cause muscle wasting.
💬 What are the 'fatal/emergency situations' in which you should go to the hospital immediately, without taking Panadol (Paracetamol) at night when you have a fever?
In most cases, this will subside in 3-4 days in a viral fever. But the biggest danger! If, along with the body ache, 1) 'high fever with shaking and stiff neck (Stiff neck / Meningitis - brain fever)' occurs, 2) difficulty breathing / chest pain, 3) weight loss for no reason, night sweats (cancer / tuberculosis), 4) urine turns dark coffee color (Dark urine / muscle weakness), you need to be hospitalized immediately!
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