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Microvascular angina: why is it more difficult to diagnose than regular angina?
Microvascular angina, formerly known as heart syndrome X and now recognized as coronary microvascular dysfunction (CMD) or microvascular coronary heart disease, is a form of angina associated with reduced blood flow to the heart tissue, although the coronary arteries It's normal. This presence causes many people to overlook the severity of microvascular angina and under-recognize the condition, especially among female patients who may have difficulty accessing the care of an expert cardiologist.
Microvascular angina is not only a painful heart-related condition, but it is also associated with an increased risk of heart attack and other heart problems.
Symptoms and Signs
Patients often experience symptoms of myocardial ischemia, which include a feeling of heaviness, tightness, or pressure in the chest and may be accompanied by sweating, nausea, shortness of breath, and fatigue. According to general consensus, the definition of microvascular angina should include the following:
- Chest pain: usually does not cause functional impairment on cardiac ultrasound examination and may last longer than a normal heart disease.
- Abnormal cardiac stress test: ST segment changes on the electrocardiogram often mimic coronary artery disease.
- Myocardial perfusion imaging: Abnormalities are seen in about 30% of patients.
- Coronary angiography: normal.
Causes
The specific cause of microvascular angina is not yet known, but a combination of risk factors may contribute to the condition. Microvascular dysfunction refers to abnormalities in the heart's very small blood vessels. Narrowing of these vessels can lead to a lack of oxygen to specific parts of the heart, causing chest pain. Several studies have shown that patients with microvascular angina have a heightened sensitivity to pain and often experience more severe chest pain than those without the condition.
PathophysiologyFitness activities and family history of heart disease are risk factors, especially in women.
The disease is usually characterized by structural and functional changes in the cardiac microcirculation, such as endothelial dysfunction, microvascular arteriolar remodeling, and increased blood flow resistance. These changes can lead to lack of oxygen to the heart and chest pain. Although a variety of physiological mechanisms have been proposed to explain this disease, there is still no definitive evidence to support the existence of a certain mechanism.
Diagnosis
The diagnosis of microvascular angina usually requires exclusion of other conditions and relies on clinical diagnosis, appropriate stress testing, and coronary angiography. Cardiac MRI is also useful for diagnosis, and there is growing evidence that microvascular angina may result from microvascular dysfunction. A strong indicator of microvascular angina is the inability of the patient's blood vessels to dilate or constrict appropriately during stressful situations such as exercise.
Microvascular angina can be diagnosed by different tests, and data show that this symptom itself requires further exclusion of other heart diseases, such as variant angina.
Treatment Options
For treatment, calcium channel blockers such as nifedipine and diltiazem are sometimes effective, and beta-blockers can also relieve chest pain but sometimes make coronary artery spasm worse. Treatment also includes lifestyle changes, such as diet and exercise. Psychotherapy and mind-body therapy can also serve as auxiliary treatments.
EpidemiologyIt is not clear why women are more susceptible to microvascular angina, but changes in hormones and other specific risk factors may be involved, especially during the reproductive process, and the mechanisms of their influence are still being studied.
Microvascular angina is a chronic disease with long-term risks, and patients need to see a doctor regularly for health monitoring and management.
Microvascular angina remains poorly understood, causing patients to face a lengthy diagnostic journey. As many doctors are not fully aware of the condition, patients may seek medical attention multiple times without receiving a correct diagnosis. Does this make you think about your own health or the health of those around you?
