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What is microvascular angina? How do you differentiate it from other symptoms of heart disease?
Microvascular angina (MVA), formerly known as Heart Syndrome X or coronary microvascular dysfunction (CMD), is a symptom of chest pain usually associated with reduced blood flow to heart tissue despite normal coronary arteries. This condition causes heart-related pain in many patients and is often made more difficult to diagnose and treat in women because of the lack of access to specialist physicians.
Microvascular angina is a condition in which patients experience intense chest pain and are associated with a relatively high risk of heart attack and other heart problems.
Symptoms of Microvascular Angina
Patients typically experience symptoms of myocardial insufficiency such as a feeling of heaviness, tightness, pressure or squeezing in the chest, which may be accompanied by sweating, nausea, shortness of breath and fatigue. Although the definition of microvascular angina is not yet adequate, there is general consensus that its characteristics include the following:
- Angina pectoris: usually does not cause dysfunction on echocardiography, and the pain may last longer than a heart attack.
- Abnormal cardiac stress test: ST segment changes on the electrocardiogram often resemble those of coronary artery disease but are the opposite of those of Prinzmetal's angina.
- Myocardial perfusion imaging may be abnormal in 30% of patients.
- Coronary angiography was normal.
Other causes of chest pain must be ruled out, including variant angina/coronary artery spasm and esophageal spasm.
Causes of Microvascular Angina
Microvascular angina does not have a specific known cause, but is the result of a combination of risk factors. The medical community believes that microvascular disease leading to insufficient blood flow and increased pain perception is the main cause of the condition. Microvascular dysfunction involves abnormalities in the heart's small blood vessels. Narrowing of these small blood vessels may result in a lack of oxygen to specific areas of the heart muscle, causing chest pain.
Some studies suggest that people with microvascular angina often experience more intense chest pain than people without the condition.
Risk factors that influence microvascular angina include abdominal obesity, dyslipidemia, hypertension, insulin resistance or glucose intolerance, and procoagulant or proinflammatory states. The risk for the elderly and women is significantly higher than that for men, and the risk for those with a family history of heart disease is relatively higher.
Pathophysiology of Microvascular Angina
This condition is usually manifested by a series of structural and functional changes within the cardiac microcirculation, such as endothelial dysfunction, microvascular arteriolar remodeling, and increased microvascular resistance. These changes restrict blood flow, starving the heart muscle of oxygen, which can cause chest pain. Although many physiological mechanisms have been proposed, there is still no evidence to support them.
The diagnosis of microvascular angina usually requires exclusion of other possible causes and relies on clinical diagnosis, appropriate stress testing, and coronary angiography. Cardiac MRI can also be used to diagnose this disease, and related research is still ongoing. The diagnosis requires attention to whether the function of the microvessels and larger coronary arteries is normal.
Treatment of Microvascular Angina
Microvascular angina is usually treated with calcium channel blockers (eg, nifedipine and diltiazem), and beta-blockers are used in some cases with caution because they may worsen coronary artery spasm. . Other prescription drugs include amodipine, estrogen, L-arginine and olanzapine, which relieve pain by improving blood flow to the heart.
ConclusionMicrovascular angina is a chronic long-term disease. Patients must see a doctor regularly for necessary examinations and treatment to reduce the risk of heart attack.
The significance of microvascular angina in women still needs further study, but it is important to rule out other heart disease symptoms and receive appropriate treatment. Think about it, do you pay enough attention to the heart health of yourself and your family?
