Study reveals dangers of angina caused by small heart vessels

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THE medical community once believed that microvascular angina — chest pain caused by the tiny arteries in the heart — occurs predominantly in females and is harmless.

However, a new study suggests that the condition increases the risk of heart attacks, stroke, and death.

The study also found no significant differences in outcomes between males and females, or by ethnicity.

Cardiologists often misdiagnose the condition and fail to treat it.
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

Maria George first experienced angina at the age of 42 years. The pain in her chest and between her shoulder blades became so intense that she ended up in her local emergency room (ER).

An electrocardiogram (ECG) suggested a possible heart attack, but an angiogram the next day found that her coronary arteries were free of any obstruction, so she was sent home.

She returned to the ER with chest pains several times over the next few weeks and months, but each time the doctors assured her there was nothing wrong.

“Indeed, I was even told by one of the cardiologists in my local hospital that if I ever had chest pain again, I should just breathe through it and not phone an ambulance,” she recalled. “Thankfully, my [physician] ignored that advice.”

The doctor referred her to a specialist, who diagnosed microvascular angina — a condition that cardiologists often fail to recognize and treat appropriately.

Like a heart attack, microvascular angina causes severe chest pain. However, standard diagnostic tests reveal the heart rhythm to be normal and find no blockages to the main coronary arteries that supply blood to the heart muscle.

The pain of microvascular angina is triggered either by a spasm in the tiny arteries within the heart muscle, by their failure to dilate and increase blood flow in response to stress, or a combination of both.

Even if cardiologists diagnose the condition correctly, they have often assumed that it is more likely to affect females than males, and that it is mostly benign.

However, a newly published study has found that almost 8% of patients with microvascular angina experience a major adverse cardiovascular event each year.

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