Microvascular angina: Jennifer’s story
Jennifer Waller, from Surrey, had quadruple heart bypass surgery in 2006 at the age of 56, but ongoing problems led to a second diagnosis of microvascular angina. Jennifer tells us her story.
Happily, my condition is presently stable and well controlled. Apart from taking my medications and accepting some limitations on my activities, I can largely ignore it. This isn’t the case for everyone, and nor was it for me before I was referred to a microvascular angina cardiac specialist, tested and treated.
Microvascular angina is caused by a problem with the smallest arteries that supply the heart muscle, whereas “normal” angina is usually caused by a blockage in the larger arteries that supply the heart.
I had been struggling for years with lowered stamina and unrecognised angina, but was not an obvious “candidate” for heart disease
It was problems with the larger arteries that led to my heart bypass. Those problems were diagnosed after I had an exercise stress test at my local hospital. I was immediately put on cardiac medication and referred for an urgent angiogram.
With hindsight I realise I had been struggling for years with lowered stamina and unrecognised angina, but was not an obvious “candidate” for heart disease as I didn’t have any risk factors. Before this test, blood pressure, blood tests, X-ray and resting ECG all came out as normal.
Before my angiogram my symptoms had become more frequent and included chest pain and central back pain while resting. But the angiogram showed several very severe blockages and I was referred for immediate surgery at St George’s Hospital in Tooting.
Problems after bypass surgery
After my heart bypass surgery I didn’t make good progress and had more unexpected symptoms which were extensively investigated. Back in 2006, microvascular angina was diagnosed by ruling out other causes for the chest pain. So while this diagnosis was considered, there was the possibility of gastrointestinal problems which took time to investigate, as well as the healing process from my surgery.
I was advised and forced to take my rehabilitation more slowly, which I found intensely frustrating
I also clearly needed time to recover after the surgery, but the harder I tried to regain fitness - including cardiac rehabilitation classes - the more setbacks I experienced. It was even difficult to resume normal daily activities when exertion continued to bring on chest pain and breathlessness. Stairs and inclines were hard, travelling was problematic. I was unable to successfully return to my work.
I was advised and forced to take my rehabilitation more slowly, which I found intensely frustrating. My mental state was deteriorating and I felt that my genuine heart pains and physical difficulties were being both underestimated and sometimes misunderstood over what became a period of several years.
Referral to a microvascular angina specialist
I now know that microvascular angina is a variable condition. Occasionally there were episodes of more severe and lasting pain, sometimes necessitating hospital emergency visits - on medical advice. It was at one of these that I was given the opportunity to see the interventional cardiologist again.
He was able to discount the gastrointestinal symptoms, and was satisfied with the condition of my main cardiac arteries and of the bypasses. He then made the crucial decision to refer me to Professor Juan Carlos Kaski, the specialist for microvascular heart conditions at St George’s Hospital.
I am now well enough to exercise, to be an active family member, to take on new projects and to enjoy world travel
Professor Kaski ordered various tests including stress echocardiogram and cardiac MRI which confirmed the microvascular angina diagnosis. Nowadays there are other tests also available to assist with diagnosis. He explained to me that, although the bypass grafts were all fine, the coronary microcirculation was on certain occasions unable to dilate or open up. This microvascular dysfunction was causing the chest pain - microvascular angina.
I was then able to start on a personal medication plan suited to my symptoms which included slow release nitrates at quite a high dose. As is usual, nitrates had not been deemed necessary after my successful bypasses. However this treatment was hugely beneficial for me. At last I could manage normal daily activities and I became able to exercise, gradually improving my fitness and stamina. I was allowed to vary my doses myself to adapt to seasonal temperature changes. And to prevent symptoms occurring during exercise I could use GTN patches.
My quality of life both physical and mental began to improve. I could walk, cycle, swim and travel.
Understanding my condition
While my diagnosis came as secondary to coronary heart disease I understand that microvascular angina can occur both with coronary heart disease and separately. It occurs to both men and women. Each patient is likely to have a slightly different experience.
I have a better understanding now of the condition as it affects me. There are still times when the symptoms are worse and times when I need more medical advice from my supportive GP or cardiologist.
Adjusting to new limits
I am one of the lucky ones, as my treatment has successfully addressed my main difficulties. I have been able to gradually rebuild my heart fitness. I can accept the remaining limitations but can feel confident about my future. Without diagnosis and ongoing treatment I feel that my future would have been severely restricted.
I am now well enough to exercise, to be an active family member, to take on new projects and to enjoy world travel – a better retirement than I foresaw in the aftermath of my bypass surgery.