Microvascular angina 

Dr. Sanjay Gupta: You are a god send. You are not an ordinary Doctor but a true healer. Thousands of people are indebted to you for the education you deliver. Thank you .

Many thanks Doctor. I have got absolute clarity now and less worried about this problem now. 🙏

Thanks so much for posting these videos.. I’ve seen a couple of your videos on angina - really easy to follow. Just really grateful there are people around like you willing to share their knowledge.

Such an informative video for a little known condition. Thank you so much Doctor. Keep up the great work! I was diagnosed with assumed Microvascular Angina about 3 years ago and am still learning about it all.

Hello Dr. Gupta it’s great to see yet another amazing video. I’m pretty sure that my daughter does have POCS 12 yrs ago she was told she needed a table tilt test. It wasn’t until I listened to your videos that I remembered that test had been done on my beautiful daughter . I asked how was the table tilt test done. She went on to tell me that a nurse had her lay on the bed for about a minute then left the room came back looked at the screen and sat her up for one minute. She immediately told my daughter that she did not POTS and that she could go now. I decided to give my daughter noodles with a lot extra salt. We talk as she ate and she told me that she had been feeling extremely nauseous and spent the night of the bath floor. What she didn’t realize was this would have been her 15th night on that floor. At that point she asked for more egg noodles which surprised me because anytime she tried to eat she would end up not holding it down. So I encouraged to add salt just to see how she’d wake up in the morning . For the first time in 15 yrs she woke up at 6:00am as opposed to 3-4pm. That salt did something. She’s been up and out of her bed for the first time she just wanted to talk about find a doctor who understands is really familiar with POTS and the Trigeminal Nueralgia. She’s going to try finding a cardiologist to see if her heart is functioning properly. We are hoping that she won’t have to get a Vascular Decompression on her brain. We were told that her veins are very small and for some reason the vascular vein in her brain is causing her : Visual disturbances insomnia. Nausea, lack of appetite, trouble lifting her head if she’s been in bed, vertigo, migraines that cause her to keep ear plugs in her ears all day and night. Her hands and feet are alway cold. She graduated Valedictorian and attending Davidison College for two years doesn’t feel well at all. Every single day that passes she feels less hopeful , she can’t sit in her Jacuzzi anymore she feels like she’s going to pass out. She’s in her late twenties and despite her intellect, her ability to play nearly any instrument, she has perfect pitch and composes her own music. I’m so afraid she’s going to die. She’s starting to look anorexic. I know she is in deep depression. She’s gone to private and group therapy. She gets 36 Botox injections monthly and self administers injections in her stomach as well as Topomax ! Just so you know the noodles with extra salt made able to have a little conversation and a laugh, with a I nearly cried When I realized she was sitting up smiling and looked straight into my eyes saying “Hi mom it’s good to see you.” To anyone else this is nothing special but for me it was a validation that may have been missed diagnosed. All I know is that something is very wrong here and if she doesn’t get help soon she could end up dead. Dr. Gupta would you consider doing a video with her. I would gladly pay . When you see her you will see a part of her heart that has been broken- her life long dream of becoming a neurosurgeon. She loves to learn and had many interest’s in many things but there is nothing that wanted more that to be a neurosurgeon. I’ll let you know how she does WITHOUT the salt . Please consider a video conference for an initial screening. We have all her medical info in a binder!

The best explanation of this desease on utube. Congrats!!!!!

Great video, thank you for this information. With all the alarmist websites out there regarding microvascular angina, this is really a relief.

Thanks much from one with high blood pressure, afib (3 ablations in 8 years-just had my third ablation last month), MVD angina, and cardiomegaly. I'm doing well with med regimen and I appreciate your taking the time to explain MVD so understandably. I've been very fit most of my life, rowed in college and continue to row an ergometer several times a week plus do construction work. Your video is very encouraging despite the daily discomfort from angina. Thanks so much.

I find your videos so informative and helpful! Thank you!

You explained my micro vascular disease clearly ,great presentation !!

Thank You Sanjay, You are so comforting to watch, i only watched this video today and i feel a weight lifted of my shoulders already, i have been diagnosed with MVA (suspected) and have been on Beta Blockers & Clopidogrel for over 12 months but felt awful on them. I have asked the GP to take them off me over 5 days ago and i feel so much better. I have a Hiatus Hernia (sliding) and i am now sure that it is this that is causing my pain. I did have an appointment with you by video call some months ago, but i missed the call, i watch all your videos all the time and find them very helpful, you are really good and informative. Thank You Thank You Thank You.

Was confused with my chest pains, all clear now. Ur videos are awesome, really like the way u explain in detail. Very useful. Thankyou.

Really helpful. Great job!!

Thankyou so much , I was diagnosed in 2017 with Micro Vascular Angina . I was living abroad at the time. I had an angiogram which the cardiologist performed some kind of thing to bring on the actual pain I suffered during an attack, all my pain is in my left arm, mostly if I am walking up an incline or trying to hurry.However since being back permanently in the Uk, because I had an ECG that came back as normal I was discharged. So this video has really helped me to realise it maybe is not as bad as it could be.Thankyou.

Thank you so much doctor ❤️ I am really thankful to you for all the information that you share, I feel very blessed and feeling emotional after watching your videos with tears of joy for finding your videos.I pray that miracles happen and I get a chance to consult you someday.I am really in need of your help Sir.I hope you get my message.May God bless you and your family. Love Feli from Mizoram,India.

Sanjay , thank you so much for this video. , it is absolutely brilliant and totally refreshed my memory ! Thank you for taking the time to do it , I hope other people will find it as helpful as I did ! Best regards Gilly

Amazing amount of knowledge and details that are so helpful thank you

Thank you for a really informative video. I'm in the process of tests at the moment and my cardiologist has said he is 99% sure I have microvascular angina. this video has settled my mind about it. I hope to be able to pick up my half marathons again soon :)

Thank you very much 🙏you’re a very good doctor

This is for you Dr, thanks a lot . I am so much in this phase of knowing what are the sources of my angina (persistent), ruled out of stenosis by CAG with mild MB in LAD. The next suspect in the epic story is MVD. I am now informed that there are many differential diagnosis of Angina that includes MVD, GERD. Thanks for the great video and always we love you..💕

Magnificent!! You are like an angel.

Good presentation thank you for your informative subject

Thank you Dr. Gupta. Why don't more cardiologists take the time to explain as you do ? I am a mv suspect and may go to a specialist soon to try and get further clarification.

Thank you; feeling much less frightened.

Knowledge is power, thanks Dr. Sanjay, for your very informativevideos Thought I was just getting older, one doctor expressed to me before she moved that I did not have to be always so tired (I have thyroid disease) you also solidify that I have options and don't have to continue to feel (excuse me) crappy.

Thank you for making this video. It really helps!

It's really very important to know about this condition.

I love this dr for reassuring my gerd

Very helpful, thank you!!

Thank You this was very helpful!

Very helpful. Thank you.

It was a helpful video! I m less scare when my coronary went to spasm. You re the best cardiologist!

Brilliant thanks again.

48 yr old . I just had my 2 ND "small" heart attack 8/4/18 my 5th over all . The vessel was big enough to stent for a grand total of 10 . Dr found out one of my bypass has quit . CAD & CHF with a EF of 38 . Just keep on keepin on

Thank you sir, feel bit relief, expecting more videos on this subject Thank you once again

thankyou for this video. very informative and easy to digest for someone like me who is looking into it. as it all adds up and i think is affecting another condition which i need clarification on. ive been told to lookfor someone who specialises in it so thanks for the recomendations.

SO HELPFULL!!

I had an echo and a carotid artery test and both came back normal. I continue to have upper chest pain/burn either across the top of my chest to my neck area or centrally located or upper left chest while exercising. Sometimes it's been happening even when climbing steps or just upping my movement speed a little bit. I play footbag which is very cardio intensive. In fact I call it aerobic foot juggling (hacky sack). Footbag is the professional version of that. See any video in my profile if you would like to see it. Within the last 2 months though I've been getting this and the first time it happened it almost gave me a panic attack and I stopped exercising. The next day I played again and it happened once more within about 5 minutes or basically once I begin to bring my heart rate up to a much higher level. I've pushed myself over the years to where I could barely breathe but I've never had this burning kind of pressure pain before. I've even experienced it twice now just sitting in the hot tub. In both cases, I stop exercising or I get out of hot tub, and it subsides. I've even given myself 2 -3 minutes rest working out and I can continue on. It does build back up but over an hour work out it seems to subside in the overall pain too the longer I go but never goes away. This sounds like what I would have but my doctor wants to do a stress test next I'm just not sure it's heart or lungs. Sitting or not exerting or bringing my body temperature up results in no symptoms. I do have high stress as well though. I've even had to take klonopin lately on a daily basis. We lost our only daughter just over a year ago so it's caused some health issues and this is just one more on the list. Normally I'm a very healthy, athletic individual. I've gained 15 pounds (195 from 180) and my blood pressure has been higher than normal. I don't notice stomach issues but in the past I've had them from time to time.

Wow this is so helpful

you have helped me understand a lot of what is happening to me. for two years I have had increasing discomfort when I do too much and I have to lie down to rest. I think I have coronary spasms as well, I have episodes where it feels like someone has gripped my arteries in my neck and chest in a vice and it doesn't go away for hours. sometimes it takes several days before I feel better. I have undergone all the tests you described, I have a 60% blockage in a small artery, but my dr doesn't believe me when I tell him what I go through. he treats me like a child, but now I know im not crazy. I am going to show my primary dr the link to your videos. thank you for explaining things so well, I am not as afraid as I was. thank you

Thank you. Informative

So,so helpful. I had post viral myocarditis recently finally diagnosed after, carotid Doppler,Echo, angiogram,& cardiac MRI. The symptoms you describe are exactly as I experience. I kept saying it's a tight discomfort going through to my back. I have been researching since the cardiologist suggested it as a likely issue. However I'm slightly reassured by you because some have indicated that it can lead on to M. I . Also I am Gilly too.

I had an angiogram in 2016 and my large vessels were completely normal, and the cardiologist says "don't worry about your heart". My symptoms did not go away, they got worse. Finally i was prescribed Nitro, because i kept going to the ER with angina. The Nitro works wonderfully. It stops the symptoms. Now I DO have GERD, and am on Lansoprazole 30 mg twice daily, and it works. no more reflux. But im still having angina. the chest squeezing is not a lone symptom. It spreads to my arm and neck, i get short of breath and feel like passing out. I have a history of TIA's as well. I am convinced i having artery spasms, because i often will get the angina at the same time as the stroke symptoms.. so maybe the arteries in my brain are spasming at the same time as my heart? EDIT: I get these symptoms with exertion, but i also get them at random, usually at night the most. Also, I get these horrible hot flashes and flushing multiple times a day. My dad will complain the house is freezing because i have the temp so low, but ill feel like im out in the desert and also have a fan on me, but then at times i get really cold for no reason and my fingers will turn white or purple and be ice cold

Thank you

Hi thank you so much for your video....very informative! I have not yet been diagnosed but it is presumed I have this condition. Just wondered whilst I wait for my condition to improve how I can help to get myself back to work? I have difficulty walking about 20 steps and get pain.

Excellent presentation. Based on symotoms, cardiac history, and multiple ECGs, I was diagnosed suffering MVA, Uncomfortable, and can be present without respite for months..it fluctuates. Apart from angina and unstable angina, at times, the heart itself feels as its being squeeze, causing pain. As far as I know, I do not suffer from GERD or other digestive issues.

Thank for posting, Doctor. I have six stents, 14 and 10 months ago, but still experience pinpoint angina in the back when working with my arms. My angiogram doctor now believes it is a blocked small vessel. It is frustrating that a final diagnosis does not appear to be a goal of cardiology, but considering a non-stemi MI left me with left ventricular damage, I assume I am doing better than the first hospitalist who looked at my chart considered possible. The microvascular angina is still a significant worry for those with lingering ventricular damage because angina can lead to repeated ER trips, as the vitals climb and heart rate reacts to the stress of angina.

This video was very helpful. I was getting ‘random’ chest pain with no obvious cause. Went to the hospital twice with suspected heart attack and then to a cardiologist. Angiogram showed not only no evidence of artery damage but no calcium build up. (0%] This is worth noting because my cholesterol is reasonably high. Most GPs would want me to go on statins based on my cholesterol but I am glad I don’t need to do that. (How many people are unnecessarily taking statins?) After describing my symptoms to a friend who has ongoing heart issues, she told me about microvascular angina. (I don’t know why the cardiologist didn’t tell me) I looked into it and thought that’s what I had, however my episodes are not linked to exercise, they don’t seem to be linked to anything. Now that I hear you speak about the possibility of it being a gastroenterology cause, I will investigate that. I do have GTN spray and that helps when I have an incident. If I need to have a second double spray, I get a headache, so I prepare for that with Panadol. I am a two times cancer survivor (breast and endometrial) because I am aware of my body. Thank you for sharing your knowledge in a way we can understand. Sheryl, Western Australia.

Great video, so informative. When you have a very painful heart spasm with MVA, does it create high troponin ?

Bro your da man ...thank you ..from alb NM

Thank you for a great video. I have been confirmed as having micro vascular angina along side Prinzmetal angina. I wish I had seen your video a long time ago ! I did indeed as you suggested had a endoscopy to rule out gastric problem, it was normal. I have been prescribed Ranexa to help protect the heart muscle. I am due to come off my HRT soon having had an oopherectomy aged 49, you mentioned women going through menopause may cause my micro vascular angina to increase over time as my oestrogen levels will drop? Any suggestions? It was Professor Kaski at ST George’s hospital in London who diagnosed my Prinzmetal and micro vascular angina. He is absolutely wonderful and so so kind. An incredibly knowledgeable physician. I just Googled his name , saw he specialised in Prinzmetal and asked my GP to refer me on the NHS. I’m hear today stable and well because of him ! If you get the time could you give a talk about ecg’s ? Just the basics please as it’s referred to when ever discussing cardiology. I would like to know what it means when they say a ST elevation heart attack verses a Non ST elevation heart attack. Thank you from a new subscriber.

Thank you so much. I’ve just been diagnosed with the spasm version. But now I’m wondering if it’s not micro vascular angina. Only because I’m getting the palpitations & aches upon exertion.

Dr. Sanjay gupta Can you please do a video on the relation between ischemia and SVT?

I have been on Ranexa since 2010. It has worked wonders for my angina. I was put on it after heart surgery. My condition isn't eligible for stent placement because of the affected area. My only issues with the medicine is that it can cause prolonged QTs. This has happened to me a few times of the years. It is also very expensive here in the states and not all insurance companies have it on their formulary. Thankfully the VA covers the cost for me, but I had to get a waiver. The last time I checked the price a few years back it was $534 dollars for 30 days. Hopefully it has decreased since then.

A video on Prinzmetal metal angina would be good as im a sufferer of this condition and it can be very painful but i still don't really understand what its about.

I had a ha last year from the 2nd obtuse marginal branch of the circumflex is this small vessel disease and I have two more blockages one 50 on lad and a 40 on rca

That is the clearest it has ever been explained to me thank you so much

thank you sir, you've bee a great blessing to my husband's health. we have gained so much knowledge from you compared to the doctors he's been seeing for years he didn't get any better. we have neen trying magnesium supplements to improve his AFib. will be commenting again and update you on his improvement. Bless your kind heart💖!

Question I have a family member with heart problem when she does have chest pains she takes a nitro tablet it stops the pain but she doesn't get that headache everyone talks about?

The WISE study! Yes MVD angina kills, my sister.

My cardiologist diagnosed me with this even though it has only happened when I am at rest. Within hours of exercise but not during. Also within hours of having a sauna. YOur video put me at ease. My CT angiography did now reveal any blockages and I kinda don’t trust this doctor-I get a bad vibe from him. The Magnesium advise was very helpful too because I may have a deficiency there.

Thanks a lot and Allah bless you and your family Sir for providing me such an important information and guidance. I am suffering from chest pain on exertion but it is increasing fast when i have gas in my stomach. I cant find out if it is a blockage problem or Acid Reflux.

Thank you Dr. Despite having two doctors treating me (the cardiologist never mentioned it and acted baffled as to why I had a heart attack with clear arteries), no one was able to make it this clear. I have been taking amlodipine for a couple of years. Is this effective in reducing these spasms?

Can you please tell me the EKG of someone who has microvascular angina episodes

Great channel. I was wondering if you could help me by answering my question. I was having a echocardiogram (DSE) to detect any problems with my heart. As I was having the test I experienced pain in my heart and mentioned and mentioned this I was told not to worry and he carried on. I then experienced pain going across my chest to which he just carried on till he got my to beat to 144 bmp. At the end of the test I was given GTN spray as the pain wouldn't go and after this I was asked what type of pain I experienced and how bad it was on a rating of 1 to 10. He later went on to tell me that my heart function was okay but I had microvascular angina. My question is in having microvascular angina and having to go through this stress test for around 10 minutes to a maximum 144 bmp would this have a negative impact on me as the week before I had hardly any symptoms of angina and yet the following week from the test had regular heart and chest pain/discomfort. I've tried to get answers from A & E but they seemed to brush it of as it wouldn't of been an issue and it could be something viral affecting my symptoms.

So i had way to much caffeine today, i had a slight pain in my chest

yhankyou dr gupta for such information, last 3 years i am suffering with excercise induced ischimia ,i had gone thourough angiogram where no blockage were found but left hand pain occur during simple walk, doctorhas advise me to take nitroglycirine twice a day along with my routine medicin, I am daibetic with mild blood pressure , should i cunsult or examin again

Thank you for an informative & easy to understand video. I suspect mine is triggered by exceptional stress over a prolonged period. A few questions please: 1. Is there a link between MVA / Coronary artery spasm and muscle cramps in the toes on or following exercise? 2. Do patients report positive benefits from taking supplements? Vitamin D / K / Mg?

Great video from you, as usual. I went into York with angina recently and the angiogram showed no problems with blockages in the main arteries. It was suggested I had microvascular disease and I was discharged without much further comment. I have a follow up with my cardiologist at the end of this month so I may glean more. Now, here is my concern. Google almost anywhere and we're told that microvascular disease should be taken as seriously as major artery blockage and it puts one at just the same increased risk of heart attack. Naturally, that is worrying. Then this video from you which largely dismisses that risk - for very good reason as you explain it. While this is very reassuring Dr Gupta, why do you think there are these contradictions when it comes to this condition? Thank you.

What about Nvidia Clara for advanced imaging?

Can you say something about SILENT ISHEMIA? Thank you.

Microvascular angina and spasm are serious debilitating painful conditions. There is no real treatment other than medication so leaves the patient with poor quality of life. Cardiac MRI can show ischemia or myocardial perfusion scan. The heart is like a leaf made up of 80% small blood vessels. I have both microvascular and spasm and it is a horrible painful condition. Chest pain not just discomfort.

I was diagnosed with this three years ago. Light exercise and 18 months later = no angina.

I for those watching in 2024 here is now a definitive test during an angiogram which can prove this.

The angina of microvascular angina tend to occur after exertion doesn’t it rather than during?

Sometimes i think i have angina but i test myself by running up my stairs over and over and i feel fine after its that good?

I have microvascular angina and small blood vessels disease some of my meds don't work what else can my doctor do to treat this

How is chest tightness from angina different from chest tightness from shortness of breath

Why is some angina/ just arm, shoulder pain only occurs due to emotional stress/ fear, not physicsl assertion ??

Is it life threatening? I have had it for years. Its so bad.

my pain was like heart burn

My bnp was at 804 triponin was an 18 this was about 15 hours later after the heart sped up to 94 bp was 209/ 110 pain or bad discomfort in neck and the pulse was just beating extra hard in my face etc

Likelyhood of angina at age 28?

Dear Dr. Gupta, Thank you very much for this informative video. I am a 35 years old man who suffers from chest pain for several years although I am on Pantroprazole daily. I had a stress test which came up with some strange results therefor I was recommended to do a coronary angiogram which came out normal. Cardiologyst things I might have either cariovascular spasm or microvascular disease. Currently I am on Nebivolol 5mg daily but this doesnt seem to help. Nitroglycerin doesnt help and chestpain is always at rest, lasts for up to 6 hours and ECGs are always normal. I have read a lot about this condition and everywhere it says that this is not a benign condition, it does increase the risks of heart attack, heart failure etc. As much as I want to believe your words that this is not a serious condition, I would kindly ask you where do you refer when you make that statement? Is there a study done about long term consequences of MVD? All the articles I read online state the opposite. Thank you for your time.

How does angina transition to a heart attack? (What exactly is angina?)

My attacks happen in my sleep too!!! And wake me up

can a cta with contrast rule microvascular angina out?

Gupta sir.,i have constant chest pressure in middle of the for about more than one year and feel palpitation. Could it be microvascular angina?

Garlic helps me expell all doses of gas for me.

My cardiologist says i have many small vessel blockages that he could not stent

I have had 2 nstemi heart attacks and told it is due to microvascular angina. I am a single mama and so scared I am going to drop dead in front of my baby. I wish dr could help me. Both my angigrams were perfect.

Women often dont have chest pain . Just shoulder, leg/ arm pain

Can microvascular disease cause a cardiac arrest?

Are the only hospitals that are doing these procedures and I must say there is a lot of risk involved in having this procedure my advise women you know what your feeling always get a second and third opinion.

How about prinzmental angina?

what meds. are used for this??

I was diagnosed with syndrome x and spasms. I was put on medication and told I could do my normal activities. I ended up having a heart attack. Angiograms come back clear. for me without medication I get severe pain. They also tried anxiety medication which did nothing but make me feel loopy. I was an extremely active person that within several years I could not get up the stairs without having to stop and I was forced to cut back all activities. You are saying you don't have to be concerned but that is how I ended up with heart attack. I dismissed my symptoms and kept up a heavy schedule because I was told they were nothing (just pain) and nothing would happen. finally I am on a combination that works but I still have to be careful and rest every day.

very dangerous to say that it is benign, please do your research or take down outdated videos that could be misleading people who need aggressive treatment.

Microvascular disease or angina is different in men the only way you can tell you have microvascular angina is by a test called Coronary artery reactivity testing and this is the only way the diagnoses will be correct. However male doctors try to dismiss this because they don't perform this procedure in a lot of hospitals. Cleveland hospital, Cedars Sinai, Mount Sinai hospitals.

Project fear from the cardiologist at least here in Germany is a daily routine for them..take those pills or else.