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How is coronary microvascular disease diagnosed?

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Posted on Fri, 11 Jun 2021
Question: How is coronary microvascular disease diagnosed? I have had several episodes where it felt like I was having a heart attack but my ekgs and stress echos were normal. I had slight ekg changes but they said it's was nothing significant. A friend said maybe the small vessels of my heart are effected because I have strong symptoms but don't have any evidence of large blockages.
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Answered by Dr. Sagar Makode (24 minutes later)
Brief Answer:
coronary angiography with slow flow

Detailed Answer:
Hello,
Firstly, there is no definitive test to diagnose it sure shot.
However, these are some of the things. Firstly, you should have typical symptoms of angina on exertion and relieves with rest. Presentation like heart attack is usually not there. Next thing, in such angina, nitroglycerin is not effective so suggest possibility of microvascular angina. Also, your tests like stress test, thallium or TMT etc will show some defect, however sometimes may be normal. In such settings, the diagnosis is considered if there is no blockages on coronary angiography or ct angiography. Coronary angiography will show no obstructive lesion with slow flow suggestive of MVA.
So yours I guess fall in atypical for non cardiac chest pain rather than MVA. Rule out the possibility of Gastroesophageal reflux disease like nausea, vomiting, chest burning, bloating, burping, increase in pain on food or lying down.
Hope this helps you and get back if you have any doubts.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Sagar Makode (3 days later)
I have tried taking antacids when I had episodes but it doesn't help. Why is it that when I get episode of tachycardia I have a weird sensation in my arms? I had a doctor tell me its just anxiety but I am not anxious and I even went to see a psychiatrist a couple of times to see what he thought and he told me that he does not believe my symptoms are psychological. Sometimes my arms feel like they have tourniquets on them, almost always on the left arm. Rarely anything on the right. One time when I had an episode my left arm felt so heavy, my chest felt strange, my heart was beating fast and and I felt lightheaded and sweaty and it felt like it took extra effort to breathe. It had been coming and going in intensity. It has happened other times, but that time was the worst.
doctor
Answered by Dr. Sagar Makode (2 hours later)
Brief Answer:
Unlikely to be microvascular angina

Detailed Answer:
Hello, you
Its unlikely to a microvascular angina. As angina should occurs on exertion and your tests should have shown some changes.
Now, regarding the possibilities other than anxiety, the first is of cervical spine problem and other is Gastroesophageal reflux disease.
Did you have antacids for a continuous period of a week or so. Because, antacids will not act immediately, they ll take some time to act. You should avoid fatty, oily and spicy diet. Have some walk after having food instead of taking rest. Avoid smoking and alcohol if any. You can get prescribed tab Pan DSR 40 mg or esomiprazole domperidone combination beforebreakfast once a day for 2 weeks.
This can be a cervical pain, due to compression of nerves between spine. Does this pain increases on neck movement, or any neck trauma, these may be the associated symptoms. You should get x cervical spine AP/ Lat view and further may need MRI.
How fast was your heart beating, did you count the pulse rate or heart rate, was it sudden of onset and offset. This is to rule out cardiac arrhythmias like psvt, which are not usually life threatening.
Hope this helps you and get back if you have any doubts.

Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Sagar Makode (14 hours later)
I've been on antacids for a while. Doesn't seem to make much of a difference. I have issues with my neck but the MRI ruled out anything that could be causing the feeling in my arm. My heart rate can be all over the place. I've had episodes where my heart goes fast suddenly. It's regular. When it happens it's usually in the 130s . But it feels different than when it goes up due to exercise. It's like it is just takes off. sometimes I can stop it with certain movements. Or it suddenly goes back to normal. It's not like it gradually slows down. I know that this is not serious because its been happening for a while and I'd be dead by now if it was. I don't get anxious about it because I am used to it. I am just curious to what is causing it. I'm familiar with reflux and musculoskeletal pain. When it happens it just feels like my heart is stressed out. It happens at work sometimes when I am under pressure and moving around a lot or if I get angry or startled. I was diagnosed with POTS and ehlers danlos recently. Taking salt helps when I get a fast heart rate and shortness of breath and dizziness standing. I don't know if that makes a difference
doctor
Answered by Dr. Sagar Makode (7 hours later)
Brief Answer:
This can certainly be related to pots

Detailed Answer:
This can be related to your pots especially if this almost always happening with standing position only. If not, then we also have to consider the possibility of arrhythmia like psvt as you mentioned it to be sudden onset and offset. To terminate these, you should cough hard or pour some cold water over the face.
To confirm this, you should get an ecg done during the episode if it is sufficiently long. If not, then ambulatory monitoring has to be done. If it is occurring daily or frequently then 24 hour holter monitoring will help or if not then longer monitoring will be helpful. Alternatively, you may get XXXXXXX based cardiac monitor attached like Alivecor Kardia if available.
Also, keep yourself hydrated and get your bp checked regularly especially during episodes if bp apparatus available at home.
Above answer was peer-reviewed by : Dr. Remy Koshy
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Dr. Sagar Makode

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How is coronary microvascular disease diagnosed?

Brief Answer: coronary angiography with slow flow Detailed Answer: Hello, Firstly, there is no definitive test to diagnose it sure shot. However, these are some of the things. Firstly, you should have typical symptoms of angina on exertion and relieves with rest. Presentation like heart attack is usually not there. Next thing, in such angina, nitroglycerin is not effective so suggest possibility of microvascular angina. Also, your tests like stress test, thallium or TMT etc will show some defect, however sometimes may be normal. In such settings, the diagnosis is considered if there is no blockages on coronary angiography or ct angiography. Coronary angiography will show no obstructive lesion with slow flow suggestive of MVA. So yours I guess fall in atypical for non cardiac chest pain rather than MVA. Rule out the possibility of Gastroesophageal reflux disease like nausea, vomiting, chest burning, bloating, burping, increase in pain on food or lying down. Hope this helps you and get back if you have any doubts.