Is it possible to get Heart Pain without blockages in major arteries? Insights here

  • Heart pain, or angina pectoris, is a pain that a person feels in the chest mainly due to low blood flow to the heart muscles
  • One experiences heart pain when these arteries are blocked by a thrombus or atherosclerotic plaque called coronary artery disease
  • A major blockage of the coronary arteries is one of the main reasons for heart pain

16 Nov 2022

Heart pain, or angina pectoris, is a pain that a person feels in the chest mainly due to low blood flow to the heart muscles. The heart muscles are supplied by coronary arteries. The two main branches of the coronary arteries are the left and right, which would divide into main branches. A person experiences heart pain when these arteries are blocked by a thrombus or atherosclerotic plaque. This is known as coronary artery disease. Although a major blockage of the coronary arteries is one of the main reasons for heart pain, there are other causes as well. Microvascular angina pectoris and Prinzmetal's angina pectoris are two other forms of angina pectoris.

Can you get a heart attack without a major artery blockage?
Although a major blockage of the coronary arteries is one of the main reasons for heart pain, there are other causes as well. Microvascular angina pectoris and Prinzmetal's angina pectoris are two other forms. Microvascular angina is caused by poor function of the tiny blood vessels that feed the heart. This results in heartache. Prinzmetal's angina is caused by spontaneous spasm of blood vessels leading to poor blood flow.

What causes microvascular angina?
Endothelium is the lining of microvessels. Endothelial dysfunction is considered to be the main cause of microvascular angina pectoris. Endothelial dysfunction is a multifactorial disorder. It is related to smoking, obesity, hypercholesterolemia and inflammation. Low levels of high-density lipoprotein (HDL) are also a cause. In addition to endothelial dysfunction, patients with microvascular angina have abnormal pain perception. This is mainly due to the release of potassium and adenosine, which ultimately leads to abnormalities in central pain perception.

How is microvascular angina diagnosed?
Cardiac catheterization with coronary flow reserve (CFR) is the gold standard for the diagnosis of microvascular coronary disease. Practically, however, the diagnosis is clinical when the patient presents with typical angina but normal epicardial arteries. Coronary flow reserve is the ratio of maximum blood flow in a coronary vessel compared to resting blood flow. In this test, a catheter is inserted into the coronary arteries and resting blood flow is measured. The person is then given vasodilators to widen the coronary vessels as much as possible. Again, coronary blood flow is measured, which is considered the maximum blood flow. The ratio between these two values ​​is the coronary flow reserve. Coronary flow reserve is low in patients with microvascular angina. Non-invasive techniques such as cardiac PET, cardiac MRI and CT scan are also reliable diagnostic tools available for diagnosis.

What are the treatment options available?
Since microvascular angina is affected by various factors, lifestyle modification is important in its management. It is recommended to stop smoking, exercise regularly, adjust your diet and lose weight. It is also helpful in managing other medical conditions such as high blood pressure, high blood cholesterol and diabetes. Pharmacological treatment can be used, which includes the use of beta-blockers, calcium channel blockers, nicorandil and nitrates. These drugs would cause the coronary blood to dilate allowing for better blood supply.


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