What is microvascular angina?
Microvascular angina, also known as cardiac syndrome X or microvascular dysfunction, is a form of angina (chest pain) caused by problems in the tiny arteries of the heart, rather than blockages in the larger coronary arteries. Unlike traditional coronary artery disease, where major vessels are narrowed by plaque, microvascular angina involves the small blood vessels that branch off the main arteries.
These microvessels fail to dilate properly, reducing blood flow to the heart muscle and causing ischemia, or oxygen shortage. This condition is often underdiagnosed because standard tests—such as coronary angiograms—typically appear normal. Despite this, patients experience classic angina symptoms: chest pain, tightness, shortness of breath, fatigue, and discomfort that may spread to the arms, jaw, or back. The pain often occurs during physical exertion or emotional stress, but it may also appear at rest.
Microvascular angina is more common in women, especially those who are postmenopausal, though it can affect anyone. Risk factors include high blood pressure, diabetes, high cholesterol, obesity, and smoking. Hormonal changes, inflammation, and endothelial dysfunction (impaired lining of blood vessels) also play significant roles.
Diagnosis requires specialised testing, such as coronary flow reserve measurement, stress cardiac MRI, or PET scans, which assess how well small vessels respond to increased oxygen demand. Treatment focuses on improving blood flow, reducing symptoms, and addressing underlying risk factors. Medications may include beta-blockers, calcium channel blockers, nitrates, ACE inhibitors, and statins. Lifestyle changes—such as regular exercise, a heart-healthy diet, stress management, and smoking cessation—are equally important.
Though microvascular angina is not immediately life-threatening, it significantly affects quality of life and can increase the risk of long-term heart problems. Early recognition and management are essential to control symptoms and protect overall heart health.
