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Normal Heart Catherization but still having severe pressure and tightne...
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Normal Heart Catherization but still having severe pressure and tightness

I am a 40 year old female, who lost 50 pounds in the last 14 months,  25 more to go. Heart disease runs rampant on both sides of my family(grandfather died 42 of massive heart attack) My cholestrol is high 250, my good cholestrol is low and bad cholestrol is high. Husband has had 2 heart attacks so we eat right, no salt and watch fats. I started exercising Dec 1,(an hour a day on the treadmill walking at 3.5 mph w/high incline-have a bad knee so no running or jogging for me.  I noticed my heart rate would go higher than my husbands, once heart rate hit 130 I would get a tightness, squeezing, pressure in my chest.  Once I stop and get the heart rate below 125, the tightness goes away. I tried working thru it and heart rate went up to over 180. This has happened when I have been under SEVERE stress also.  Went to family doctor, he had me do a nuclear stress test, it was normal.  Doctor sent me to Cardiologist who said I needed a heart cath.  I had the heart cath and they found no blockages, my blood pressure would be really high than drop really low than back up again. My blood pressure is normally in the normal range but lately is running higher than normal.  Cardiologist is saying it sounds like Microvascular angina.  I am unable to find any real information on Microvascular angina.  Can you give me some insite.  Also is it normal for the heart rate to go up when I take a nitro.  I quit smoking from December 1 but started up again about a month ago do to the stress. I feel like I am going crazy, I KNOW something isnt right and I am scared.  Any insite would be appreciate.
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239757 tn?1213813182

some people do get pains related to the small arteries in the heart we cant see, while others get spasm of their normal arteries which can temporarily limit blood flow.

The remedy for this is to try and provide a healthy environment for the small cells that coat the lining of these vessels such as tight control of your cholesterol, weight, blood pressure, aerobic fitness and other cardiac risk factors.  

Heart rates can increase with nitro as it decresases the amount of blood that is in the cardiac chamber with each heart beat and the heart increases its rate to compensate for this. This is usually more pronounced in states of dehydration.

The absolute most important thing you can do for these sympomts and your overall health...I repeat...the ABSOLUTE MOST IMPORTANT THING YOU CAN DO FOR ALL OF THESE SYMPTOMS AND YOUR OVERALL HEALTH -- IS TO QUIT SMOKING.   It has impact on your heart and lungs and can certainly be a contributing factor to the chest pains you are having currently.

good luck
Avatar n tn
Thank you so much for your information. A couple more questions.

Is there a definate test that they can do to tell me it is definately Microvascular angina?  Why is it so difficult to find any information on Microvascular angina?  Does Microvascular angina mean that I have the beginning of heart disease?

I have had EKG's and they were in the normal range, last year I had one that was abnormal.

The nitro does take the pressure away when exercising or when I get the severe stress.  Does it hurt to take the nitro prior to exercising.  I do exercise 6 days a week.

I am currently on Toprol xl 25 mg, and nitro as needed.
Should I be talking a statin to get my cholestrol under control, (my appointment with my cardiologist is this coming Friday)?

Could the blood pressure be causing the symptoms even though half the time it is in the normal range (both parents and 21 year old brother have high blood pressure)

I have quit date of June 1, for the smoking.  

Having a husband that has MS and 2 heart attacks all before the age of 45 has made me learn that you must inform yourself and learn about your condition and speak up with any questions you have so I really appreciate your time and assistance.
38309 tn?1270893703

From MedHelp archives on Microvascular Angina:

Microvascular angina refers to myocardial ischemia (reduced blood flow to the heart muscle through the coronary arteries) with macroscopically normal coronary arteries on an angiogram.

The coronary arteries originate from the aorta and are usually
3-4 mm in diameter. The arteries progressively taper to their distal terminal branches which are less than 1 mm in diameter. On an angiogram, cardiologists can see the opacified arteries to the level of 0.5 - 1.0 mm of resolution. Thus, if there are no blockages in the arteries to that level of resolution,
the coronary arteries will be reported as being normal.

However, if a stress test has been done that demonstrates reduced blood flow to the heart muscle, microvascular angina will be inferred if there are no macroscopic blockages
in the coronary arteries. Stress tests use radioisotopes to image blood flow to the heart muscle via the coronary arteries and try to localize areas of the heart muscle that are ischemic. Then, an angiogram provides a "road map"
of the arteries to try to correspond a blockage with the area of ischemia on a stress test.

The difficulty with microvascular angina is that the presumed blockages (presumed because they can't be seen) can't be treated with angioplasty or bypass surgery so only medications can be used.  


I was diagnosed with microvascular disease after having a thallium stress test and adenosine cath where a provocation drug is injected to try and reproduce chest pain. In my case, my arteries constricted and did not dilate normally.

If you have chest pain and smoke, you're at high risk for having a coronary artery spasm that could lead to a heart attack and death. I hope you'll find new ways of handling stress versus smoking!


Avatar n tn
I had an angioplasty 12 days agow hich fortunately showed no blockage.  However, now I feel very sick.  Some of my many sick symptons are tiny sharp chest pains- almost unknoticable, slight nasuea off an on, exhaustion,waves of unbearable malaise, feeling like passing out, feelings of death, sudden tiredness and the need to lie down immediately. I don't like to walk normal speed.

These symptons occur throughtout the day and I basically walk around the house slowly and ly down all day. Sometimes, after lying down , these feelings disappear and I fell normal for a while. Then the symptons reappear..
My doctor told me last week that I have an inflammed sac that is around the heart and I take Naproxen and Prevacid . I also take an aspirin and ativan .40 mg.
I originally went crewing 18 days ago and woke up with palpitations. I went to the emergeny room that evening and they gave me a stress nuclear test that revealed an old small heart attac. That's when the doctors decided to give me an angioplasty.
My question: Isn't there something MORE wrong with me, other than the inflamed heart sac. Sometimes I feel like I am going to die.
Avatar f tn
A related discussion, Chest discomfort after heart cath was started.
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