Microvascular disease and Calcium Channel Blockers

[Gemini72]

I am a 34 year old female with a strong family history of heart disease.  At 31, I underwent all tests including an coronary angiogram which came back fine.  I have been tested for GERD etc as well (negative). To date, I am still experiencing chest pressure/pain, shortness of breath, nausea, dizziness, severe upper back pain (at times) etc.  My cardiologist has now prescribed CCB's instead of betablockers along with nitroglycerin.  In January, he wants to repeat many of the tests that I had underwent a few years back because of a "questionable" stress test.  It had something to do with (pardon my ignorance) inconsistencies in the ST waves.  My question(s) to you then are these:  Could something worse be developing unbeknownst to me?  Is this all in my head?  Can microvascular disease of the heart be this debilitating?  Can you explain ST waves in general terms?

My blood pressure is on the lower side.  I am 5'5, approximately 140lbs, light smoker, and a non drinker.  

Please advise.  Thank you.

[Gemini72]

Thank you so much for your reply.  It is a serious problem that many cardiologists don't seem to acknowledge.  I've been told a thousand times that it's all in my head, it's my nerves, it's acid reflux, it's this, it's that...I'm tired of this.

Once again, thank you for taking the time to respond.  It was most informative.

[Al Dente]

Hi,

Microvascular disease or cardiac small vessel disease is not in your head by all means.  Calcium channel blockers can be very, very effective in helping to treat this (Norvasc & Cardizem CD are quite effective).

I think your doctor is doing the right thing by retesting.  ST segment elevation or depression can be signs of some cardiac issues, including coronary artery spasm.

There is evidence coming out regarding small vessel disease and women specific coronary artery disease where the vessel walls become thickened themselves...normal caths unless IVUS technology is used won't pick it up--everything will be smooth.

You need to quit smoking ASAP.  Small vessel disease will not heal with smoking.

I'm 30, and was diagnosed with 3 vessel CAD at 28, and have a stent in my RCA.  I have a very long & severe family history of heart problems.  I have as well been diagnosed with small vessel disease.  Lipid treatment, as well as treating diabetes/insulin resistance is important.  Long acting nitroglycerin is also helpful.

SVD can be very dehabilitating.  I had CCS Class IV angina for about a year (strong angina at rest).  It has taken alot of effort by my docs (me), and the meds.  I have gotten better as a result of treatment and a good exercise regimen.

I would strongly recommend seeking the advice of preventative and invasive cardiologists at large centers that specialize in small vessel disease--some "old school" cardiologists will dismiss it as heart burn or anxiety and be totally wrong.

Good luck,
Al.