Glad to see this posting about Coronary Microvascular Disease. Most people have never heard of it and if one tries to explain it, again, most people have no idea what you are talking about. But it is very real, affects more women than men and it's a systemic disease. It is contributing to my brain function (among other issues).
Commonly called INOCA in cardiology (Ischemia with Non-obstructive Coronary Arteries).
The "clogging/plaque" of the very small arteries in the heart which, due to size, can not be stented. Treatable only with medications and a healthy life style. To be "officially" diagnosed invasive coronary function testing is done (& again, most people never heard of these specific cardiac tests) and not all top rated medical centers in the US even do such testing. Such testing includes: Measurement of coronary flow reserve, measurement of the Index of Microcirculatory Resistance (IMR) and Acetylcholine provocation testing to assess endothelial dysfunction and microvascular spasm (all invasive tests & certainly not easy to get through)...in addition PET scans, stress cardiac MRI, stress echo's & other routine cardiac tests.
Off the top of my head, I believe Emory University in GA does this testing and I know for a fact Cedars-Sinai Medical Center in LA does. Dr. C. Noel Bairey (cardiologist) at Cedars-Sinai is well known for her expertise in CMD and has published many studies on this particular cardiac disease plus studies in cardiac disease differences in women vs. men (& there are lots). I have never had such testing but my cardiologist has determined by my history and symptoms I do have MVD. Another time to tell my story of how I was diagnosed but the "gold standard" medication to treat the symptoms of this cardiac issue is Brand Name: Ranexa and generic: ranolazine. Dosing is either 500 mg. x2/day or 1000 mg. x2/day.
I have been maintained on the 500 mg. dosing since 2013.
I have found this medication is effective...however, I have had some episodes of angina through the years, usually brought on by terrible stress. Which, with my cardiologist's permission, I will take a low dose alprazolam to help reduce. I always carry nitroglycerin tablets with me but, thankfully, never used them unless I was in the ER with a bout of very high blood pressure/angina episode (which now seems to be under control for the most part). Frankly, I am afraid of the nitro tablets (using outside of a hospital setting) as I know such can bottom out your blood pressure/pulse. And I am very labile with my heart rate...running from 40 to over 150. Diagnosed with atrial tachycardia. What is especially frightening about this condition is that your heart can be pumping very well with a "normal" ejection fraction (one measurement to determine heart failure) but can still go into heart failure with a fatal outcome. Scary. So medication adherence and healthy life style choices are especially important. All the best to those of us who have been diagnosed with this unfortunate cardiac condition - Coronary Microvascular Disease.