Want to connect with people who have Coronary Microvascular Disease (MVD)

@freyarmr I'm on the same dose of Ranolozine (1,000 mg twice a day) for angina caused by small vessel disease, and it's worked well for me for many years. Minimal episodes of chest pain.

@susanejw
Hi, So glad I found your post. I am a 76 year old woman and seem to have similar symptoms. My cardiologist recently “suspects” I may have micro vascular disease.

It all started 5 or 6 years ago with the PCP at my annual checkup hearing a heart murmur. Referral to cardiologist and echo showed mild/moderate mitral, tricuspid and slight pulmonary valve stenosis and regurgitation. Cardiac Cat Scan showed no blockages with 0 calcium score. Cardiologist felt I was de conditioned and I started walking on the treadmill 30 minutes x 4/5 days per week improving vascular health for a while. Some setbacks in exercise due to flare ups of non cardiac/chronic but painful conditions.

On treadmill started to develop chest pain R side which cardiologist thought ulcer/gastrointestinal. Advised to stop treadmill when experiencing chest pain. Time walking, speed and use became much reduced as a result of the pain.

Consult with gastroenterologist was not GI but anxiety. Finally got scheduled for upper endoscopy and GI was r/o. Tried treadmill again but with exertion pain sooner, lasting increasingly longer and SOB sooner. Thought Angina but didn’t make sense to me since no artery blockages. It seems with stress or feeling reactive emotionally or anxious (usually health related ) long lasting chest pain. Also definitely more fatigued but thought lack of sleep.

In a nutshell how the “probable” MVD affects you sounds just like me!

Cardiologist prescribed propranolol ER (a beta blocker) but reluctant to take it as my heart rate is relatively low and blood pressure with the exception of white coat syndrome in normal range with diastolic sometimes low.

You’re right newly recognized and not much research to go by. If you don’t mind, may I ask what is your experience with taking a beta blocker?

@dougajoi Hi, I’ve been on beta blockers (Metropolol) for 4 years or so, initially because of tachycardia. They didn’t bother me, but I know they make me more tired than I already was. I’ve just learned to accept that the symptoms from the problems and the symptoms from the meds are both part of having heart problems.
I don’t remember which site I found it on, but there was a video on one of a cardiologist explaining that when you exert, the tiny vessels that feed the heart itself are supposed to expand, but instead, with MVD, they contract. That’s the best explanation I’ve seen.

@freyarmr Are you not a candidate by choice or for medical reasons?

@susanejw
Thanks for your reply. I can understand with having tachycardia it being beneficial for
medication to help slow down your heart rate a bit. How does your blood pressure run??? Is that high too???

I have a seemingly normal heart rate and blood pressure that can fluctuate beteen a hypertensive 140/82 at a doctors office to a low of 92/50 at home but mostly within a more normal range.

My understanding is fatigue affects many heart
patients but not all. From your postings it sounds like you have a positive attitude and are coping well at this time.

My concern with the beta blocker is not so much fatigue but being that my heart and pressure rates are not routinely high but dropping too low. When my blood pressure is low I feel completely awful and cannot function in the slightest way.

The video you mentioned sounds interesting and I will search for it. Thank you.

@dougajoi I have labile high blood pressure, which means it comes & goes. My diastolic (bottom number) is usually low, so I often have a “widened pulse pressure,” meaning there is a great difference between the top & bottom numbers, more than 60. I thought it was because of moderately leaking valves, but I just had a them do a better test, which showed the valves only have minor leakage. So now I don’t know if that could still be causing the widened pulse pressure.
Yes, I feel awful sometimes from occasional low blood pressure, but it only lasts about half an hour. I’m used to just needing to lie down for a while.
Also, I find I need to sit down often, can’t stand in one place long, and am really bothered by bending over. Makes me feel faint.

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.

@susanejw
Thank you for your reply. I can certainly identify with the standing in one place for any length of time but thought of chronic venous insufficiency or peripheral neuropathy. Yes sitting better. Now I know MVD could be the culprit.

Showers are not the enjoyment they once were. Now it is more of a mission to get clean, shampoo and cream rinse the hair all accomplished without fainting. I have learned to use only moderately warm water with only short bouts of increased temperature. The winter months are more challenging. A space heater outside the bathroom with the fan going helps.

I checked the hx on my blood pressure machine and I seem to run in the high fifties in pulse pressure and going into the 60’s on occasion over an 70 difference during readings of hypertension stage 1 or 2. Also indicates irregular heartbeats have been detected mostly when pressure too high or too low.

Regarding the pulse pressure difference thinking perhaps that could also be from stenosis as well as regurgitation in the valves? Just a thought as I also have stenosis. The cardiologist says it is common with aging. I guess he’s trying to normalize things for me so not to heighten anxiety.

Thanks again for your reply. Let’s stay in touch. Support and sharing with others experiencing similar challenges helps.

@briarrose
Thank you so very much for your very informative text. It is very much appreciated.

As you pointed out. I too never heard of it before seeing the words “suspected MVD” and an arrhythmia that showed on my last ekg as mentioned in my patient portal physician’s notes. I didn’t know what MVD was. I knew I had valve issues, an occasional irregular heart beat not within my physical awareness and a normal EF score but didn’t give thought to having an artery disease when my cardiac cat scan test showed (zero) blockage in the arteries. Now I understand why at that last visit the cardiologist prescribed Propranolol, a beta blocker when I don’t have tachycardia.

I also noticed

@briarose I also noticed becoming a bit more forgetful memory wise and attributed it to stress and normal aging. Now I know MVD can effecting the small blood vessels in your brain. UGH. Years ago suffering a bout of migraines a neurologist sent me for an MRI and mentioned white matter along with normal results, nothing to worry about. Now it all makes sense.

Hopefully the three of us can remain as a little mini support group.