How tests are ‘missing deadly peril of angina’


Tests are ‘missing deadly peril of angina’: Thousands of patients could be at risk because scans and angiograms can fail to spot small blood vessels

  • Until now, microvascular angina was widely thought to be a benign disease
  • But experts have found the condition can lead to deadly heart attacks 
  • The illness is thought to affect up to 100,000 men and women annually in the UK

Thousands of people with angina could be at risk of deadly heart attacks and strokes, research suggests.

Until now, microvascular angina (MVA) was widely thought to be a benign disease that mainly occurs in women and is often blamed on hormonal changes caused by the menopause.

But experts have found the condition – thought to affect up to 100,000 men and women annually in the UK – can lead to deadly heart attacks.

The illness, also called cardiac syndrome X, is caused by problems with arteries in the heart muscle that play a crucial role in regulating blood supply to the heart.

But the blood vessels are too small to show up on standard tests such as scans, electrocardiograms (ECGs) and angiograms, making the condition difficult to diagnose.

Thousands of people with angina could be at risk of deadly heart attacks and strokes, research suggests (stock image)

A study involving 686 patients from seven countries, including the UK, US and Japan, found 78 (the equivalent of eight per cent of patients annually) either died, suffered a non-fatal heart attack or stroke or were hospitalised with the condition over a three-year period.

Researchers warned the lack of diagnosis is costing lives, adding there is a ‘massive unmet need’ of patients worldwide.

Professor Hiroaki Shimokawa, of the International University of Health and Welfare in Japan, who led the study, said: ‘Currently, many doctors are not aware of the importance of coronary microvascular dysfunction. 

‘As a result, many patients with MVA are misdiagnosed as having postmenopausal disorders or an imbalance of conscious and unconscious nervous system, for instance. 

‘However, previous research has suggested that the number of patients with MVA is three to four million in the USA, which is equal to or greater than the number of patients with breast cancer, so it is an important global problem.’

Patients can experience chest pains similar to those of a heart attack and shortness of breath.

Patients can experience chest pains similar to those of a heart attack and shortness of breath (stock image)

Patients can experience chest pains similar to those of a heart attack and shortness of breath (stock image)

Those with suspected angina are given an angiogram – a heart X-ray – to identify the cause and work out the best treatment.

Some 250,000 are carried out in the UK every year – but these only spot blockages or narrowing in the large arteries that supply blood to the heart. About two in five patients are found not to have this problem and told they have a healthy heart, which may not be the case.

It also means people often have to go through multiple tests over a prolonged period of time before a condition is diagnosed.

Professor Shimokawa told the European Heart Journal the findings also helped to explain why fitting stents or heart bypass surgery was not always successful, with around 40 per cent of patients still experiencing chest pains following the procedures.

Patients are usually treated with drugs to prevent blood clotting or dilate blood vessels. But experts say more should be done to tailor treatment to the condition.

Filippo Crea, professor of cardiology at the Catholic University of the Sacred Heart in Rome, said millions of people are affected worldwide and ‘deserve to be carefully identified and treated. In addition, these data should stimulate the development of drugs that specifically target coronary microcirculation.’

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