Overview
Microvascular angina (MVA), also known as cardiac syndrome X, is a type of angina (chest pain) caused by abnormalities in the small coronary arteries (microvasculature) rather than the major epicardial coronary arteries. Unlike traditional angina due to large artery blockages, patients with MVA may have normal coronary angiograms, making it a challenging condition to diagnose.
In Korea, MVA is increasingly recognized and treated at advanced cardiology centers equipped with cutting-edge imaging, functional coronary testing, and personalized treatment programs to manage symptoms and reduce cardiovascular risk.
Key Facts
➤ Microvascular angina is chest pain resulting from impaired blood flow in the small coronary vessels.
➤ Patients often have normal coronary arteries on conventional angiography.
➤ More common in women, particularly post-menopausal women.
➤ Symptoms may mimic classic angina but require specialized diagnostic tests.
➤ Korean cardiology centers provide advanced testing and management strategies.
What is Microvascular Angina?
Microvascular angina occurs when the tiny blood vessels within the heart muscle fail to dilate properly, reducing oxygen delivery to the heart tissue. This results in chest discomfort or pressure, especially during physical exertion or emotional stress. Unlike traditional angina caused by blockages in large arteries, MVA involves endothelial dysfunction, inflammation, or abnormal microvascular constriction.
Symptoms Associated with Microvascular Angina
Patients may experience:
➤ Chest pain or tightness lasting minutes, often triggered by exertion or stress.
➤ Shortness of breath during activity.
➤ Fatigue or weakness with exertion.
➤ Palpitations or irregular heartbeat in some cases.
➤ Symptoms may persist despite normal coronary angiograms, leading to diagnostic challenges.
Causes / Possible Causes
Microvascular angina is usually caused by dysfunction in the coronary microcirculation rather than a blockage in major arteries.
Primary Mechanisms
➤ Endothelial dysfunction – reduced nitric oxide production affecting vessel dilation.
➤ Microvascular spasm – abnormal constriction of small vessels.
➤ Structural remodeling – thickening of small vessel walls.
Risk Factors
➤ Female sex, particularly post-menopausal women.
➤ Hypertension.
➤ Diabetes mellitus.
➤ Obesity and metabolic syndrome.
➤ High cholesterol.
➤ Smoking and sedentary lifestyle.
Complications
If untreated or poorly managed, MVA can lead to:
➤ Recurrent chest pain affecting quality of life.
➤ Increased risk of heart attack or myocardial ischemia, though rare.
➤ Anxiety and depression due to persistent symptoms.
➤ Exercise intolerance and reduced daily activity.
When Should I See My Doctor?
Seek medical evaluation if you experience:
➤ Recurrent chest pain or pressure without a clear cause.
➤ Shortness of breath or fatigue during normal activities.
➤ Chest pain not relieved by rest or usual medications.
➤ A family history of heart disease.
➤ Risk factors such as diabetes, hypertension, or high cholesterol.
Early consultation is essential to diagnose MVA accurately and prevent complications.
Care and Treatment
Treatment focuses on symptom relief, improving microvascular function, and reducing cardiovascular risk factors.
Lifestyle Modifications
➤ Regular aerobic exercise to improve coronary microvascular function.
➤ Heart-healthy diet (low sodium, rich in vegetables, lean protein, and whole grains).
➤ Weight management and smoking cessation.
➤ Stress reduction techniques (yoga, meditation, cognitive behavioral therapy).
Medical Treatments
➤ Anti-anginal medications – nitrates, beta-blockers, calcium channel blockers.
➤ ACE inhibitors or ARBs – improve endothelial function.
➤ Statins – control cholesterol and reduce inflammation.
➤ Antiplatelet therapy – for patients with cardiovascular risk factors.
Monitoring & Follow-up
➤ Regular cardiac evaluations, including stress testing and imaging.
➤ Blood pressure, cholesterol, and blood sugar management.
Treatment Options in Korea
Korea provides advanced cardiac care for microvascular angina through specialized cardiology centers.
Diagnostic Services
➤ Coronary angiography with microvascular function testing.
➤ Stress echocardiography or nuclear stress tests.
➤ Cardiac MRI for myocardial perfusion assessment.
➤ Blood tests for lipid profile, inflammation markers, and diabetes.
Medical Treatments in Korea
➤ Tailored pharmacotherapy including nitrates, beta-blockers, and calcium channel blockers.
➤ Interventional procedures for patients with concurrent coronary artery disease.
➤ Lifestyle modification programs guided by cardiologists and nutritionists.
Supportive Care
➤ Cardiac rehabilitation programs.
➤ Patient education on recognizing and managing angina episodes.
➤ Regular monitoring for long-term cardiovascular risk management
