What causes chest pain with no major blockages in the heart?

Question

Hello doctor,

Three months ago, I experienced chest pain accompanied by nausea and shortness of breath. Since my blood pressure (BP) has been controlled, the shortness of breath has decreased. However, even though the Nitropatch dose was increased to 0.6 and beta blockers were started, I am still having fewer but occasional episodes. I had an angiogram last week, which showed no major arterial blockages. The cardiologist mentioned that the thickened heart muscles are likely due to high blood pressure.

I would like to know:

How can I get tested for microvascular angina?
Is there a need to visit the emergency room when I experience severe chest pain?
Why am I still getting chest pain despite having no major blockages?

In addition to my heart concerns, I have diabetes, chronic obstructive pulmonary disease (COPD), severe arthritis in my spine, and diabetic neuropathy in my feet, which may partially be nerve pain caused by my spinal condition. I have had two knee replacements, and I currently have carpal tunnel syndrome in both hands, but I have not addressed that yet.

Lastly, could the thickened heart muscle be the cause of my acute chest pain?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

Microvascular angina can be diagnosed on nuclear stress test with perfusion defects if any and also on angiography which shows slow flow in the absence of blockages in major arteries. So, if these tests are showing any abnormalities, then we have to consider the possibility of microvascular angina. Another modality is a treadmill test which can also show changes, but another test is not necessary as two tests are normal and you were not able to complete it. And microvascular angina usually causes pain on exertion rather than severe chest pain at rest. So we have to find other causes for it. If you had been evaluated or examined and had ECG (electrocardiogram) etc., at the time of chest pain, then it also rules out other causes like vasospastic angina or accelerated hypertension as a cause of chest pain, which are relatively rarer causes. So, overall appears to be noncardiac pain. I hope this helps you and get back if you have any doubts.