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Q. I have acute chest pain inspite of no major blockages in the heart. Why?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on May 06, 2019

Hello doctor,

Three months ago I had chest pain with nausea and shortness of breath. Since the BP got controlled, the sob decresed. Though they increased the Nitropatch to 0.6 and started the beta blockers, I am having a fewer episodes.

I had an angiogram last week. It showed no major arteries blocked. The cardiologist mentioned thickened heart muscles are due to high blood pressure. I would like to know how to get tested for the micro angina and is there a need to go to emergency when I have severe chest pain? Why am I getting chest pain with no major blockages?

I have diabetes, copd, severe arthritis in my spine, and diabetic neuropathy in my feet that could also partially be nerve pain from my spine. I have had two knee replacements and at present have carpal tunnel in both hands but have not delt with that yet. Also with the thickened heart muscle, will that be the cause for acute chest pain?

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine


Welcome to

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 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.

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