How women can have heart attacks without having any blocked arteries

~ Carolyn Thomas

by Carolyn Thomas  ♥  @HeartSisters

Turns out that the kind of heart attack that I had (caused by a 95% blockage in the big left anterior descending coronary artery) – the so-called widowmaker heart attack – may actually be relatively uncommon  in women. You might guess that fact by its nickname.  It’s not, after all, called the “widower-maker”.

While cardiologists warn that heart disease can’t be divided into male and female forms, there are some surprising differences. Cardiologist Dr. Amir Lerman at the world famous Mayo Clinic in Rochester, Minnesota, told the Los Angeles Times recently:

“When it comes to acute heart attacks and sudden death from cardiac arrest, women have these kinds of events much more often without any obstructions in their coronary arteries.”

Instead, it appears that a significant portion of women suffer from another form of heart disease altogether. It affects not the superhighway coronary arteries but rather the smaller arteries, called microvessels. These tiny arteries deliver blood directly to the heart muscle.

Ironically, I can now boast two diagnoses for the price of one – first, the widowmaker heart attack caused by a fully occluded coronary artery back in 2008, and then, after several months of puzzling, ongoing cardiac symptoms – like chest pain, shortness of breath, and crushing fatigue – a second diagnosis of inoperable coronary microvascular disease.

In 2006, research published in the journal Circulation looked at the Women’s Ischemia Syndrome Evaluation (WISE) study data on almost 1,000 women referred for cardiac testing due to their symptoms(1). Here’s what they found:

  • 62% had non-obstructive coronary artery disease – defined as blockages less than 50% of the artery
  • 17% had one coronary artery vessel significantly blocked or narrowed
  • 11% had two vessels narrowed
  • fewer than 10% had three vessels affected

Dr. Noel Bairey Merz, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, headed up the WISE study, which began in 1996. The average age of her participants was 58, but a quarter were younger and pre-menopausal.

Researchers found that what’s known as ischemic heart disease (any decreased blood flow and oxygen to the heart muscle) is often caused by a blockage within one or more coronary arteries that are feeding the heart muscle, but can also be due to at least two other possibilities: 

  1. dysfunction of the smallest coronary microvascular arteries
  2. coronary spasm

1. Coronary Microvascular Disease

They used a test in which doctors first measured blood flow through the heart and then injected a drug that should have made the arteries dilate and increased the flow. If the flow did not rise, the patient most likely had microvascular disease.

One third of the women in the L.A. study had low blood flow to the heart muscle caused by coronary microvascular disease.  For these women, the rate of deaths or heart attacks was higher than would be expected for other women with normal angiograms.

According to the Texas Heart Institute, coronary microvascular disease most likely happens when small blood vessels in the heart tighten or constrict. This tightening reduces the blood flow to the heart muscle and causes the pain of angina pectoris (a Latin phrase that means “strangling in the chest“).

The encouraging news at first:  because these vessels are so tiny, early research suggested that they may not increase the risk of a heart attack or death. But the Journal of the American Medical Association reported in 2005 that the prognosis of patients with unstable angina and non-obstructive coronary artery disease is not benign and includes a 2% risk of death or heart attack at 30 days of follow-up(2).  (JAMA. 2005;293(4):477-484. doi: 10.1001/jama.293.4.477)

Problematically, coronary microvascular arteries are too small to detect with the standard cardiac tests that cardiologists would normally use to see larger vessels, so women in particular are often dismissed and sent home with a misdiagnosis in spite of severe and distressing cardiac symptoms.

For example, in typical patients with coronary artery disease, coronary angiography – considered the ‘gold standard’ of cardiac diagnostics – usually shows a clearly blocked artery that slows blood flow to the heart muscle.

But in patients with coronary microvascular disease, these test results are normal – even though symptoms may be as debilitating as those experienced during a heart attack.

Dr. Noel Bairey Merz adds that angiograms that would clearly spot blockages in major heart arteries can miss coronary microvascular disease altogether. As a result, many women who have gone to their doctors with chest pain have gone home with a clean bill of heath – and most likely feeling very embarrassed for having made a fuss over nothing.  She says:

“Historically, women have been told that it was in their head.”

According to the Harvard Heart Letter, the preferred diagnostic tool for correctly identifying coronary microvascular disease is coronary reactivity testing.

“Coronary reactivity testing is an angiogram-like test lasting 60 to 90 minutes; it allows doctors to see how very small vessels supplying the heart respond to different ‘challenges’ from medications. “

Texas Heart Institute experts tell us that up until recently, the only treatment for coronary microvascular disease (also sometimes known as Cardiac Syndrome X, a name that’s generally hated by those of us diagnosed with MVD because of its implication that this disorder somehow doesn’t exist!) has been with these medications:

  • Nitroglycerin (nitro) can widen or dilate the arteries and improve blood flow to your heart. Nitro can be given through a skin patch, pills, an ointment, or a spray. See more on nitroglycerin.
  • Beta blockers “block” the chemical or hormonal messages sent to your heart. When you are under physical or emotional stress, your body sends signals to your heart to work harder. Beta-blockers block the effect these signals have on your heart, so they reduce the demands on your heart.
  • Calcium channel blockers can help to keep your arteries open and reduce your blood pressure by relaxing the smooth muscle that surrounds the arteries in your body. The oxygen demand of the heart is also reduced by these medicines.

Physical exercise has also been shown to be helpful in managing MVD symptoms. A Swedish study reported in the Journal of the American College of Cardiology in 2000 suggested that being out-of-shape is a “prominent feature” in patients diagnosed with  MVD. Researchers found that a 30-minute workout on an exercise bike three times a week resulted in increased exercise capacity with lesser chest pain for the MVD patients they studied.

As more physicians become educated about the widespread incidence of coronary microvascular disease, particularly in women patients, more treatments are becoming available, including my own particular current treatment for microvascular disease: wearing a portable TENS machine all day long to help increase blood flow to the heart muscle and thus reduce chest pain symptoms. Read more on this underused, non-drug, non-invasive cardiac treatment in “My Love-Hate Relationship With My Little Black Box”.

And emerging research has shown significant success using TENS neuromodulation to treat the chest pain of angina. In fact, the U.K. National Refractory Angina Group now recommends TENS therapy for the debilitating chest pain of angina:

“Neuromodulation owes its origins to Melzack and Wall’s gate theory of pain that predicted that stimulation of vibratory afferent nerves would reduce or gate the transmission of pain traffic relaying through the spinal cord at the same point.

“Transcutaneous electrical nerve stimulation (TENS) was specifically designed to make use of this predicted effect and was used to treat a variety of pain conditions before it was shown to be effective in angina.

“TENS neuromodulation should be offered as part of a multidisciplinary angina management programme based on the current guidelines.“

2. Coronary Spasm Disorders

Another example of non-obstructive heart disease often seen in women is called Prinzmetal’s Variant Angina, chest pain caused by a spasm of a coronary artery. While Prinzmetal’s is not thought to cause a heart attack, chances of a cardiac event are higher in those with underlying heart conditions.

We don’t yet know exactly what causes coronary spasms like Prinzmetal’s.

One theory lies within the thin lining of the blood vessels called the endothelium. Usually this artery lining produces a chemical (nitric oxide) that helps to widen the blood vessel, allowing blood to flow through with ease.  

But if the artery lining is damaged or isn’t working properly, the blood vessel may narrow and cause a coronary spasm. Levels of the artery-widening chemical are higher when estrogen levels are also high at certain stages of the menstrual cycle. A 2001 study published in the journal, Annals of Internal Medicine, suggested that during times when estrogen levels are high, women have fewer chest pain symptoms(3). In addition, smokers tend to have lower levels of nitric oxide in their blood vessels than non-smokers, and smoking is a major risk factor for coronary spasm.

Symptoms of angina can also occur in the absence of any coronary artery disease. Up to 30% of people with a heart valve problem called aortic stenosis, which can cause decreased blood flow to the coronary arteries from the heart, can have angina. People with severe anemia may have angina because their blood doesn’t carry enough oxygen. People with thickened heart muscles need more oxygen and can have angina when they don’t get enough.

We do know that cardiovascular disease kills more women than any other cause, about six times more women each year than breast cancer does, and in fact, more than all forms of cancer combined. Each year since 1984, more women than men have died of cardiovascular disease. Men tend to develop heart disease on average 10 years earlier than women do.

Anatomically, male and female hearts look about the same. When healthy, both should be about the size of a fist (a man’s heart is the size of a man’s fist, and a woman’s heart is smaller because it’s about the size of a woman’s fist). If you’re a woman, yours weighs about the same as a green pepper and, also like a green pepper, has hollow chambers inside.

Both men and women have three main coronary arteries surrounding their hearts. These are the large blood vessels that wrap around the outside of the heart, supplying blood, oxygen and nutrients to heart muscle to keep each heart pumping properly – and thus the arteries most susceptible to life-threatening cardiac events through obstructive – or non-obstructive – heart conditions.

But women who have a heart attack fare worse right after the event and also suffer a poorer quality of life.

Learn more about coronary microvascular disease:

  • in this LA Times feature
  • on this 22-minute video about identifying hard-to-catch diagnoses in female patients via medical imaging called Diagnosing Cardiovascular Disease in Women with cardiologists Drs. Redberg, Shaw and Bateman
  • in this 5-minute video about my heart sister Joan Jahnke of South Carolina, who went to Emory Heart & Vascular Center to have her coronary microvascular disease appropriately diagnosed and treated
  • on these websites from Mayo Clinic and the Texas Heart Institute .

♥

NOTE from CAROLYN: Please do NOT leave a comment here describing your current symptoms. I’m not a physician and cannot diagnose you online (nor can anybody else). If you are experiencing distressing symptoms, seek a medical opinion from your physician.

See also:

1. Shaw L, “The Economic Burden of Angina in Women With Suspected Ischemic Heart Disease”. Circulation. 2006;114:894-904.
2. Bugiardini R, Bairey Merz CN. “Angina with ‘normal’ coronary arteries: a changing philosophy”. JAMA. 2005;293(4):477-484.
3. Kawano H, Motoyama T, Ohgushi M, Kugiyama K, Ogawa H, Yasue H. “Menstrual Cyclic Variation of Myocardial Ischemia in Premenopausal Women with Variant Angina”. Ann Intern Med. 2001;135(11):977-981.

Published by Carolyn Thomas

99 thoughts on “How women can have heart attacks without having any blocked arteries”

  1. I have a trifecta of diagnoses that pretty much guarantees coronary micro-vascular disease:

    Coronary Artery Disease w/ stent in Circumflex, diabetes, and Hypertrophic Cardiomyopathy. I am also statin intolerant with hyperlipidemia. I have mild 3-4/10 angina 3-4 times a week. unrelated to activity.

    When I mention coronary microvascular disease to my cardiologist, he says “Yes, you probably have it but the treatment is no different than what you are on already.” I’m on aspirin, Calcium channel blocker, etc. He has given me nitroglycerin to use for severe symptoms which I haven’t tried yet.

    If I’m already on all these drugs…. not to mention diuretics, Coumadin and ARB…. is there really a value in chasing the diagnosis? I belong to an HMO and would have to get a referral to somewhere that does the endothelial testing. I’ve thought of trying to get one for Mayo because they also have a statin intolerance clinic….

    But It will be difficult I’m sure….. How do you think it might help?

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    1. Hi Jill – personally, I believe it always feels better to have a definitive diagnosis, although your doctor’s likely correct in saying that the treatment WITH a diagnosis might probably what’s recommended WITHOUT a diagnosis. Except that… you’re still experiencing unstable angina a few times a week, so these meds are NOT controlling your symptoms. But if you CAN manage to get a referral for further testing via your HMO (Mayo would be a great move!). What would be the downside of seeking more information?

      I’m not a physician, but I’d urge you to try the nitro next time you have another angina episode. Think of it as a drug trial. If it works to alleviate your angina, don’t be afraid to use it. You need all the help you can get. “Nitro is your friend”, as I like to say. Read this for more info. https://myheartsisters.org/2013/08/19/nitroglycerin/

      Best of luck to you…

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  2. Hi:
    I was diagnosed with Small Vessels Spasms back in 2012 but I know I had this for over 30 years before I got this diagnosis. I can tell you this – they have a long way to go with this woman’s heart problems.

    I was very active including being a runner, swimmer, weight trainer and had an excellent diet. So reading articles regarding women that are out of shape and need to exercise 3-4 times a week gets me really angry. I do think that working out might have saved me from a heart attack, but I think even if I didn’t work out, I still had an underlying problem with my vessels.

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    1. Thanks for sharing your perspective, Deborah. It’s not uncommon for women who have “done everything right” to feel betrayed when they (of all people!) develop a heart condition, but there is no “fair fairy” out there when it comes to this diagnosis. And we know that cardiovascular disease is 20-30 years in the making, no matter what we do or don’t do during those decades.

      When I went to Mayo Clinic after my own heart attack for their Science & Leadership training, we had a variety of women (all heart patients) from age 31 to 71, and our group of 45 included vegans, two triathletes and a physician – just a handful of many who were asking “Why me?!” in disbelief. While your own healthy lifestyle didn’t prevent your cardiac diagnosis, it may well have postponed it by a decade or even two. There’s simply no way to predict sometimes…

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  3. I have had 3 heart attacks, yet all tests show my heart as healthy. The first 5 yrs ago although I had raised troponin levels and diagnosed as a heart attack, was then told it was a VasoSpasm that triggered QT levels and I now have Acquired Long Qt Syndrome. This was put down to Migraine medications.

    Since then I have had another 2 diagnosed Heart Attacks the last in Oct 17, Troponin level was 64. For years I have had shortness of breath and chest pain especially when stressed. All tests come back clear. I have fluctuating blood pressure and Bradycardia so any attempts to treat BP lower heart rate further.

    I love to walk and can for miles but when I stop I have chest pain and heart rate drops and I just want to sleep. My GP is trying to get answers, he thinks my migraine and vasospasms are linked, also have discovered an Aspirin allergy. Getting a diagnosis seems to be a problem!

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    1. Hello Barbara – I’m not a physician, but I can say that the link between migraine (especially migraine with aura) and heart/stroke events (not just vasospasm) has been studied for a long time, although some researchers suggest that the mechanisms for this link are still unknown. Some people who have migraines with aura are more likely to have worse cholesterol numbers and a strong family history of early heart attacks; some researchers believe that better migraine management can reduce the cardiovascular risks. It’s a very complex problem, as you know already. Hang in there and good luck to you…

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  4. Thank you for your article. I have ongoing chest pain and trouble breathing since a heart attack in November that I didn’t know I had and my doctor thought that’s what had happened. Because two stress tests, two ECHO’s and a pulmonary function test all came back normal, my doctor says it was not a MI…it is anxiety. I do have a history of anxiety and would happily raise my hand and tell my doctor because I know it is not anxiety. But, if I have symptoms of a MI, he wants me to go to the ER…that would happen about five times a week. Thank you for delving into this with women as the focus. If you have any insight (could it still have been a MI? Q waves and T waves were messed up…EKG said suspicious for ischemia) or something I can say to my doctor to get off of this anxiety theme, I would appreciate it. Your work is very appreciated.

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    1. Hello Laryn – I’m sorry to hear of these distressing symptoms of yours. I’m not a physician so cannot comment specifically on your experience, but I can say generally that a pulmonary function test does not rule out a heart attack. As you know, chest pain/trouble breathing can be symptoms of anxiety and panic disorders. Please seek a second opinion to get both issues considered.

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  5. This was tremendously informative. Thank you. I believe this is what I recently experienced. All tests came out great. But I knew something was causing the discomfort.

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    1. Adele, here’s a link to a study on the Women’s Ischemia Syndrome Evaluation that was published this month in the cardiology journal Circulation. Show it to your physician. Right now, you just don’t don’t know for sure, based on “normal” diagnostic tests so far, if your symptoms are heart-related or not, but all doctors should be aware of current research on non-obstructive coronary artery issues.

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  6. I was grocery shopping, pushing my cart rather slowly around the aisles and got short of breath and had chest pain (usually have this at home). Tried to manage this at home with my nebulizer (I have asthma), but I got worse. Finally headed to the ER. Was admitted to the hospital overnight for chest pain and had an echo stress test which my cardiologist wanted me to have as an outpatient this coming Friday. I felt as though my heart was spasming every couple of minutes. (I have Prinzmetal’s Angina, but this was nothing like that.). After the echo, a male prick of a cardiologist looked at the pictures and asked me what I was doing there. The test was normal and I was told to follow up with my cardiologist, my pulmonologist and the psychiatrist whom I stopped seeing a year ago.
    So frustrated.

    Can you have microvascular disease with a normal stress test – just a general question?
    I’ve read both likely and not likely.

    Thanks.

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    1. Gerri, short answer to a complicated event and your question: yes, you can have microvascular disease even with a ‘normal’ stress test. But I’m confused by your description that this felt like spasms every few minutes and that you have been diagnosed with Prinzmetal’s angina (a spasm disorder) yet neither you nor the cardiologist linked your symptoms with Prinzmetal’s. Good luck following up with your cardiologist and other doctors.

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  7. 11 years ago I was admitted to coronary care, age 58, with slightly raised troponin levels. I was discharged 5 days later diagnosed with Cardiac Syndrome S (Rx Tildeam and Isosorbide). I eventually became more stable on this. Recently my BNP or BMP? A new test.. levels were tested as normal per my GP who declared nothing was wrong with me.

    I have had 3 diagnoses now by UCLH and Lister Stevenage. I remain on the medication but my symptoms are ignored. I recently had a bout of Vasculitis out of the blue. I am doubtful of this diagnosis and see it as an extension of my poor venous return. Just ignored again “I do not have heart disease”. Dip Reg Nurse (retired) BSc (Hons) Health Studies (“I don’t know anything either!”)

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    1. Hazel, something is causing your symptoms. If your current treatment plan/meds are not adequately addressing those symptoms, perhaps you need to seek a second opinion. Best of luck to you…

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  8. This is the ammunition I need to take to my doctor. A test was done several years ago that showed calcification; however, there was no blockage in any artery. Today, my echo stress test showed “normal range” so blockages were ruled out by the nurse and technician. My question before taking this a step further is this… is it possible to have the MACE test show a reading of 110 and no blockages be a sign of un-obstructive heart disease?

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    1. Hi Michelle – I’m not a physician so cannot make any comment about your test score (MACE = Major Adverse Cardiac Events), but I am assuming you are having severe cardiac symptoms to warrant the diagnostic tests that have been booked for you. If your symptoms continue or get worse, you should consider a second opinion.

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  9. I had chest pain since I was in my early 20’s and now that I am 62 years of age the medical field came a long way and still have a long way to go because I know that my tiny arteries are not diseased but in fact they Spasm on me. I never experienced pain during exercise only hours later. So I get sick and tired of the Cardiologists trying to put me in the same category with women having small vessels Disease which is not the same as having spasms, I just hope sometime in the future they will have different categories for women.
    Thank you for your time

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    1. Hi Deborah – 40 years is a long time to go without a clear diagnosis! Coronary microvascular disease isn’t the same as a spasm disorder, but they do share one important thing in common that sets both apart from garden variety coronary artery disease: they’re both considered non-obstructive heart disease. As you know, unlike in most heart attacks in which a significantly blocked artery is the culprit causing heart attack symptoms that can be addressed by stenting or bypassing the blockage, both small vessel and spasm disorders lack that significant blockage. For example, I have coronary microvascular disease. My symptoms, like yours, never occur during exercise, just as you have experienced with a spasm disorder. Whether our symptoms are caused by a blockage, a spasm or by dysfunctional small vessels – all three succeed in blocking blood flow to the heart muscle.

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      1. Hi:
        Thank you for the clarification, I did not think my spasm was related to non-obstructive heart disease due to the fact that I never experienced a heart attack or stroke. I was able to get a diagnosis in 2012 at the Cleveland Clinic, after 35 years of searching for an answer. I now have a dysfunctional ear which I am going to have a balloon Dilation next month. My thinking is I think I have some sort of dysfunction of all of my arteries and possibly my veins. I say this because my veins hurt on the top of my hands and I have this horrible burning in my scalp that is deep into my scalp, most likely my arteries are on fire. I guess it could be worse. How old were you when you started to experience your problem?

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        1. Deborah, your symptoms may or may not be artery-related at all. Trying to guess at what’s causing them (e.g. “my arteries are on fire”) means you’re likely to come up with conclusions on your own that just aren’t accurate (like before you learned that your spasms are in fact a non-obstructive disorder, whether or not you’ve ever had a heart attack). You’ve had success at solving your diagnostic mystery at Cleveland Clinic – could you return to ask them about these other distressing symptoms? In answer to your question, I was in my late 50s when my coronary microvascular symptoms first hit.

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          1. Hi Carolyn:
            Unfortunately my Cardiologist will be retiring in the late fall. I am seriously thinking about transferring to Emory Clinic. My understanding Emory’s is much more advanced in Women’s Spasms and Women’s Heart problems.
            I did get tested for Vasculitis many years ago which was negative.
            Who should or what kind of Doctor do I see for that
            Thanks Debbie

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              1. Thanks Carolyn:
                I just got off of the phone with Dr. Samady’s Office. I am going to have all of my records transfer to Dr. Samady’s Office in the next few weeks.
                Thank you for your help.

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  10. I had an angiogram and my arteries were fine. I know something is wrong as I have chest pain and breathlessness. I really need to find out what is wrong with me.

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    1. Hello Pamela – I’m not a physician so cannot of course comment on your specific situation, but I can tell you generally that something is causing your symptoms. Right now, you simply don’t know if this issue is heart-related or not. Your symptoms may be entirely due to some other cause, and you need to find out what that is. There are many causes for chest pain and shortness of breath, as I wrote about here. See your doctor if anything on that list seems familiar, and if your symptoms continue.

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    2. Hi Pamela, I too had all the standard heart tests after going to the ER three times anad being told there was nothing wrong with my heart. My primary care Dr ordered a stress test and I collapsed 3 minutes into the test… A cardiologist was called and I was admitted to the hospital. Fortunately I had the very good fortune of having one of the most notable cardiologists in the country as my treating physician… He immediately diagnosed my condition as Cardiac Syndrome X. Please research it and share this Heart Sisters post with your doctors. Don’t stop until you find a Dr that knows what you have. Your life depends on it! Good luck!

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  11. Genetics play a huge factor in heart disease. I was running 7 miles, a vegan, no oil. I weigh 104. Perfect picture of health. In 2015 I had 2 heart attacks, then in December 2016, 2 strokes. There is nothing they can do for me. I take nitro every day to keep my arteries open. My Dad died at 48 years old, massive heart attack. My older sister has had 3 heart attacks. I am 63 years old….

    Liked by 1 person

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    1. Genetics can indeed be a significant cardiovascular disease risk factor, Lu Ann. Still, you must have been shocked and surprised when you – of all people! – had not only two heart attacks but then two strokes! As I wrote here, there is just no ‘fair fairy’ in life!

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  12. It is amazing to me that doctors and comments focus on drugs and operations in 2017 when there is so much science showing that the primary focus should be on diet and moderate exercise.

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    1. Hello Richard – you’re right. Many studies suggest that up to 80% of heart disease is preventable. What we eat and how much we move can indeed affect our risk. Yet I’ve personally met triathletes, vegans and other extremely fit and healthy women who also developed heart disease – despite their seemingly risk-free lifestyle. (See Lu Ann’s comment below, and above).

      Women who experience a heart attack caused by SCAD, for example (Spontaneous Coronary Artery Dissection) typically have few if ANY cardiac risk factors. Women who have a history of pregnancy complications (like me) can go on to develop heart disease directly due to those complications – often years later. So it’s not as straightforward as you might think, and poor diet/exercise are just two of many, many other equally significant risk factors.

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      1. It is more straight forward than you comment indicates. I do not have the energy, time or motivation to cite the studies that prove my point.
        You might try looking at Dr Greger’s site that has thousands of videos and his recent book , “How Not To Die.”.

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        2. Hi Richard:
          What part did you not understand? Her father had a heart attack at the age of 48 years old and her sister also had a heart attack. You have no idea about women’s hearts. Not everybody has a bad diet or fat. So keep your comments to yourself.

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  13. I too have that awful heavy feeling in my chest plus jaw & teeth ache. Just had a stress echo & heart cath. Everything looks fine, even my stent from a few years ago. Looking for some changes to happen with my doctor now. Meds changed so far. Had a silent heart attack years ago & shows up all of the time when having an EKG. Nitro helps but would like to not have to worry & wonder when it’s going to happen again, even have me woke up during the night. It’s scary. Enjoyed reading all the responses from women like me. By the way I’m 83 yrs old with an active life style, cruises are my favorite. Worry on a ship at times?

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    1. Hi Laura – I’m not a physician so cannot comment on your specific symptoms. I can tell you generally that many of us live with cardiac symptoms for years that do respond well to nitro. I once met a woman with chronic angina, for example, who was a keen tournament tennis player; she would take her nitro spray before starting every game, stop halfway through the match to sit down to take another dose – and then after a few minutes continue to play tennis good as new. It sounds like your symptoms are stable (e.g. not getting worse) and that you are being taken seriously and getting appropriate diagnostic tests. Cruise ships do have doctors onboard, right? Talk to your doctor about planning your next cruise…

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  14. In 2015 I had 2 heart attacks. In Dec. 2016 I had 2 strokes. Friday April 14 I had a angiogram and my doctor said my arteries look good. I have bad angina everyday, shortness of breath, no energy. The first heart attack was a widow maker. 80% blockage, they put in a stent. I am a vegan, use to run 7 miles a day right up to the first heart attack. 5 feet tall, 100 lbs. I thought I was in good shape.

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    1. Hi Lu Ann – you have been through quite a lot in just two years! You WERE in good shape, which may have actually helped you survive both heart attacks/strokes. Your arteries may be “good” but something is causing your daily symptoms. I hope you will seek a second opinion to rule out non-obstructive heart disease, valve problems, or another cause. Best of luck to you…

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  16. Had treadmill with infusion, came up with 2. Still have tightness and twinges. Can there still be something wrong? I’m told I don’t have heart disease, they won’t do anymore. What should I ask next, or just quit going. It’s all in my head?! I’m 70 yrs old. Female.

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    1. Hello Pat – I’m not a physician so cannot comment on your specific symptoms, but I can say that generally, your own family physician is like the ‘quarterback’ of your care. Make an appointment to discuss your overall health and possible next steps. Good luck to you…

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  17. I’m recovering from a cardiac catheterization and the doctor found no blockage. I’m not sure what’s going on. It makes me feel like it’s all in my head but my body tells me differently. I guess we’ll find out what he thinks when I follow up with him. :/

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    1. Good luck with that follow up appointment, PJ. Having a diagnostic test that shows “no blockage” is a good news/bad news scenario if you have ongoing symptoms. The good news, says your doc: “It’s not your heart”. The bad news: “It’s not your heart”. Yet something is causing symptoms – you just need to find out what! Best of luck to you…

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