Misdiagnosed: women’s coronary microvascular and spasm pain

by Carolyn Thomas  ♥  @HeartSisters

Findings from the federally funded Women’s Ischemia Syndrome Evaluation (WISE) study — a landmark investigation into ischemic heart disease (meaning reduced blood supply to the heart muscle) – are helping us to understand that, as the Harvard Women’s Health Watch puts it: heart disease – like cancer – is not one, but several disorders.

While I was at Mayo Clinic shortly after my heart attack, I also learned that at least two of these disorders are far more commonly seen in women than in men’s “Hollywood heart attacks”. These two heart conditions are coronary microvascular disease (MVD) and coronary artery spasm (CAS).

For example, these also happen to be the diagnoses delivered to an Australian woman who suffered a serious heart attack at age 51 – despite having no identifiable cardiac risk factors.

It took her a year after surviving that heart attack before she was finally appropriately diagnosed* with a coronary artery spasm disorder sometimes known as Prinzmetal’s variant angina, and then another two years before she received a further diagnosis of coronary microvascular disease (MVD) – missed because most standard coronary artery tests are designed to identify only obstructive heart disease in major coronary arteries.

CAROLYN’S NOTE: After my heart attack in 2008, I too was subsequently diagnosed with MVD following a second trip to the cath lab ruled out “stent failure” (gotta love that terminology!)  See also:  My Love-Hate Relationship With my Little Black Box

Frustrated with the lack of awareness of these conditions by many of the medical staff that she had encountered during this time, the Australian woman set out to gather a solid list of credible journal references about these under-appreciated conditions in women to share with other women, and with her health care providers.  As she explained:

“At my last visit to our local hospital, I suspected that all the nurses were treating me as if I had an anxiety disorder, even though my medical chart clearly indicated Prinzmetal’s variant angina.  Some staff were very gentle and some were extremely rude. Some ignored my requests for chest pain relief and some were helpful.

“Overall, it was a really bad experience.  I decided that I would have to do something about it. So after cooling down, I put together some very relevent material for ‘the powers that be’ in the hope that the hospital staff may actually be educated about coronary artery spasm (CAS) and microvascular disease (MVD).

“To be honest, I hold out little hope that anything will change, but at least I can say to myself that I have made a genuine effort to better my situation.”

To help her better her situation  – and especially that of other women whose debilitating symptoms may have been blown off by uninformed medical staff because of “normal” cardiac test results – I asked her permission to republish her comprehensive resource list here.

If you (like this Australian survivor and I both experienced) had “normal” cardiac test results during what turned out to be a heart attack, please print off her resource list below and share it with your friendly neighbourhood physicians and nurses:

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Negative Stress Test Does Not Rule Out MVD – American Heart Association: Circulation: Cardiovascular Interventions

“The presence of a negative non-invasive stress test does not rule out coronary vasomotor dysfunction (MVD) in symptomatic patients with non-obstructive coronary artery disease.”

Andrew Cassar, M.D., M.R.C.P.(U.K.), Panithaya Chareonthaitawee, M.D., F.A.C.C., Charanjit S. Rihal, M.D., F.A.C.C., Abhiram Prasad, M.D., F.R.C.P., F.A.C.C., Ryan J. Lennon, M.S., Lilach O. Lerman, M.D., Ph.D., and Amir Lerman, M.D., F.A.C.C.


Standard Tests Don’t Detect Microvascular Disease Harvard Women’s Health Watch

“Heart disease, like cancer, is not one, but several disorders. Discoveries from the WISE study suggest that many women have a form of Heart disease called coronary microvascular dysfunction (MVD) that isn’t detected by standard diagnostic procedures and thus goes unrecognised and untreated.”

“The research, led by Dr. Noel Bairey Merz at Cedars-Sinai Medical Center in Los Angeles, is laying the groundwork for better ways to evaluate and treat women with heart disease.”


Coronary Microvascular Disease Can Cause Serious Problems – Mayo Clinic

“Because small vessel disease can make it harder for the heart to pump blood to the rest of the body, small vessel disease can cause serious problems if left untreated, such as coronary artery spasm, heart attack, sudden cardiac death, heart failure.”

MayoClinic.com, Small Vessel Disease

Coronary Microvascular Disease is Difficult to Diagnose PBS Second Opinion transcripts

“Coronary microvascular disease is an elusive disease. It doesn’t show up on many standard tests. MVD is a disease that’s just as dangerous as coronary artery disease, and it increases the risk of heart attacks and heart failure. The characteristics of microvascular dysfunction include:
no obvious blockages but blood flow to the heart is still low;
vessels that don’t expand or dilate properly during physical or emotional stress; vessels that spasm abnormally.

“Diagnosis remains the biggest hurdle for people with coronary MVD.”

Louis J. Papa, MD, FACP, Kathy Kastan, LCSW, MAEd Kim Kachmann-Geltz, Noel Bairey Merz, MD, Matthew Burg, PhD, Gladys Velarde, MD


Coronary Spasm–Induced Non–ST‐Segment Elevation Acute Coronary Syndrome – Journal of the American Heart Association

The study showed frequent involvement of coronary spasm in the pathogenesis of Non-ST Elevation Myocardial Infarction- Acute Coronary Syndrome (NSTE-ACS).  Variant angina was observed in one third of patients with spasm‐induced NSTE‐ACS. Compared with the obstructive group, patients of the spasm group were younger and were less likely to be hypertensive or to have dyslipidemia, diabetes, or previous myocardial infarction. Coronary spasm should be considered even in patients with fewer coronary risk factors and non-obstructive coronary arteries.”

Koichi Kaikita et al. J Am Heart Assoc. 2014; 3: e000795


Vasospastic Angina and Coronary Microvascular Spasm Journal of the American College of Cardiology

“Coronary microvascular spasm causes myocardial ischemia in patients with vasospastic angina. The result suggests that coronary microvascular disease may also contribute to angina in patients with “vasospastic angina (CAS).”

Hongtao Sun, MD; Masahiro Mohri, MD, PhD; Hiroaki Shimokawa, MD, PhD; Makoto Usui, MD; Lemmy Urakami, MD; Akira Takeshita, MD, PhD


Coronary Artery Spasm and Coronary Microvascular Spasm  Cardiovascular Sciences Research Centre

“Microvascular angina affects a large number of people. These patients have typical chest pain and some evidence for myocardial ischemia, but the coronary arteries are absolutely clean. Many of these patients are considered to have non-cardiac problems, who are then ‘reassured’ that there is nothing wrong with the heart. They are sent back home with the same problem that they came with.

“It is an important condition to be taking into consideration. There is a connection between coronary artery spasm and microvascular angina, particularly when the microvascular angina patients develop coronary microvascular spasm.”

Professor Juan Carlos Kaski, Head of the Cardiovascular Sciences Research Centre and the Microvascular Angina Clinic, St. George’s University of London, U.K.


The ACOVA Study: Abnormal COronary VAsomotion in patients with stable angina and unobstructed coronary arteries Journal of the American College of Cardiology

“Nearly 50% of patients undergoing diagnostic angiography for assessment of stable angina had angiographically normal or near normal coronary arteriograms. The ACH test triggered epicardial or microvascular coronary spasm in nearly two-thirds of these patients.”

Ong P, Athanasiadis A, Borgulya G, Mahrholdt H, Kaski JC, Sechtem U. Robert-Bosch-Krankenhaus, Department of Cardiology, Stuttgart, Germany.


Coronary Artery Spasms Often Occur At Rest – Mayo Clinic

“A coronary artery spasm is a brief, temporary tightening (contraction) of the muscles in an artery wall in your heart. This can narrow and decrease or even prevent blood flow to part of the heart muscle. If the spasm lasts long enough, it can lead to chest pain (angina) and possibly a heart attack (myocardial infarction). These spasms may also be referred to as Prinzmetal’s angina or variant angina. Unlike typical angina, which usually occurs with physical activity, coronary artery spasms often occur at rest.

“Only about 2 percent of angina cases are Prinzmetal’s angina. Coronary artery spasms are more common in people with risk factors for heart disease, but the spasms also happen in people who have no risk factors. Coronary artery spasms can also occur in people who have conditions that affect their immune systems, such as lupus.”

Martha Grogan, M.D. Mayo Clinic cardiologist


Joan Jahnke Shares Her Story Emory University

Joan Jahnke, a patient of Dr. Habib Samady (Professor of Medicine at Emory University School of Medicine and Director of Interventional Cardiology at the Emory Heart and Vascular Centre), shares her journey through cardiac microvascular endothelial dysfuntion with vasospastic angina:

“A big frustration with many MVD patients is that our complaints and symptoms often bring us to an urgent or emergent care setting where none of our signs show on any EKG, echocardiogram, ultrasound or treadmill stress tests.

“We look well, present with chest pain and shortness of breath – perhaps anxious – but the tests are generally negative, even the cardiac enzymes. We repeatedly return seeking help, knowing that it is our heart, but we repeatedly fail the best current technology tests.”


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* Diagnosing non-obstructive coronary artery disease:  If a physician is not familiar with coronary artery spasm or coronary microvascular disease, it’s often unlikely that additional cardiac tests will be ordered once conventional EKGs, stress tests or cardiac enzyme blood tests are interpreted as “normal” in the Emergency Department. Coronary Artery Spasm is explained by Mayo Clinic cardiologists as a temporary tightening (contraction) of the muscles in a coronary artery wall in your heart. This can narrow and decrease or even prevent blood flow to part of the heart muscle. Unfortunately, spasm disorders are often missed using conventional cardiac diagnostic tools like cardiac catheterization (angiogram) – unless accompanied by what’s known as “provocative testing” to try to provoke a spasm during the procedure using a type of medication or hyperventilation.  Unlike typical angina, which usually occurs with physical activity, coronary artery spasms often occur at rest.  Similarly, diagnosing Coronary Microvascular Disease is difficult using standard cardiac diagnostics that are designed to identify large blockages in large coronary arteries. Dr. Noel Bairey Merz believes that the best current diagnostic test for detecting MVD may be something called coronary reactivity testing. This angiogram-like test lasts 60-90 minutes and allows doctors to see how very small vessels supplying the heart respond to different “challenges” from medications.

UPDATE:  Coronary vasospasm disorders have also been found to be caused by a rare allergic reaction called Kounis Syndrome, treated with corticosteroids and antihistamines.

There may also be a line between hypothyroid issues and spasm disorders. Learn how this heart patient tracked down the culprit here

Q:  Have you had “normal” cardiac test results despite what turned out to be a serious heart issue?

See also:


117 thoughts on “Misdiagnosed: women’s coronary microvascular and spasm pain

  1. I just experienced my 3rd heart attack due to small vessel disease. The first two involved one vessel. This last one involved 3. I had one angioplasty and some heart damage because the other two vessels were completely blocked with blood clots and it took hours for medications to open them.

    I am on a Nitro patch and 6 other medications. I was 55 at the time of my first heart attack and 60 now.

    I went through early menopause at 32.

    Liked by 1 person

    1. Third heart attack due to small vessel disease – so much for the common medical reassurance that microvascular disease is “not dangerous”. Thanks for sharing your experience here, Edyie!


  2. Carolyn, thank you for suggesting that I consult my pharmacist. You’re right – they are an often overlooked resource. As I am on 15 medications, I seem to be there every other day getting a refill and they know me well! I will definitely take the time to talk to them. Thanks again and thanks for the link.

    Liked by 1 person

  3. It was helpful to read everything that was posted here. After being diagnosed with anxiety by a male cardiologist, I sought a second opinion at a women’s heart center in New York City and received a diagnosis of coronary artery spasms and was put on the proper medication.

    The doctor said that they no longer test for it with ergomine testing because it can result in death, but because I have migraines and due to my history, this diagnosis is probable. She also said that it’s possible that albuterol which I use a lot for my chronic obstructive asthma can provoke a spasm, but she didn’t tell me to stop. I also read that sumatriptin injections which I use as an abortive medication for my migraines is contraindicated, so I have to ask my neurologist about that.

    I feel relieved that I finally got to the bottom of this, but concerned about all these chronic illnesses on top of one another, and the fact that these medications seem to be contraindicated.

    Liked by 1 person

    1. Andrea, yours sound like a ‘good news, bad news’ story: good news that you have a diagnosis, but bad news to discover that some of your meds might no longer be appropriate.

      On top of consulting with your neurologist and other specialists, I’d also suggest making an appointment with your local pharmacist to discuss medications and contraindications. These health care professionals are often-overlooked resources, and know far more about drugs that many physicians do – not only the effects of individual drugs, but also about drug-drug interactions that can affect your health. Best of luck to you…


  4. Hi everyone – well, last week I had another trip to the ER with them sending me away. I woke up early, got ready for work, and went to work having chest pain all day long. It was totally different then my normal pains. It felt like I had an elephant sitting on my chest. I had it all day long until I couldn’t take it anymore.

    I left work early to go to urgent care and get an EKG done. My EKG again showed as abnormal with myocardial ischemia and once again I was transported by ambulance to the ER hospital nearby. After all the IV’s, more EKGs showing the same, and blood tests coming back as not having a heart attack, they sent me home. My cardiologist was the one on call; all she said was maybe I should increase my Diltiazem. But that lowers my blood pressure which causes even more symptoms.

    I completely stopped drinking caffeine of any kind and that has helped a lot so far. I know caffeine is a vasoconstrictor even though I only drank one cup in the morning and that was it.

    I am still having pains but not as bad. I have good days, bad days and horrible days. I think if I continue to have such pain, I am going to have to get the reactivity testing. The only place that does it here is in Dallas, but I am willing to do it so I can find out exactly what is going on. I really need to know.

    Liked by 1 person

    1. Hi Renee,

      I am on Diltiazem too — it helps with my shortness of breath so much (I have low blood pressure too). So, when I have symptoms — this is a choice: to be short of breath & in pain and with normal BP, or to have everything opposite. What a game…

      Do you have any other symptoms except pain? I think it’s a good idea to ask your GP for cardiac MRI referral. I am sure they did not check your blood twice at ER. I mean, they had to check it for Troponin if only every 6 hours about three times to rule out a MI. Also, it is necessary to do a BNP blood test. I bet they did not do this too in your case. You can ask a referral for these tests too. Also, the doctors will see any signs of past heart events on your cardiac MRI even if the ER “rules it out”. MRI can show scars, heart muscle damage and injury.



      1. Thank you so much! I did not know about the MRI – I will definitely ask for that. You are right also, they only checked my blood one time and sent me away – it’s very frustrating.


    2. So I found out there isn’t a place here in Texas to do the reactivity testing. I did have an apt with my cardiologist yesterday and I was able to get an event monitor for 2 weeks so hopefully this will show what is really going on. My dr swore to me that all my pains couldn’t possibly be heart related and that there was no way I could have a heart attack because there is no blockage at all. I really hope she is right. I have recently given up caffeine completely and my symptoms have decreased a lot which is good. I still have pains just not as severe as before. But this disease always surprises me. I am trying to lower my stress level and my pcp put me on paxil once a day. I hope it helps. Recently I have had some new symptoms appear in my sleep. My heart flutters like I have butterflies in my chest it wakes me up out of my sleep. It’s only happened twice but still it scared me.


      1. Renee –

        I have read your posts. It sounds like you are having microvascular ischemia which is a diagnosis that is very often missed and not every physician is aware of. When patients present with chest pain the focus is on MACROVASCULAR ISCHEMIA which shows up easily and clearly on an angiogram.

        Microvascular ischemia cannot been seen on angiography. Often, if the patient has chest pains and the angiogram is negative, then heart disease is often dismissed as the cause and the focus shifts to something else like anxiety or chest wall pain.

        Recently there has been more focus on microvascular disease and cardiac Syndrome X which, as another reader pointed out, requires reactivity testing for correct diagnosis. Microvascular ischemia can cause heart failure, heart attacks, sudden death and arrhythmia. Your flutter is most likely caused by paroxysmal atrial fibrillation, a heart rhythm abnormality that can come and go every so often. Another indicator that you have heart disease.

        The treatment for microvascular angina is often unsatisfactory. The pain can last for hours or days. The best drugs are beta blockers and calcium blockers but only those that lower the heart rate like diltiazem. Any cardiac drug that increases the heart rate will likely trigger chest
        pain including nitroglycerin.

        The bare truth is, microvascular ischemia gets no attention because there is no money in it (yet). Stents cannot be used as treatment. Pharmaceutical companies are more interested in large vessel disease because a single stent can cost over $10,000. The companies (and some doctors) follow the money and not the patient. Sometimes a patient has to take matters into their own hands . The doctor that reassured you that it is not your heart despite the EKG changes, needs to go back to school.

        Good luck and I hope this was helpful.
        Dr. John


        1. Dr. John, that’s a pretty distressing assessment that medicine is not incentivized (financially) to take MVD seriously.

          Just curious: what diagnostic tool would you recommend for Renee and others like her who have NO ACCESS to reactivity testing?

          It’s virtually impossible (and not recommended!) for you to make any kind of definitive medical diagnosis online based only on a blog reader’s comment.

          One point re your nitro comment (“will likely trigger chest pain”): the opposite is true in my own case (severe refractory angina due to MVD). Short-term nitro spray is my best friend, would never, ever leave home without it. In extreme cases of chest pain, time-limited nitro drip in hospital has also been successful for some MVD patients. Dr. Bairey Merz at Cedars Sinai in L.A. routinely recommends nitro for her MVD patients.

          Nitro and my TENS therapy allow me to function with MVD (TENS recommended by both my cardiologist and my Pain Specialist at our local heart hospital (who did a fellowship in Sweden studying coronary microvascular disease – luckily for me!)


          1. Microvascular ischemia can be very unpredictable both in terns of symptoms and response to therapy. So I am not surprised that in your case nirto works. In general, anything that causes an increase in the heart rate, ( which results in an increase in oxygen consumption by the heart) will worsen the ischemic pain. This is the exact opposite for MACROVASCULAR ISCHEMIA where nitro is of course , very helpful. Some people have both microvascular and macrovascular ischemia ( having one does not exclude one from having the other as well). This is another reason Nitro may be helpful . And yes, I agree that TENS therapy can help but i am opposed to spinal cord stimulation as a treatment, because this simply masks the pain and does nothing to improve the ischemia which ultimately is the cause of the pain. My opinion is that spinal cord stimulation can be dangerous because the ischemia is present and do harm to the myocarddium but yet the patient does not senses this. The pain is there to remind the patient that there is a problem here and to ” dumb the pain simply defeats the purpose. The pain serves as an early warning system for the ischemia and the SCS removes this warning. It is like turning off an airplane’s altitude warning system when flying near Mount Everest. Ok, enough said, i wish you the best.

            My comment was for Renee.


            1. I understand that your comment was for Renee. But since this is my blog, I feel compelled to quickly interject whenever anybody (doctor or not) offers my readers here an online medical diagnosis.

              I can also add (as a patient who does live with the daily pain of refractory angina that has not responded to beta/calcium channel blockers or standard cardiac meds prescribed for MVD) that “masking the pain” is what all pain patients desperately seek.

              If there actually were in fact a way to address the ischemia that originally causes the pain, then of course we would be thrilled to try that option. But in the meantime, we must take what we can get simply in order to function – and for my cardiologist and pain specialist that may well include a SCS implant some day should my TENS/nitro combination fail to offer adequate relief.


        2. I have had a few other people tell me they think I have MVD as well. I did order an event monitor and I wore it for a week. I am going to get my results this friday and I will let you all know what they show. I did have a few flutter episodes while I was wearing it as well as my heart rate jumping to 120 bpm just sitting on the couch. I am hoping this will show my Dr that it is my heart and not all in my head. I have also been put on anti-anxiety meds to lower my stress levels because they are a huge trigger for my spasms.


          1. Hi Renee – right now, it’s impossible to know for sure what your diagnosis is. It may be microvascular disease – or it may not. MVD is not picked up via EKG, so your Holter monitor (while it may capture flutter and pulse variations) would not likely help to identify MVD. Best of luck on Friday…


            1. Thanks Carolyn. My main thing why I wanted the event monitor was to see if I am always in an ischemic state or only when I am having the attacks. The Dr’s seem to think I am constantly ischemic but that was not always the case before all this started happening to me. My EKG’s used to be totally normal.


              1. I got my results today and good news! I am not always ischemic. It seems to be only when I am having bad attacks. My results showed I have Sinus Bradycardia (slow heart rate) and PVCs (Premature Ventricular Contractions) but otherwise, it looked good. My Doctor increased my Diltiazem to 180mg instead of 120mg and she referred me to UT Southwestern Medical Center in Dallas for further testing. She still swears there is no way I can have a heart attack from this. I asked about the Microvascular Disease; she said if it is that, there is no way to test for it so she still has me as a diagnosis of Vasospastic Angina. I am hoping I can get some better answers from UT Southwestern since they have more experience with this.

                Liked by 1 person

                1. Great news about your referral for further tests at Southwestern, Renee! – one step closer to solving the mystery. Meanwhile, you might also be interested in learning more about your PVCs: e.g. “In an overwhelming majority of patients, especially those with a structurally normal heart, PVCs are benign. The word benign means the extra beats do not indicate heart disease or predict sudden demise.”


                  1. CAROLYN’S NOTE: This reader’s comment has been deleted because its unsolicited and anonymously submitted online medical advice has now expanded to include criticism of a patient’s physicians (the ones who actually do have access to the patient’s medical records)

                    Dr. John, if you insist on continuing to dispense your unsolicited medical advice online, why not consider starting your own blog under your real name with your professional credentials and liability coverage disclaimer clearly itemized?


                  2. I had another attack today at breakfast. I was with my family out to eat and all of a sudden I got very sick, my heart was pounding, I started sweating and my chest and left arm were hurting. I had to go home and lay down for a few hours. I still do not feel very well. I have had these symptoms many times before but always dismissed as not having a heart attack. I am going to demand to be kept overnight for observation next time I have to go to the ER.

                    I am also starting to have a weird new symptom of muscle twitches. It comes on randomly it feels like I have pulses in strange places in my body and sometimes my leg will twitch and move a little like jerk real fast. I do not know if this is related to my prinzmetals or not. I have made a list of all my symptoms to give to UT Southwestern when I actually get in there. (Still waiting)


      2. Everyone, I am so glad I came across these posts! I have been through several heart tests the past several years, and like many of you have said, symptoms of irregular heartbeat and tightening of the chest… But always passed the stress test and no blockages. And I’ve experienced over the past couple of weeks being woken up with my heart fluttering so fast and short of breath that I thought I was having a heart attack!

        I’ve been extremely exhausted and wear out fast during the day. Did anyone else experience clamminess or sweating? I had a pulmonary test done yesterday and now they say my lungs are of someone that’s 10 yrs older than I actually am. Gave me an inhaler to sample. I read the side effects….warning of possible death if you have thyroid or heart problems which I have. Why would my Dr. do that? I have sleep apnea and use a CPAP machine….which could be detrimental to my lungs, but detrimental to my heart if I don’t use it! Up until this year I would consider myself a pretty outgoing active person… But now I don’t have the energy to get done what I want! I know I’m rambling but I’m desperate. I want to feel better! Thanks everyone… Lots of good information. God bless!


  5. Please, I need your advice, somebody living on the West Coast… I have read the article, it is really helpful… But it seems I am in the middle of my “adventures”. My situation is even more hopeless than described in the article. I have abnormal cardiac tests – not normal at all. My ECGs are 3 from 5 like “consider inferior ischemia and ST changes”. My stress test was positive (ST changes). I have cardiac symptoms (classical + awful shortness of breath). My Dad passed from sudden cardiac arrest at the age only 5 years older than I am now. I was diagnosed with myocarditis. And my new cardiologist says that widely known phrase: “This is not your heart. You are too young”. and refuses to consider any possibility of any other cause except massive artery blockage. I was unlucky to experience general angio — and he was happy to kick me out of his office.

    I feel really helpless. I have three delightful kids, and a loving husband. I am successful at work. But my symptoms do not want to go away “by themselves”. I am ready to go out of the country to seek help, even paying for this help.

    Honestly, there is something very wrong. We pay our premiums for the best standard health care. But we do not get it and have to look for it in a different country.

    Please, somebody who has experienced similar situation — I will highly appreciate your advice/thoughts/ideas or even a good word.

    And dear Carolyn — thank you so much for everything you are doing for us.

    Take care and have a wonderful day all!

    Liked by 1 person

    1. I’m sorry you’re experiencing these distressing symptoms (while being dismissed by your new cardiologist as “too young”). I’m not a physician so cannot comment on your specific case. But you do seem to have abnormal diagnostic tests and at least one cardiac diagnosis (myocarditis, an inflammation of the middle layer of the heart wall) which could account for your shortness of breath. While this condition does often clear up on its own, there IS treatment available depending on the underlying cause. The point is: SOMETHING is causing your symptoms, and whether these are heart-related or not, you need to find a doctor who will help you determine what’s causing them, and then come up with a treatment plan. You don’t say what country you’re in; if you’re on the west coast of the U.S., I’d consider getting a referral to the Barbra Streisand Women’s Heart Center at Cedars Sinai Hospital in Los Angeles. If you’re in Canada, the Leslie Diamond Women’s Heart Health Clinic at Vancouver General Hospital would be a place to start to seek a referral (phone 604.875.5389). You need a second opinion. Best of luck to you…


      1. Dear Carolyn, thank you very much for your answer! I am in Canada. Do you know which tests should be performed to exclude microvascular disease? I have asked my doctor to check it out but he “does not know the names of these tests”. Leslie Diamond Women’s Heart Health Clinic in Vancouver needs a referral from my doctor to see me. It is closed circle…

        Good luck to you too..

        Liked by 1 person

        1. I just sent you an email about this, too. You can ask your doctor to refer you to the Leslie Diamond Centre in Vancouver. While you’re talking to him, tell him that the MVD test he’s wondering about is called Coronary Reactivity Testing, as Dr. Noel Bairey Merz at Cedars Sinai mentions in this article. This test is available at Vancouver General Hospital (so far the only hospital in Canada that performs it). Good luck…


  6. When I received this email and began reading, tears started to fill my eyes. It felt like you were talking about me. I have Spontaneous Coronary Artery Dissection (SCAD) and constant angina symptoms.

    If I’m going to be somewhat active, I have to take nitroglycerin just to get thru the task. I had to push my primary for a second opinion from a cardiologist because the 1st one wrote me off with not having coronary-caused chest pain. The 2nd doctor admits to having no experience regarding SCAD but is willing to help me. Out of the blue the 1st cardiologist calls 2 months later to tell me I may have Coronary Microvascular Disease (MVD), then asks what do I want to do???? Um Get well!!!! Duh..lol to keep my sanity…

    So after changing my primary, I’m waiting on following up appts for treatment plans. I ordered copies of my angio and CT pet scan. Angio shows small curly veins in and near circumflex where my cardiac-caused tear was and LDA. Pet scan determined I have a 0 calcium score, a PDA (patent ductus arteriosus) and a possible tear in my RCA that could not be ruled out… It was diagnosed as a smudge. The PDA never mentioned. Received raves for the calcium score and scolded because I wasn’t as elated as the doc was…

    I’m 51 years old and quality of life has just deteriorated. I am so grateful for you, Carolyn. For having the courage to bring this issue out. I will be putting together a report for my primary and cardiologist and hope they accept it and read it. Maybe it will help someone that comes along after me with same issue.

    Liked by 1 person

    1. Thanks Mary – it’s hard to be “elated” even in the face of zero calcium scores when one lives with “constant angina symptoms”. I too live with refractory angina, and your preventive nitro dosage is exactly what I do as well. I met a woman at Mayo Clinic who had been a competitive tennis player before her heart attack – she’s the one who first encouraged me to stop thinking of my nitro spray as a remedy only AFTER the chest pain has become unbearable! She stops halfway through each tennis game for a nitro spray, waits five minutes, then she can complete the second half. Planning ahead. Pioneer cardiologist Dr. Bernard Lown says the same thing. Good luck with your report for your doctors – an important start!


  7. What a relief to find this article and these comments!! I had to cry like a baby. Have been living with severe s/s for over 15 years . . . been to ER multiple times with all the same unkind treatment: after multiple heart meds, anti-anxiety meds, anti-depressant meds (none of which worked, but indeed much worse off), I gave up . . . have finally diagnosed myself!! Undoubtedly MVD . . .

    Now onto the unrelenting search for the right MD and relief . . . thank all of you for the suggestions.

    Liked by 1 person

    1. I am on statins, high cholesterol, 57 years old, CT angio shows blockage is mild. After years of ER visits, the chest pain I am told is not from heart, only happens at rest…wake up with chest pain in the mornings, I can hardly move for about 20 minutes. Could I have this, how does the spasm feel? My upper chest hurts to move, if I don’t move a muscle or breath deep, it is okay; if I try to get up, it hurts. Does this sound like the MVD? Have had chest pains for years….first time this year upon waking…they say my stress test was false positive./ iDEAS./


      1. Eva, I’m not a physician so cannot comment specifically on your situation – except to say generally that chest pain due to coronary artery spasms or small vessel disease often does occur at rest unlike the more frequently seen obstructive coronary artery blockages (pain on exertion, relief with rest). Please get a second opinion.


  8. I am in so much turmoil and frustration. Finally diagnosed with coronary pulmonary spasms, without being tested mind you, and put on Adalat 60mg only to have chest pain worsen. Went to ER where all tests came back normal and told to see cardiologist. Very unsure what to do next, still experiencing pain, waiting to hear from the doctor……what tests should I be asking for?

    Liked by 1 person

    1. Hello Caroline – re-read the last paragraph of this post (Diagnosing non-obstructive coronary artery disease) – this may help you decide what diagnostic tests to ask your cardiologist about. I’m not a physician so cannot advise you specifically on your case, but I can tell you in general that if you are being prescribed a drug for symptoms that are getting worse on the drug, you need to go back to whoever prescribed that drug and report this, and discuss a change in drug or dosage until you are appropriately treated. That referral to see a cardiologist sounds like it was good advice from the ER doctor – please follow up and best of luck to you.


      1. I am 38 yrs old and was recently diagnosed with Vasospastic Angina. I tried for the longest time to get help with my situation. It was getting worse and worse and after numerous trips to the ER only having them say nothing was wrong it was extremely frustrating.

        I was finally able to find a good cardiologist who ran some tests such as the stress and echo which of course was normal and the CT angio also normal. My pain was so bad I had to leave my job for 2 months and I was having pains every 5 minutes. It felt like I was having a heart attack every single day but I wasn’t. After some trial and error of medications and dosages I finally found a plan that works great for me. I am on 120mg long acting Diltiazem which I take once a day for the spasms and I have to take 4 fludrocortisones with 2 salt tablets every day with lots of water. I have hypotension which means my blood pressure is very low this keeps my blood pressure normal. It’s a balancing act because the Diltiazem lowers it and the Fludrocort raises it along with the salt. I also drink a protein shake a day. This has helped me to be virtually almost pain free. I do have the occasional spasm but not nearly as bad as before. I can actually live a normal life now and I am so happy I found a solution for my problem. I hope this helps you.

        Liked by 1 person

      2. Oh thank you so much for taking the time to respond. I am crying as I write this…. I finally heard from my cardiologist and she is simply taking me off the Adalat 60mg with no further medication suggestions, and told me to go to the hospital if the chest pain continues and follow up with family Dr.

        I am back to square one, even though she told me I have coronary artery spasms. I feel so defeated and at a loss….the ER doctors do not know how to treat someone with spasms.

        Thank God you have this website for support and information. I guess I will make an appointment with my regular Dr as the chest spasms are daily.

        Liked by 1 person

        1. Hi Caroline – that’s so discouraging that your cardiologist took you off meds “with no further medication suggestions” for your spasms. Adalat is in a family of drugs called calcium channel blockers; others include Norvasc or Procardia or Caduet among others commonly used for vasospasms – ask your family doctor to discuss the pros and cons of each type. Sometimes, if one drug in a family doesn’t work, another similar-but-different member of the same family might. Other meds used for vasospasm include the long-acting nitrates (a “vasodilator” like nitroglycerin that help to widen blood vessels). Daily chest spasms should NOT be dismissed, ever. Make that appointment with your regular doctor and insist on discussing treatment options to help you. Do NOT give up until you get help in solving this mystery.


          1. Hi Carolyn,
            I followed up with my regular doctor and I am trying nitroglycerin patches. She is also willing to refer me to a new cardiologist who performs coronary reactivity testing if I can find one here in Ontario. Would you happen to know of any doctors here in Toronto who perform the testing by chance? My current cardiologist says it’s too risky and won’t do the test. She is the one who is guessing that I only have vasospasms…..I’m not prepared to live according to a “guess”.
            Any information is greatly appreciated and insight welcomed.
            Thank you.

            Liked by 1 person

            1. Great news about the nitro patch – I hope that begins to address your symptoms. I’m not familiar with Toronto cardiac diagnostic centres, although you could probably start with either Sunnybrook or the Peter Munk Cardiac Centre. I do think it’s a bit odd that your doctor seems to expect you to track down somebody who does coronary reactivity testing. My guess is that it’s far easier for physicians to get this info about experienced professionals via their own peers than it is for a patient. In any case, best of of luck to you…


              1. Once again thank you for replying and yes I agree with you, it is odd that I have to find the physician. It is a daunting task and thank you for recommending Sunnybrook or the Peter Munk Centre; I have actually been looking on their websites.

                This whole journey has been exhausting and I can relate to so many of the other women on here. I don’t understand why it’s so hard to get treated with respect as a woman with chronic chest pain who doesn’t “fit” the normal cardiac testing process.

                Thank you for this website and your dedication.

                Here’s hoping that the nitro patch helps!! And that I can find a physician…..I will try but if I can’t, I will tell my doctor that it’s up to her…

                Thanks again!

                Liked by 1 person

                1. Well so far no one has even heard of “reactivity testing” in Toronto….I will keep searching but I am having an angiogram done in the meantime.
                  I’m shaking my head…


                  Liked by 1 person

                  1. Hi Carolyn,
                    Well I’m updating you on my progress and it isn’t great. I met with a second cardiologist and was told again that nobody does the reactivity testing because the arteries spasm anyways during an angiogram. I never did get an angiogram, I was denied. I was also denied a holter moniter this morning which another cardiologist wants to put on me, but this one didn’t see it necessary.

                    Still having daily chest spasms so my nitro patch was increased to .4. Today the Dr. said double it and if it doesn’t help then your spasms aren’t heart-related. Feeling so frustrated and confused by our healthcare system. Now I really don’t know what or where to go. Will double the dosage of the patch and hopefully respond well…..if I don’t I don’t know what I’m going to do. Any suggestions?

                    REPLY FROM CAROLYN, June 16th, 2:07 pm: Can’t respond in a separate reply to your comment, Caroline – this site allows a max of 10 “nested” replies per comment, so if you respond to this, do so by starting a new comment, okay?

                    Now, here’s my reply: “Oh no!” This is confusing and distressing for you. I do hope that the new nitro dosage does help address your symptoms. If not, please return to your GP – who is like the quarterback of your health care team. If, as the second cardio suggests, this might not be cardiac-related, your GP is the one who will refer you elsewhere for help. Learning to suffer in silence or ignoring symptoms is not an appropriate option. Best of luck to you…


  9. I was diagnosed with diastolic dysfuntion, with preserved EF with concentric hypertrophy. I was just hospitalised with a lot of pain on my chest, upper and under my breast. My skin is very sore and the pain goes to my back and left arm. It starts Saturday night and early morning. ECG shows nothing. Dr prescribed anti depressants. I don’t know what to do. Will see cardiologist on the 22 of April after waiting for 4 months to see him.

    Liked by 1 person

    1. I’m glad you’re seeing a cardiologist soon to discuss a treatment plan, Fatima, although it’s distressing that you’ve had to wait so long. If your symptoms worsen, do not hesitate to return to Emergency.


  10. I’m surprised there is no mention of Kounis Syndrome – coronary spasms caused by a mast cell reaction to high histamine foods or aged foods.

    This kind of Prinzmetal’s angina can be controlled (somewhat) by diet (eating low histamine foods to avoid reactions) and by lowering the amount of tyramine in your body – these patients are unable to clear tyramine, which causes adrenaline, in your body, same as patients taking the old antidepressants, MAO inhibitors. Also you will find that coronary spasms/mast cell patients often have a combo of three diseases – hyperadrenegic POTS, mast cell activation disorder and Ehlers Danlos syndrome. Also … every time I’ve gone to the ER with Prinzmetal’s angina, I’ve had blood work that SHOWED HEART ATTACKS. I’m not understanding why most of you didn’t.

    My events are stopped or reduced, often cold, by taking benadryl and atarax (another antihistamine), along with the nitro, which never seems to stop anything but lower the pain. When they are not stopped, I am usually having a hypertensive crisis (part of the hyperadrenegic POTS) contributing to the spasms – so I get on an alpha blocker drip in the cardiac ICU (dangerous drug most hospitals don’t use in the ER) which blocks adrenaline – this stops the hypertension AND the spasms.

    I would urge all of you to google Kounis Syndrome and Mast Cell Activation Disorder relative to your Prinzmetal’s angina.

    And fire the doctors that tell you your Prinzmetal’s angina is nothing – I had a PA tell me that it was no more significant than a broken fingernail – my husband says “Does she have heart damage from this?” The PA said yes. My husband then let her have it! Sadly, she got mad and then tried to release me with BP of 200/120 – I refused to leave but the hospital was little help UNTIL I found a cardio that read my Kounis Syndrome material.

    Now I have a letter from the head of the biggest teaching hospital in my city of 6,000,000, who is now my cardiologist, explaining the condition(s) and appropriate treatment – which does NOT include telling me it is nothing!

    Liked by 1 person

    1. Thanks so much for this reminder, Ellie. Here’s a link to more information about Kounis Syndrome (a paper written by Dr. Nicholas Kounis)

      Dr. Kounis calls this syndrome a “a pan-arterial monster”, and cites potential allergies to a number of things from bee stings to drug-eluting stents (possibly due to the nickel, polymer coating, or the impregnated drugs that applies continuous, persistent, repetitive and chronic inflammatory irritation to the coronary artery). Ironically, even Plavix (clopidogrel) – the antiplatelet drug given to prevent stent thrombosis – has been (rarely) found to itself induce stent thrombosis in Kounis Syndrome patients. I’m adding a link to the resource list on this post, thanks to you.


  11. I was just diagnosed with this last week. Thank you for the wonderful information.

    I have been complaining for about 4 years. About a month ago, the pains became excruciating. I’ve been to the hospital 4 times thinking I was having a heart attack. Finally had an emergency angiogram, which showed I have beautiful clear arteries.

    I am fifty years old, was running/walking 13-17 miles a week, doing Pilates 2-3 times a week, and I’m a vegetarian. One nurse after the angiogram made me feel so stupid. Your heart is fine! There’s nothing the matter with it.

    It made me feel like I was going crazy! I’ve had a panic attack before and this was nothing like it!

    I’m going back to the hospital to educate them. Telling someone their heart is fine when it’s not can have serious consequences for the patient (and the hospital…ie lawsuit!)

    Thank you for sharing your stories and hope! I believe I was led to this site, so I wouldn’t feel so alone! Thank you ladies and thank you Jesus!

    Liked by 1 person

  12. Hi I was recently diagnosed with Vasospastic Angina. I guess it’s also called Prinzmetal’s Angina or Cardiac Syndrome X. I have been reading all your posts and I suffer these exact same symptoms. I went through the stress test, the CT angio, the echo all normal. Only thing that’s ever “abnormal” are all of my EKG’s they show Myocardial Ischemia.

    My PCP basically blew me off saying it was stress and anxiety but I finally found a cardiologist who takes me seriously and probably only because she has 4 other patients with the exact same problem. (makes you think) I am on Diltiazem long acting and fludrocort to keep my blood pressure up. I have extremely low blood pressure and was told to go on a high water intake high sodium diet.

    I have been doing all these things and I was fine for 2 weeks until I had my CT angio last week. Now the spasms are really bad. I don’t understand how they can constantly say it doesn’t affect the heart when it’s causing such severe pain! I have been to the ER twice for this and the same thing they just brushed me off, said I did not have a heart attack and that was that. This is so frustrating I really need to figure out how to stop these spasms. I know cold is a huge trigger for me.


      1. So sorry to hear of your recent experience, Renee. Please call your cardiologist to report this increase in spasm pain. If she has at least four other patients with the same diagnosis, she’ll likely have more experience than many ER physicians do in managing this condition. Coronary spasm is fairly common during an angiogram but severe pain should not be continuing for two weeks following the procedure. Meanwhile, remember that nitro is your friend. Read this for more info; you might be a candidate for a nitro patch but while your symptoms are this bad, ask your cardiologist about other options; some Prinzmetal’s patients have found relief with an I.V. nitro infusion (done in hospital).

        Liked by 1 person

    1. I spoke with my doctor and the problem was my fludrocort wasn’t high enough so she raised me up to 4 a day; 5 is max. This seems to have helped dramatically. I was only taking 3 before; the difference between 3 and 4 made a huge difference.

      Liked by 1 person

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  14. You have got it in a nut shell, I have CAS & MVD for the past three years. In Australia it is not so common but I was diagnosed by Prof Chris Zeitz and Prof John Beltrame. I am in good hands and I am on a cocktail of medication which is helping to control it all.

    Liked by 1 person

      1. Medications I am currently taking are as follows: in morning, Ivabradinen 7.5mg, Nifedipine 30mg, Amlodipine 2.5mg, Pregabalin 75mg, Sertraline 100mg, Aspirin every second day, 7.5mg meloxicam-ga, in the evening, Ivabradinen 7.5mg, , Nifedipine 60mg, Amlodipine 2.5mg, Pregabalin 75mg, Levlen 30mg, vitamin D 1000ium, Loratadine, Nitro Dur 10 patch when needed.


    1. Please tell me what the cocktail is? Been going thru this since 2008. So tired of all the Doctors and Nurses thinking I am crazy.


      1. See Sue’s November 20th reply (above) for a list of her meds. Remember that these happen to work for Sue – may not be appropriate for you or me or anybody else. Best of luck to you, April…


  15. My wife has similar issues going on and the incidence rate seems to be increasing. We are located In South Arkansas. Does anyone know of a doctor experienced in Prinzmetals, small artery disease, and artery spasms somewhere near Shreveport La, Little Rock Ar, Dallas Texas, Houston, or even Oklahoma City? Any suggestions would be appreciated.


  16. Hi! I’m glad I found this. I feel the need to tell someone what’s happening to me. For a period of over ten years (I’m about to turn 38) I’ve had symptoms like shortness of breath, syncope and dizziness always exhausted but with periods of just extreme fatigue, palpitations, and more recently chest pain but not excruciating pain, more like my chest is being squeezed or a big weight on my chest. What first made me look for medical attention was when I was going through some really stressful situation in my life all of a sudden I just started feeling dizzy but the kind of dizzy that would start with ringing in my ears and then everything goes black. It was hard for me to go up the stairs as I was out of breath and extremely tired just by doing that. Went to the cardiologist and after an echo he said that there was thickening in my heart’s left muscle. That is all he said and he prescribed toprol 20mg to help with the palpitations. After that I didn’t have insurance so I never went back to the cardiologist. Now 5 years later, I found myself helping out in a remodeling project for my church when suddenly I started feeling the squeezing of the chest with some mild pain, shortness of breath dizzy and just an overall feeling sick. Instead of going to the ER I drove home and went to bed. I felt as if I had been hit by a truck and like I had the flu or something like that. It took some weeks for to start feeling somewhat better. Did all I could to get insurance and now my primary doctor, I feel is not taking me serious at all. He finally gave me a referral to a cardiologist. They did a stress test and an echo and they both came out ok. So I started researching my symptoms and came across Microvascular disease and this just described me because my symptoms are not always present, they come and go except for now they kinda have stayed a little longer and the fatigue which is always present. I asked my cardiologist if could rule out microvascular disease and his response was that there’s not a test that exists to rule it out. I found it hard to believe because all the information I’ve come across suggests otherwise. He just dismissed me saying I should live my life as normal as possible. Can anyone help me?


    1. Hi Susana – I’m not a physician so of course cannot comment on your particular medical diagnosis. I can tell you generally however that the preferred diagnostic tool for correctly identifying coronary microvascular disease (MVD) is called coronary reactivity testing – although diagnosis is always the trickiest part of this condition. Right now, you have no idea whether your symptoms are heart-related or not – it’s entirely possible that they have nothing to do with your heart, especially as you say that you had a 5-year break between symptoms. We also know now that chronic anxiety can duplicate cardiac symptoms and can make all symptoms feel even worse than they are. Try this: start recording your significant episodes in writing, tracking what you were doing/eating/feeling both before and after each one to see if there’s a pattern you can identify and report to your doctor – and then in between these significant episodes, try not to focus on minor symptoms. If you become hyper-vigilant, I guarantee that you WILL find lots to worry about (whether or not they’re heart-related at all). Best of luck to you…


      1. Carolyn, thank you for replying and your kind advice. My husband and I have decided to do just that. I just want to clarify that that I’ve always had the symptoms, I would simply try to take it easy and I would start feeling a little better in a manner of days. I kept doing this for the past 5 years until that particular episode I had a few months ago. It was so bad that looking back I know that I should’ve gone directly to the hospital and not home. It just shook me in a way that I started seeking help.

        Thank you again. I am convinced that’s exactly what I need to do, keep a record of the significant episodes and try to make some lifestyles changes. I’m determined to live my life as normal as possible even if there are limits to what I can physically do at the moment. I’m done trying to convince doctors of my symptoms. I have faith that the day will come when I no longer will say I’m sick. Isaiah 33:24

        Liked by 1 person

  17. Well it’s Sept 2014 – are y’all still keeping this conversation going? Cause i’m loving it. I’ve had unexplained chest pain for 25 years. I can still remember my first one vividly, terrible. Had every test known to man, best diagnosis, possible prinzmetal angina. Haven’t seen a cardiologist in 5 years, pain is awful. Quit going to the ER. I take a nitro and pray pray pray. Any words of encouragement gladly taken. I’m 65 yrs old now, female and listening very carefully what to do. I have had 25 episodes since Jan 1st, 2014. Today is Sept 15, I keep a log now, sound familar to anyone, mostly during the night.

    Liked by 1 person

    1. Hi Susan – “unexplained chest pain” for 25 years? That’s a long time with no answers. If your diagnosis of Prinzmetal’s angina is correct, there are medications that can help, including your nitro. Another is the “calcium antagonist” family of meds such as Norvasc, Cardizem, etc. It’s time to see a cardiologist, preferably one with experience in treating microvascular or vasospasm issues of the heart. Bring your record of episodes with you to the appointment – and print off this post as well in case your doctor wants to see sources/journal references. As you already know, symptoms tend to become worse with cold, emotional stress, smoking etc. and can come and go in cycles (which is “normal” for a chronic diagnosis like Prinzmetal’s). Best of luck to you…


  18. Oh my gosh, Carolyn, thank you again. Like you, I am in the “special” group of women who have had the LAD “widow maker” MI, just 95% in my case, with two stents. That was 11 years ago. I had a perfectly normal stress test with nuclear studies six months ago and a heart attack while perfectly relaxed on vacation two weeks ago. Guess what? “Grossly normal coronary arteries” shown in the cath. I’m happy to be alive, truly.

    But the docs on vacation, in that small town in Colorado that used to be home, gave me a secondary diagnosis: “anxiety disorder” (gasp, sputter!), based on what!?! They didn’t do a psych eval and completely ignored my husband and me when we tried to tell them I do not have that! And they wouldn’t call my home doctor, who would confirm our claims. One doc suggested maybe some “micro vessel micro spasms,” but in the end they landed on stress induced cardiomyopathy, which still makes no sense. They sent me home from 3 days in the ICU with elevated troponins (3.4) and a bottle of Ranexa and Valium. (What the – huh!?)

    I was so relieved to get home and see my own cardiologist, who looked at all the reports and said, “yep, you had a heart attack.” But the next day, yesterday, I had a “perfectly normal” stress echo. He has no idea why it happened or how I can prevent a recurrence. I was kind of stunned when he denied the existence of microvascular disease. Hello? What?

    So I don’t know where to go next. Mayo? Cleveland? A beach in Hawaii?

    Liked by 1 person

    1. So many thoughts whirling around my head while reading your story, Beth. First, microvascular disease, as I like to say, is not something you “deny the existence of” – like Santa or the tooth fairy. And there’s only one thing more anxiety-producing than having a frickety-frackin’ heart attack – and that’s being told there’s nothing wrong with you but a little anxiety disorder. My prescription: Mayo, Cleveland AND the Hawaiian beach but not necessarily in that order . . .

      Liked by 1 person

  19. Thank you for this article. I too have MVD and CAS. All my tests came back normal but I had a doctor who knew something was wrong. Only problem is she left the practice and I got stuck with a Doc who believed if you didn’t have a blockage you didn’t have a heart problem.

    At one point he told me it was my stomach. I have now switched doctors to someone who believes in MVD and CAS, he just doesn’t seem to know how to treat it if it’s persistent. He has thrown every drug at it and it is still uncontrolled. So at the end of the month I am going to bring up the research about the TENS machine. I dislike those machines but I just really want some relief and I want to be able to play and keep up with my 3 year old this summer. My goal is to be able to be active again, not run a marathon active, but to be able to keep up with my son’s activities and maybe just maybe cut down on the pharmacy worth of meds I take at 35.


    1. Thanks for sharing your story. It seems odd to have a doctor described as somebody who “believes” in coronary microvascular disease or coronary artery spasm.

      We are not talking about Santa Claus here! These are known cardiovascular conditions that have been studied and reported on in the medical literature – not something about which belief is optional. Good luck to you in your ongoing treatment decisions.


      1. My new doctor is very good, just stumped. It is my words that he “believed in it.” It’s the one old doctor who didn’t seem to acknowledge the heart condition. I think sometimes it has to do with small town doctors. I now drive 2 hours to a big city and see the head of a cardiac practice at a well known hospital. The doctor who didn’t believe has since been let go from the hospital so at least that’s some good news in case I ever have to go back to that hospital.

        Liked by 1 person

        1. You raise an important issue about reality: the difference between small or rural hospitals that may never/rarely treat certain conditions and big city hospitals that have far more experience in doing so. It’s worth the 2-hour drive.


        2. Long story short, I am 40 years old, female, former smoker and recovering addict. A few months ago, I started having really bad pains in my chest, while I was just sitting at work, driving, or even sleeping.

          Went to a local doctor in my itty bitty town, and he said I’m having anxiety attacks. I knew that wasn’t the case. This week, I made the hour and a half drive to UT in Knoxville, where the doctor told me I have Prinzmetal’s angina. Not sure what to do, say, think or feel about all this. But, I do know what you mean, Shelley.

          Out here in itty bitty-ville, they chalked it up to a dramatic female. Glad I took the time off work to go to Knoxville.

          Liked by 1 person

          1. Laura – big city health care is such an important factor in how we’ll be diagnosed/treated. Smaller health centres simply don’t get the traffic in patients with Prinzmetal’s or MVD that big hospitals get (nor do they tend to attract physicians who are experienced in many rare or unusual conditions). This is true in all departments, not only in cardiology. Best of luck to you…


    2. I too was in the same situation. One day when unable to see my doc, I saw her PA. When I told her how unhappy I was about taking meds and the side effects, she suggested I take the amino acids L-arginine and L-carnitine. Two days later spasms stopped. After researching this on my own I am now taking nitric oxide daily and feel better than I have for years. BP is awesome now too.


  20. I have had shortness of breath, worsening chest pain, shoulder (front and back), arm (both), clavicle (both), neck and jaw pain worsening since February 2013. Yesterday I was seized by hard chest pain radiating through to my back. I went to the hospital, and they knew I had a “slightly abnormal” lexi-scan, and slightly abnormal EKGs – all of them) so they sent me to a hospital where they had a cath lab. The doctor did a cursory cardiac cath, told me that I had 25% blockage in one of my main arteries, and a small amount in some of the lesser ones.

    “Congratulations! Your heart is fine”.
    They kept me overnight and even though I was still experiencing bad arm (rt side this time), shoulder, and neck pain, the nurse offered me Tylenol. The doctor came in today and asked how I was feeling and I said my symptoms are no different than when I came in here. He said, well, since there is nothing wrong with your heart, it’s probably just anxiety and sent me home. No further testing offered.

    I see my primary on Aug 2, who will actually listen to me and work with me and request a PET scan. I’ve had it with knowing there is something wrong PHYSICALLY with me, but being basically patted on the head and sent on my way.

    Thank you for sharing this information. I never would have known about this without it

    Liked by 1 person

  21. I have had Coronary Spasms since I was 41 diagnosed by doctor then and at that time I did have the ST elevation. Last year was so bad 30+ a day chest pain was referred to Mayo Clinic.

    Mayo is treating for Endothelial dysfunction and Coronary Spasms. The Cardiac group that sent me to Mayo still has 2 doctors that still won’t believe the diagnosis even though the chest pains recreated 3x in cath lab and show the diagnosis.

    I was horrified yesterday when I had a followup after ER with the Cardio nurse in the doctors office to find that the treating physician here disagrees with Mayo now. It is a very big battle to get proper treatment and then to have a doctor flip and say he no longer believes the diagnosis and disagrees with Mayo. So waiting for a call from Mayo with a referral to another group of doctors in my area – may be 1 hour away but at least perhaps I won’t have to deal with doctors that are so far behind the times. I think Cardios should have refresher courses.


    1. Sadly, I hear stories like yours far too often – it is absolutely appalling. I hope your Mayo doctors will be able to point you in the right direction to new physicians very soon. An hour’s drive is well worth the trouble if it leads you to quality care – but isn’t it a shame that the onus must fall on the patient, rather than on the doctors to educate themselves about this well-documented disorder?


  22. This article has been an eye opener. Thank you so much. I have suffered for so long. Seen so many doctors that I can’t even count them all. All saying the same thing, giving that look like I’m crazy or having me feeling like I am. Was just recently diagnosed. I finally have answers.

    Wow I felt so alone for so so long


  23. Thank you for this great article and all the info. So MANY women need to know that Heart disease and heart attacks can be vastly different in women. So many women go undiagnosed each year because they and their primary care physicians lack this kind of information!!

    Liked by 1 person

  24. I just had a right and a left heart cath Tuesday and it came back all clear. As soon as he said he was done and I was about to be wheeled out of the cath lab, the pain hit me again and I was crying on the table. The nurse asked me was I okay, and I told her I was in pain and it was a 7 on a scale of 10.

    He came in and said he didn’t see anything while performing the caths and that he can reassure me I did not have Coronary Artery Disease and would not drop over of a heart attack. I asked him could it be vasospasms and he again said he didn’t see any indication while performing both caths. He took me off of Toprol XL and put me on Verapamil.

    I’ve had all the testing I know of, and this chest pain is not changing with Toprol or Verapamil. I’m scared to death about having a heart attack if the spasms don’t let up.

    This is going on for a month, and nothing is taking away this pain. I’m about to get a 2nd and 3rd opinion because this chest pain at rest and not on exertion is beyond concerning to me. Why don’t these doctors listen? WHY?

    I’m scared to death. I know my body, and I know something is not right. I shouldn’t be having chest pains that make me grab my chest or chest pains that travel to my shoulder, elbows, fingers and back and the insides of both arms. That’s not normal.

    I’m scared and I’m sick of everyone not taking my concerns seriously…even my family. I never complain about being ill…but when I do, it’s always been proven to be something major that I wind up in the hospital for weeks at a time. So I know this chest pain, that is momentarily relieved with nitroglycerin is more than meets the eye.

    I’ve had anxiety and panic attacks…this is not the same. I don’t have a racing heart and shortness of breath at the same time. I’m short of breath, and only get a racing heart when I’m exerting myself. And the chest pain is not GI…that came back normal again during my endoscopy, and 50 million tests 2 weeks ago when I was admitted to the hospital with the pain not getting better.



    1. Hello Dolores – sorry to hear of this litany of distressing symptoms. No wonder you are scared. So much of medicine is simply ruling out what the problem isn’t – but when we continue getting “normal” test results, it makes the mystery that much harder to solve. Verapamil (a calcium channel blocker) is often prescribed for spasm disorders, so if this were caused by coronary spasm, you could expect some relief. If symptoms were caused by coronary microvascular disease, one of the tests that can diagnose MVD is called Adenosine Coronary Flow Reserve and Acetylcholine Endothelial Function Test with Cardiac Magnetic Resonance Imaging (MRI) – have you had one of these? More on this here.

      Right now, these frightening symptoms may or may not be heart-related, but you just don’t know for sure yet. Getting a second (or third opinion) seems like a reasonable option for you – good luck and please let us know what you find out!


      1. Hi Carolyn it’s Bruce.

        It’s not just women with this disease. I got chest pain 10 years ago worsening at rest radiating to neck, ear, left arm, leg, back mainly when I went to bed. Also cold hands (raynaud) and cold feet. Like everyone else, had every test, angiograms the lot but nothing.

        Was prescribed sleeping pills for pain and kept on going. Chest pain got better but I still carried this feeling of an impending heart attack; my heart would start to race and blood pressure would go through the roof but because my weight was normal, I was only 34 and pretty fit, though I did smoke – all this would be put down to anxiety.

        This was enough to give you anxiety. I mean you know were the pain is and what your body’s telling you. So by this time my wife had had enough, we had seen that many doctors, the last one a general physician with a psychiatric degree who gave me a thorough examination and agreed that my condition seemed physical. Yes, like I needed to know that.

        So I lived with this thing for about ten years without medication living a fairly normal life but having a limit on how far you could push yourself. Scared to do a lot of things like flying or drinking too much or anything that would put undue stress on my heart. You can imagine what my wife’s going through with doctors saying nothing’s wrong test after test, she’s starting to side with them.

        So about 4 months ago, my dad had a heart attack and was in hospital for a month. All this stress brought on a few of these heart racing moments one being worse than I’d ever had. I was at Fremantle hospital at the time and admitted myself to E.D. so here we go again: blood tests, ECG and after 10 years – guess what, everything normal, just anxiety,yeh great.

        So next few days, I start working again but start running short of breath, at end of day really bad chest pain and left arm. Things get worse, run out of breath at rest. Returning to Fremantle E.D. about five times, even Christmas day I left my 11, 13, 15 year old children crying with their presents in their hands.

        Leaving them that morning is one of the worst moments of my life. not being able to enjoy that moment. After about 5 hours at hospital I was lying there waiting for it to cool down, it was 40 degrees and you don’t do well in heat with this thing. The nurse said to me come on, off you go, there’s nothing wrong with you we’re not a hotel you know, with 20 vacant beds next to me and christmas day – thanks. Just another bit of humiliation that comes with this disease.

        Seeing specialist, getting all tests including myocardial perfusion scan but nothing. I just lay on the lounge all day now, my quality of life gone. Before this I didn’t stop, my eldest girl says I was a workaholic. She says get up dad and do something..

        Symptoms now are spasms in my arteries in my legs, which are now starting all over my body. My heart’s too weak now but I would have liked a diagnosis so my wife and kids could believe how sick I really was. But reading about microvascular disease it makes sense. Can’t believe how they are overlooking these symptoms if they had put me on medication for the symptoms I had 10 years ago I might not be so bad.

        But they are still dismissing thousands of cases. Not fighting one disease but two: cardiovascular & humiliation anxiety

        Liked by 1 person

        1. Oh Bruce. What a nightmare ride you’ve been on. Please see your physician again and ask for a referral to a cardiologist who is familiar with microvascular disease and spasm disorders. Print off the journal articles noted here to bring with you. Hang in there – Good luck to you on this journey.


          1. THANK YOU!! for your story, it has given me so much relief . . . suffered symptoms for 15+ years; your story is so much mine! Thank you . . .


        2. Bruce, as another man I can relate to your post so much. The suffering of my family makes me want to cry – not having a ‘legitimate’ diagnosis makes so much in our lives uncertain, and planning for anything difficult or even impossible.

          Liked by 1 person

    2. I too have chest pain for the last 30 years. I finally got diagnosed with coronary small vessel spasms not small vessel disease. I do not have any heart disease only the spasms in the small vessels. I went thru so many test for so many years. I finally went to the Cleveland Clinic in Cleveland and saw Dr. Heupler, Cardiologist. The Dr. prescribed diltiazem 120 MG C. I took myself off the medicine because too many side effects. I did a lot of research (2 years) and decided to take the fast acting nitro (only when needed) I also take L-Citrulline, L-Arginine, vitamin c, vitamin d, calcium and mag. this seems to work for me. No chest pain at all. I know my vitamin d was very low(9) now it’s up to 60. Good Luck


      1. I was happy to see what you posted here although it was some time ago. Hope all is still well by taking your supplements. I, too, take all these plus quite a few more, but with these supplements and my daily walks & bike rides I no longer suffer any more spasms. I was diagnosed 6 years ago by having an angiogram. The artery went into spasm during the procedure or I probably wouldn’t have got a proper diagnosis. I, too, didn’t want to be dependent on a bunch of prescriptions, although I do always keep a little vial of nitro with me at all times just in case.

        Liked by 1 person

    3. Dolores, this is late, late to the game, but you should know that many of us have pain, post cath (particularly if it is a provocative cath challenge test meant to make the endothelial dysfunction and vasospam occur). On the table, whilst the cath is inserted, they give you nitro via cath to relax the spasm that does occur. You may not have had that, or your heart may have been irritable due to the test. Also, many of us have post-test pain, particularly when exertion is part of it. It comes after the test, later, after all the observation has stopped!

      It’s normal to know that that the test must stop at some point, but tracking for an extended period post-test would reveal more data, I believe. I hope you have found some better help and are having some progress in treatment.

      Liked by 1 person

  25. Thank you, thank you!!! I believe I just experienced this last Sunday! I have been having these ‘events’ for about 5 years and they can be terrifying. It is so disturbing to have spent 8+ hours in the ER (this time) and to have been sent home with the same pain I arrived there with.

    I have had stress tests, nuclear stress tests, endoscopy, and numerous other exams. I have been diagnosed with GERD and anxiety and treated like a second class citizen by the local ER. I have worn Holter monitors and been evaluated by cardiologists with no result that suggested heart involvement.

    It is so amazing that I found your information on a website! I have an Internist (I ditched my GP) appointment in the morning and I am taking this information with me!

    Liked by 1 person

  26. What a wonderful compilation. Thanks to our Australian sister and to CT for making yet another outrage into an opportunity to learn and build our own confidence.

    I just got a different “non-standard” cardiac diagnosis after years of reported symptoms and abnormal EKGs. Over 6 years ago, a clear angiogram led to reassurance and dismissal of my symptoms; my primary doc and the cardiologist clearly thought I was obstinate and wasting their time. The Gold Standard – yet again. It didn’t help that (by error) ANXIETY was on my medical record.

    Come to think of it, maybe I AM obstinate, and for good reason. Yes, it is a wonder that some of us are still here.

    Liked by 1 person

  27. Hurrah! Excellent references. Although I do not suffer from this disorder I feel you have surely contributed to your karmic bank account in the sky on this one. Perhaps you need to be kicked in the Smart Car-ma rear end more often? Just look at the good it led to!! Beamie

    Liked by 1 person

    1. Thanks so much Beamie – but I’m just the messenger; this list came to me from our Australian heart sister who compiled a whack of (credible) resources. Best list I’ve seen yet. PS Still driving and loving my little green car…. 🙂


  28. Hi Carolyn! Yes, yes, and yes. Prinzmetal angina, coronary spasm, micro vascular disease, MI, wrong diagnoses, dismissiveness at ER, endless “healthy” labwork, imaging, stress tests.

    All part of my saga yet I am still here to talk and, at times, rant about it.


    Liked by 1 person

    1. It’s amazing that some of us are actually still here. Reminds me of an E.R. story one of the women in my heart health talk audiences told me: she overheard the (male) doctor saying this to the (male) patient behind the curtain in the next bed: “Your blood tests are fine, your EKG is fine – but we’re going to keep you overnight for observation just to make sure it’s not your heart!”

      Thus yet another man with cardiac symptoms but “normal” diagnostic tests is kept in hospital to carefully observe, while women in the same boat are booted out the door, feeling embarrassed, misdiagnosed with everything from indigestion to menopause or anxiety. Keep ranting, JetGirl!


      1. That is amazing – thank you! Few times over the past 15 years, after some major stressful periods I would have heart issues and after many tests, hospital stays I would be sent home with no diagnosis!

        This year though in May I was finally diagnosed with Small Vessel Disease still not convinced yet because my pain comes on with exertion and with rest, This time around it didn’t go away, it’s here to stay I’m afraid!

        Liked by 1 person

        1. Hurray, you finally have a diagnosis! It’s common for MVD to come on during rest. My symptoms flare with stress, too. Always better to know than to be told “it’s nothing”. Take care….


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