A recent study involving 250 British patients experiencing angina-like chest pain has uncovered a significant issue: half of these individuals were given the all-clear despite actually having microvascular angina. Published in Nature Medicine and funded by the British Heart Foundation, the research suggests that up to 50% of patients assessed for suspected angina may be receiving incorrect diagnoses.
Angina refers to chest pain or discomfort caused by reduced blood flow to the heart. Unstable angina can signal an immediate risk of heart attack or stroke, requiring prompt medical attention.
In this study, patients initially underwent standard scans that appeared normal, even though they reported symptoms consistent with angina. However, when researchers performed additional MRI scans that measure blood flow, they discovered that 51% actually had microvascular angina—a form of the condition caused by dysfunction in tiny blood vessels invisible on conventional angiograms.
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To reduce missed or delayed diagnoses, the researchers recommend that blood flow scans be standard alongside traditional angiograms, especially for patients with unexplained chest pain. Yet, many parts of the UK do not currently offer such tests.
Professor Colin Berry from the University of Glasgow, senior author of the study, explained, “Additional scans like these could identify thousands more cases of microvascular angina across the UK annually. This condition is particularly underdiagnosed in women.”
He added that without these extra tests, patients with chest pain but normal angiogram results are often sent home without heart medication, with symptoms mistakenly attributed to non-cardiac causes such as indigestion or anxiety. This frequently leads to repeated doctor visits due to ongoing chest pain and breathlessness.
Microvascular angina—once referred to as ‘cardiac syndrome X’—has long been challenging to diagnose. Patients show angina symptoms despite no visible artery blockages, as the problem lies in tiny vessels less than half a millimeter wide within the heart muscle.
Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation and consultant cardiologist, emphasized the condition’s real impact. “Coronary microvascular dysfunction, more common in women, can severely affect daily life through chest pain and breathlessness. Unfortunately, many remain undiagnosed or misdiagnosed for years.”
She praised the study for demonstrating that heart MRI scans can greatly improve diagnosis, leading to better treatment and health outcomes.
The research also showed that patients who adjusted their treatment after diagnosis experienced decreased chest pain and improved ability to perform everyday activities.
This study underscores the importance of expanding access to advanced diagnostic imaging to better identify and treat microvascular angina, improving the lives of many who might otherwise be overlooked.