A new study has revealed that half of Brits suffering from angina-like chest pain were wrongly given the all-clear when they actually had a potentially deadly heart condition.
The research, funded by the British Heart Foundation and published in the Nature Medicine journal, suggests that 50% of people investigated for suspected angina may be missing the correct diagnosis. Angina is a medical term for chest pain or discomfort caused by reduced blood flow to the heart. It can become a medical emergency if it is unstable, increasing the risk of an imminent heart attack or stroke.
In the study, 250 patients were examined after reporting chest pain that suggested they might have angina. However, their initial scan results came back clear. The researchers then conducted an additional MRI scan on these individuals and discovered that 51% did indeed have a form of angina known as microvascular angina. This specific type is triggered by tiny blood vessels that can’t be seen on a standard coronary angiogram.
To reduce the number of missed diagnoses like this, the researchers recommend using blood flow scans alongside angiograms for patients with unexplained chest pain. However, many parts of the UK currently do not offer this service.
Professor Colin Berry, senior author of the study from the University of Glasgow, said: “Further tests like the scan we used could help to reveal thousands more people with microvascular angina in the UK every year. Microvascular angina is currently particularly under-diagnosed in women.
“We need these extra test results because people whose angiogram results suggest their chest pain is not heart-related can be sent home without medication, on the assumption that their symptoms are due to things like indigestion, anxiety or arthritis.
“It is not uncommon for these people to then have to return to their GP multiple times, with continuing symptoms like chest pain and breathlessness.”
Microvascular angina has traditionally been a challenging condition to identify. It was previously known as ‘cardiac syndrome X’ due to how much it baffled doctors when they were confronted with patients experiencing angina-type symptoms yet showing no narrowing or obstructions in their coronary arteries that might explain it.
Only recently has it been uncovered that tiny arteries in the heart muscle measuring less than half a millimetre across are responsible.
Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation and consultant cardiologist, said: “Coronary microvascular dysfunction, which is seen more commonly in women, is real. It can have a serious impact on people’s everyday lives, as they struggle with chest pain and breathlessness, and is often misunderstood.
“Unfortunately, many people go undiagnosed, are misdiagnosed, or are only diagnosed after years of delay, because the diagnosis of inadequate blood supply in tiny coronary blood vessels slips through the net.
“This important study shows that it doesn’t have to be this way – having heart MRI tests improved chest pain diagnosis, which in turn led to changes in treatment and better health.”
The research went a step further as well, with some patients choosing to alter their treatment after learning about their microvascular angina.
Those who made changes saw a decrease in how often they suffered chest pain and struggled with daily tasks.