Unstable Microvascular Angina / Prinzmetals Angina

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I have angina that is unstable an occurs mainly in my sleep, wakes me up and I have difficulty breathing, and so can lie awake for hours afraid of going back to sleep. My cornorary arteries are clear and a perfusion MRI last year did not find anything remarkable regarding ventricle output.  I see a Consultant Cardiologist 6 monthly and he has diagonsed Cardiac Syndrome X / Prinzmetals Angina.  I am not convinced this is Cardiac Syndrome X (Microvascular Angina) as this usually presents as stable angina, whereas my angina symptoms occur at rest, without any triggers and particularly when asleep.  Does anyone have Microvascular Angina that is unstable rather than stable and / or Prinzmetal's Angina that produces symptoms similar to mine?  I am taking Viazem XL, Ranolazine, Isosorbide and I have a GTN spray.  This manages things quite well during the day, but my breathing at night and waking with chest pain 3 or 4 times a week is worrying!  I have also been dianosed with Nocturnal Paroximal Dyspnea.  Does any else have this along with their angina?  Thank you!

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  • Posted

    I was diagnosed with Prinzmetal's Angina last June. I'd say 80% of my attacks happened between 10:30pm and 6:00am, either while first falling asleep, or during the middle of the night--and 100% are while I'm at rest. With Prinzmetal's, the attacks generally occur during periods of rest, which is what helps distinguish it from regular Angina. Stable Angina is caused by plaque build up in coronary artery, impeding the blood flow during times of exertion. With Prinzmetal's, you are having spasms of the coronary artery/s (like getting a cramp or muscle spasm that constricts the artery) which close the artery/s off for periods of time, restricting blood flow to the heart, causing the Angina pain... I'm currently on 240mg of verapamil/day and have a nitroglycerin spray to take during attacks. I went from having at least one attack a day (mostly at bedtime and during sleep), to now having an average of one every two weeks... good luck.

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  • Posted

    So sorry to hear your worried about sleeping , l also get angina when lm asleep as well  but mostly when lm awake and doing just that little bit to much .

    I last week l had two in the night and l was woken up with that awful dam pain and sweating , lve been diagnoses with unstable angina but l also have other heart problems which seem to set each other off .

    Im on so many drugs including controlled pain killers as one of my heart conditions leave me in pain 24/7   I think l take on average 22-24 drugs a day .

    lve had so many ECGs .....MRIs......SCANS.......and so many other heart tests for years l should be a qualified cardiologist by now, l know l  laugh about this and l probably sound 'flippant'  but having had heart problems for so long( since l was 13 years old )  ......you just have to sleep, eat, laugh and live when you can.

    When you wake at night in pain have a shot of GTN ....have a drink then go back to sleep , staying awake worrying is more likely to set another attack off then sleeping  also if you have been awake all night your more likely to get an attack that day as well......errrrr, woman here had four the day after not sleeping ????.

    If your awake you can always talk to me in facebook under ami and my surename..

    Ami ...take care xxxxx


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  • Posted

    Hi isobel,

     I was originally diagnosed with microvascular spasms around 18 years ago but over time that diagnosis was changed to Prinzmetal Angina by a couple of other doctors and cardiologists. Mine would come on at rest as well or while sleeping, the one thing different about mine was that it didn't have a time when it came on, it would come on anytime of the day, when I first started getting this awful chronic condition it felt as though it was running on a time schedule as it occured more at night or early hours of the mornings. When first diagnosed with both of these conditions, now only PM Angina, they abandoned the microvascular diagnosis about 10 years ago, any rate I went a bit off track there a bit, my arteries were also in pristine condition until the age of 46 but they still remain non flow limiting and the artery spasms are no better, I can have up to 3 bad episodes a week where nothing settles it down, the only thing that relieves the pain is morphine or endone but that doesn't stop the spasms, but to be honest I don't really care as long as the pain is controlled, if none of the above takes care of the pain ( that includes the gold standard treatment of unstable angina medication ) is when I have to go to the emergency department.

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    • Posted


      Thank you.  This sound exactly like me.  At the moment I have a diagnosis of Microvascular Angina / Prinzmetals Angina.  Reading what you have said, I think my consultant also needs to drop the Microvascular diagnosis and focus on Prinzmetals.  I have a consultation with him in August, so I will emphasise Prinzmetals again.  My medication works fairly well though most of the time, particularly the isosorbide mononitrate because it is slow release throughout the night.  Hopefully, they will begin to listen!  I don't think many cardiologists have sufficient expertise in Prinzmetals, nor Microvascular Angina. Good luck with everything!

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  • Posted

    Sorry you are going through all of this. Prinzmetal's is not a fun diagnosis, and nothing can be done at this time other than to try to manage things. My spasms happen only at rest, too, of course.

    But, I have noticed that mine are exacerbated by a sudden change in temperature that has me inhale cold air. (For example, one time I pulled the front door open suddenly and a gust of freezing cold air came in the house. Or I was running out of the house to the car in an emergency and was blasted with the cold air. Or when I was sleeping in my warm bed and my husband left the window open over my head. Or when I was in a hotel room and the AC was on so high, that as the night went on, I had a spasm. ) Each time, between 15 and 30 minutes later, I was in full throttle.


    All this to say, try to keep track and see if there is anything that could be related, so that you can control the frequency.

    I know how it is to be afraid to sleep, and I don't have any help for that. Just gotta go with it. You'll wake up if there is more pain. 

    I didn't see a calcium blocker on your list of medications. That is the most important medicine for this. Doctors will typically start patients with these symptoms with beta blockers and those are the WORST thing for the condition.  

    Good luck to you.  Be sure to manage your own health. You know your body and you are one to them. Be your own advocate. 

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