Study Reveals Misdiagnosis of Microvascular Angina in Patients

A recent study involving 250 individuals in the UK experiencing angina-like chest pain revealed that nearly half were incorrectly diagnosed as healthy. The research, published in the journal Nature Medicine and funded by the British Heart Foundation, highlights significant gaps in the identification of microvascular angina, a condition often overlooked in standard medical evaluations.

Participants in the study initially underwent standard diagnostic tests after reporting chest pain. Despite clear results from these tests, a follow-up MRI scan uncovered that 51% of the patients actually had microvascular angina, a type of angina that arises from dysfunction in small coronary blood vessels. These tiny vessels, less than half a millimetre in diameter, are not visible on traditional coronary angiograms, which often leads to misdiagnosis.

Implications of Misdiagnosis

The findings indicate that many patients may be sent home without appropriate treatment, with their symptoms attributed to less serious conditions such as indigestion, anxiety, or arthritis. Professor Colin Berry, the senior author of the study from the University of Glasgow, emphasized the need for enhanced diagnostic measures. “Further tests like the scan we used could help reveal thousands more people with microvascular angina in the UK every year,” he said.

The condition has been particularly under-diagnosed among women. Professor Berry noted that patients whose angiogram results suggest their symptoms are not heart-related often experience prolonged distress, returning to their general practitioners multiple times with persistent issues such as chest pain and breathlessness.

Dr. Sonya Babu-Narayan, clinical director at the British Heart Foundation and a consultant cardiologist, stressed the reality of coronary microvascular dysfunction. “It can have a serious impact on people’s everyday lives, as they struggle with chest pain and breathlessness, and is often misunderstood,” she explained. Many individuals either remain undiagnosed or face delays in receiving the correct diagnosis, primarily due to the subtle nature of the problem.

Proposed Solutions and Improved Outcomes

To mitigate the risk of missed diagnoses, the researchers advocate for the incorporation of blood flow scans alongside angiograms for those presenting with unexplained chest pain. Currently, many regions in the UK do not offer these additional scans, which could significantly enhance diagnostic accuracy.

The study also revealed that some participants chose to adjust their treatment after learning they had microvascular angina. Those who made these changes reported a notable decrease in the frequency of their chest pain and found it easier to engage in daily activities.

“This important study shows that it doesn’t have to be this way,” Dr. Babu-Narayan stated. “Having heart MRI tests improved chest pain diagnosis, which in turn led to changes in treatment and better health.” The findings underscore the critical importance of comprehensive testing in managing heart health, particularly for those presenting with atypical symptoms.