What is microvascular angina? 

Microvascular angina is intense chest pain (angina) caused by problems in the small blood vessels in the heart muscle.  This can affect people with no narrowings in the large coronary arteries that we see on a coronary angiogram (x-ray).  The small blood vessels cannot be detected using a coronary angiogram so we use other tests such as an MRI scan.

The chest pain symptoms associated with microvascular angina can be very different from patient to patient, and a patient may have “good” and “bad” days, weeks, and even months. For many patients, knowing when the pain will occur is unpredictable; it may occur at rest or during exercise or at times of stress.  Some patients suffer from shortness of breath, tiredness and lack of energy as well as chest pain.

Other names for microvascular angina

You may also know this condition as cardiac syndrome X or non-obstructive coronary artery disease. 

What causes microvascular angina?

The exact cause or causes of microvascular angina are often difficult to find. Possible cause include: 

  • a problem with the lining cells of the small blood vessels that means that they can't deliver more blood when it is needed
  • spasm of the small blood vessels
  • increased heart pain sensitivity

Who can suffer from microvascular angina? 

Microvascular angina occurs in both men and women, although only about one patient in every nine treated is male. 

Most of the women with microvascular angina are post-menopausal – symptoms commonly start in the early 50’s. Our research shows that women with microvascular angina generally have lowered oestrogen levels. Chest pain began either during the menopause or after the menopause, and a large number of younger women with microvascular angina had a history of hysterectomy.



Microvascular angina treatments

Chest pain symptoms are often difficult to treat so specialists use a number of different treatments depending on the patient, including medication, cognitive behavioural hypnotherapy and exercise.

Support group at Royal Brompton Hospital

We have been successfully running a monthly support group for several years at the Royal Brompton Hospital.  It allows patients with microvascular angina to meet each other for general discussion and support, and sometimes there is a speaker or a discussion topic. Topics cover medical and non-medical subjects that are generally about microvascular angina or living with microvascular angina.

Further information

For more information, you can contact Professor Peter Collins on 0330 128 8112


The clinic runs once a month on a Thursday afternoon in Outpatients East at Royal Brompton Hospital. 

Useful links

From the British Heart Foundation