A recent investigation has uncovered a startling oversight in the diagnosis of heart conditions in the UK. According to the study, half of British individuals experiencing angina-like chest pain were incorrectly told they were fine, despite actually suffering from a serious heart issue.
Funded by the British Heart Foundation and published in the prestigious journal Nature Medicine, this research highlights a significant gap in diagnosing angina. Angina, the term for chest pain resulting from reduced blood flow to the heart, can escalate into a critical situation if it becomes unstable, increasing the likelihood of a heart attack or stroke.
In this study, researchers evaluated 250 patients who reported chest pain indicative of angina. Initial scans suggested these patients were in the clear. However, a deeper investigation using MRI technology revealed that 51% actually had microvascular angina. This type of angina is caused by issues in the tiny blood vessels that standard coronary angiograms cannot detect.
To address such diagnostic challenges, researchers advocate for the inclusion of blood flow scans alongside traditional angiograms for individuals with unexplained chest pain. Unfortunately, this comprehensive testing is not yet available in many regions across the UK.
Professor Colin Berry, a senior author from the University of Glasgow, emphasized the potential impact of these findings: “Additional testing like the scans we utilized could potentially identify thousands more cases of microvascular angina annually in the UK. This condition is notably under-diagnosed, particularly among women.”
Professor Berry further explained the importance of accurate diagnosis, noting that individuals whose angiograms suggest non-heart-related causes for their chest pain may be discharged without necessary medication, under the mistaken belief that their symptoms stem from less severe issues 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.
