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“Routine angiography only evaluates the resting state of the epicardial coronary arteries”
Kaski, Berry and Ang
On this page you will find frequently asked questions about INOCA with general responses from members of our Medical Advisory Board and doctors treating INOCA. Please note that answers given are not specific to individual circumstances. You can use the search box below to filter your results and can also ‘like’ answers from our experts too!
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Transient myocardial ischemia is reversible with no residual damage, unless severe and prolonged enough to cause cell death. Inducible ischemia may get worse if the responsible mechanism changes.
0The subendocardial layers of the left ventricular wall are more sensitive to ischemia. Infarcts start in the subendocardium and progressively extend to the mid and subepicardial layers if ischemia is severe and prolonged enough. It is not exclusive of microvascular dysfunction, but of any mechanism that may precipitate myocardial infarction .
0Calcium transients are an essential mechanism in muscle cell contractile function. Calcium channel blockers reduce the tone of vascular smooth muscle cells, resulting in vasodilation and reduced resistance to flow and in the prevention of hypercontraction in response to stimuli. Ranolazine is a metabolic modulator that favours cell utilisation of glucose instead of free fatty … Continue reading "Can you explain a little about how Calcium channel blockers and Ranolazine work in the body and why they work please?"
0Angina reported hours after activity simply is not triggered by that activity but by other mechanisms. The heart does not “remember” what has he been doing hours before.
0Ischemia is a condition of the cardiac muscle precipitated by local mechanisms. It is not directly related to hypoxia in the systemic circulation, with the possible exception of rare and dramatic conditions of systemic severe hypoxia.
0The Oximeter reads the Oxygen saturation of circulating haemoglobin, that is the percentage of Hb bound to oxygen. ABG blood test provides much more detailed information on circulation arterial blood gases, including oxygen and Carbon dioxide concentrations, pH, Hb etc etc
0CADASIL (Cerebral Autosomal Dominat Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a dominant autonomic disease associated with migraine, cognitive impairment, cerebral infarcts and eventually dementia. I am not aware of an association with INOCA
0This observation further supports the notion that outcome of ischemic patients is dictated by extension and severity of myocardial ischemia more than by the mechanisms responsible for ischemia.
0This is a very important question with limited scientific evidence to support any answer. However, the physiology of the coronary circulation is so peculiar that systemic microvascular dysfunction (if it does exist) would have unique consequences in the coronary circulation.
0Coronary Microvascular Dysfunction is a dynamic condition that can be stable or get better or worse in time, either spontaneously or in association with treatment. It has been reported that MD can resolve after a few months after an acute coronary syndrome.
1I’m not sure that I have seen an increase in patients presenting with CAS/CMVD but we are in rather unusual times! Certainly before lockdown I had queried the diagnosis in several of my patients and sent them off to cardiology for investigation. I think it is more my increased awareness that has changed rather than … Continue reading "Have you seen an increase in patients presenting with CAS/CMVD as a result of increased awareness?"
0It depends! If you are just above the lower limit of normal and it is the start of the winter then I would be looking to optimise your level by taking a supplement as it is likely to drop further without strong sunlight exposure. If it is at the start of the summer months or … Continue reading "Is it ok to have Vitamin D levels just above the lower limit of normal? "
0Vitamin B12 deficiency can affect every body system potentially. It is more common in vegetarians and vegans as it is mostly available from animal sources but also common in people taking certain medications which reduce its absorption from the stomach and anyone with malabsorption disorders such as coeliac disease or after gastric bypass surgery. I … Continue reading "What are the main symptoms of B12 Vitamin deficiency? "
0The common symptoms I find in general practice are musculoskeletal pains. But vitamin D is involved in so many other body processes, not just bone and muscle health. It has roles in the immune system, in blood sugar regulation, cancer prevention, it helps to reduce inflammation and is important in mental illness too. It is … Continue reading "What are the main symptoms of Vitamin D deficiency?"
0Angina associated with severe coronary stenosis is triggered by exercise and relieved by rest. Angina associated with CAS or CMVD is not precipitated by excess cardiac work but by transient impairment of myocardial perfusion. But the common background is always cellular ischaemia and therefore it is difficult to imagine that pushing through might be irrelevant.
0Angina by definition is a transient Ischaemic episodes not leading to cellular death. As such it should not cause chronic fatigue. However, during an anginal episode, if the ischaemic territory is large enough or if critical component of the heart are involved (e.g. Papillary muscles and mitral valve), then it may be associated with fatigue … Continue reading "Why does angina cause fatigue? "
0Both CMVD and CAS may caused prolonged myocardial ischaemia leading to myocardial infarction. So, both mechanisms may be associated with permanent cardiac damage through multiple episodes or prolonged episodes
0Myocardial ischaemia has been traditionally perceived as the consequence of atherosclerotic obstructions of the coronary vessels. More recently an overwhelming body of evidence has proven that atherosclerotic obstructions are just one of several mechanisms that can precipitate myocardial ischaemia. CAS, CMVD and Endothelial Dysfunction are included among the mechanisms that, in isolated fashion or in … Continue reading "Can you describe the relationship between CAS, CMVD and Endothelial Dysfunction?"
0The wall of the blood vessel (coronary artery) supplying the heart muscle has got three layers: the innermost layer contains endothelial cells, the middle layer contains the smooth muscle cells and the outermost layer contains collagen fibres for support. The endothelial cells naturally release a substance called nitric oxide (NO), that then diffuses along into the neighbouring smooth muscle … Continue reading "What is the difference between Endothelium Dependent CMD and non Endothelium Dependent CMD?"
0The wall of the blood vessel (coronary artery) supplying the heart muscle has got three layers: the innermost layer contains endothelial cells, the middle layer contains the smooth muscle cells and the outermost layer contains collagen fibres for support. The endothelial cells naturally release a substance called nitric oxide (NO), that then diffuses along into the neighbouring smooth muscle … Continue reading "What is the difference between Endothelium Dependent CMD and non Endothelium Dependent CMD?"
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