Study Reveals Half of Chest Pain Patients Misdiagnosed with Angina

A recent study conducted in the United Kingdom has found that approximately half of patients experiencing angina-like chest pain are misdiagnosed. The research, which followed 250 individuals reporting such symptoms, revealed that many were incorrectly given the all-clear despite actually suffering from a condition known as microvascular angina. Published in the journal Nature Medicine and funded by the British Heart Foundation, the findings highlight a significant gap in the diagnosis of coronary conditions.

Angina is characterized by pain or tightness in the chest due to reduced blood flow to the heart. In its unstable form, angina can escalate into a medical emergency, increasing the risk of heart attack or stroke. In this study, patients initially underwent standard diagnostic scans that returned clear results. However, subsequent MRI scans revealed that 51% of these individuals did, in fact, have microvascular angina. This specific type of angina arises from dysfunction in tiny blood vessels, often undetectable by conventional coronary angiograms.

To address the issue of missed diagnoses, the researchers advocate for the incorporation of blood flow scans alongside traditional angiograms for patients presenting with unexplained chest pain. Presently, many regions in the UK lack access to these advanced diagnostic techniques.

Professor Colin Berry, senior author of the study from the University of Glasgow, emphasized the potential benefits of further testing. “Additional tests like the scan we used could help to reveal thousands more people with microvascular angina in the UK every year,” he stated. He also noted that the condition is particularly under-diagnosed in women, which can lead to continued suffering and mismanagement of symptoms.

Patients who are incorrectly diagnosed may be sent home without appropriate treatment, often assuming their symptoms are linked to non-cardiac issues such as indigestion, anxiety, or arthritis. Unfortunately, this can result in individuals returning to their general practitioners multiple times, still experiencing chest pain and breathlessness.

Microvascular angina has been historically challenging to diagnose, previously referred to as cardiac syndrome X. It is characterized by angina-like symptoms without observable blockages in the coronary arteries. Recent discoveries indicate that the condition is caused by narrow arteries in the heart muscle that measure less than half a millimeter in diameter.

Dr. Sonya Babu-Narayan, clinical director at the British Heart Foundation and consultant cardiologist, highlighted the serious implications of coronary microvascular dysfunction. “This condition can significantly impact daily life, as individuals struggle with persistent chest pain and breathlessness,” she explained. “Unfortunately, many go undiagnosed or misdiagnosed, often after years of delay, because the inadequate blood supply in tiny coronary blood vessels can slip through the diagnostic net.”

The study also demonstrated that some patients opted to change their treatment following the diagnosis of microvascular angina. Those who made adjustments reported a reduction in the frequency of their chest pain and found it easier to engage in everyday activities.

As the medical community continues to grapple with the complexities of diagnosing microvascular angina, these findings underscore the need for improved diagnostic measures. By adopting advanced imaging techniques, healthcare providers could significantly enhance the accuracy of diagnoses and ensure that affected individuals receive the appropriate care and support they need.