Imaging technology offers hope for diagnosing patients with unexplained chest pain

Interventional cardiologist and researcher Dr. Bryan Har, MD, recently led the first of what are now monthly microvascular angina days at the Foothills Medical Centre, offering hope for Calgarians with unexplained chest pain. 

There are numerous possible causes behind unexplained chest pain. Sometimes, this pain is related to muscle problems, blood clots or even anxiety, but it can also be related to the heart. 

Women are more likely to experience a type of heart attack—or symptoms of a heart attack, including chest pain—that occurs because of diseases of small blood vessels of the heart. 

Because the vessels are so small, special imaging tests are needed to assess these tiny vessels for abnormalities. Until recently, Calgary physicians didn’t have the tools to perform the test. 

“New technology is now allowing us to undertake microvascular angina testing,” says Har. “This technology allows us to use regular angiograms to look for this coronary microvascular disease.” 

Testing is now taking place in the cardiac catheterization lab as a simple add on when testing for coronary artery vasospasm, a sudden temporary narrowing of the blood vessels that can also cause chest pain. 

Har said new national guidelines for treating microvascular angina motivated the desire to test for the condition. 

“We have medications to treat this condition,” he says. “So it’s important that patients are properly diagnosed so they can be treated appropriately.” 

Dr. Roopinder Sandhu, MD, the director of the Libin Institute Women’s Cardiovascular Health Initiative and the the Women’s Cardiovascular Health Clinic (under-development), agrees. She is excited this option is now available in Calgary. 

“Until now, the specialized equipment needed to make this diagnosis was not present for the women in Southern Alberta,” she says. “Making a diagnosis is important for women because it represents an actual condition rather than being told their symptoms are unexplained.”

According to Har, feedback from patients has been positive. 

“Patients have been quite satisfied with the testing,” says Har. “The ones who come back with normal tests are glad to rule microvascular angina out and those with abnormalities are happy to have an answer to explain their symptoms.” 

Har says there is a plan to develop a national registry to allow for future research. 

The Women’s Cardiovascular Health Initiative is focused on clinical care and providing women with access to testing needed for diagnosis and to research optimal treatment. 

Bryan Har is a clinical associate professor in the Department of Cardiac Sciences and the director of the Cardiac Catheterization Lab at Foothills Medical Centre. He is a member of the Libin Cardiovascular Institute. 

Roopinder Sandhu is a Professor of Cardiac Sciences at the University of Calgary. She holds the Martha Brauer Chair in Women’s Cardiovascular Health Research and serves as the Director of the Women’s Cardiovascular Health Clinic (under-development) and Initiative. She is a member of the Libin Cardiovascular Institute.