First, it is important to treat any risk factors for heart disease such as diabetes and high blood pressure. Chest pain symptoms are often difficult to treat and so specialists use a number of different treatments depending on the patient.

Medicines

Some patients, but not all, respond to drugs we usually use to treat chest pain (beta blockers, calcium channel blockers and nitrates).  Newer drugs such as nicorandil, ivabradine and ranolazine can also be helpful.

A medication called imipramine, at low doses, has anti-pain properties and reduces chest pain in some patients with microvascular angina.

Hormone replacement therapy (HRT) is beneficial to some women with microvascular angina, especially if their chest pain is associated with hot flushes.

Cognitive behavioural hypnotherapy

Hypnotherapy has been used successfully to treat many types of chronic pain, including microvascular angina. In hypnotherapy sessions, the aim is to alter how the body perceives the pain by teaching the brain to pay less attention to it. Hypnotherapy is sometimes combined with cognitive behavioural therapy (CBT) to treat any issues surrounding the chest pain.

Exercise

Our research shows that increasing physical activity can improve chest pain symptoms and quality of life in those with microvascular angina.