Microvascular Heart disease - dilemma

Peregrinelady · May 2020

So, after going to the ER twice for chest pain, I have been diagnosed with microvascular heart disease (MVHD) wherein the small vessels in the heart do not dilate properly. I am on 2 blood pressure meds and need to take nitroglycerin if I plan on doing anything strenuous. The kicker is that low estrogen is one of the causes of this disease. I had my ovaries out and am on Anastrozole for another 5 years due to a high BCI. My dilemma is deciding whether to continue on an estrogen lowering drug when it may be contributing to the deterioration of my heart. Has anyone else been diagnosed with MVHD? My cardiologist just said “we don’t know much about it.” I found the estrogen info. on the internet. My other concern is that my former oncologist ordered the BCI right after diagnosis before I had my oopherectomy. Would that change the outcome? Thank you for any thoughts you may have.

Peregrinelady · May 2020

Bump

ShetlandPony · May 2020

Well this is a dilemma. Ugh. Since your cardiologist says we don’t know much about it, you could try to find a MVHD expert, a cardiologist with a sub-sub-specialty at a university teaching hospital. Maybe see who authors the scientific papers on the subject. Then get a consultation to try and get a better idea just how important stopping the anti-estrogen therapy might be. Then when you have gathered as much information and expert opinion as possible, I would get this cardiologist (or your cardiologist who has spoken with the MVHD cardiologist) to speak directly with your oncologist and let them discuss which disease is most threatening to you and how to prioritize.

As far as the BCI, I believe that is a genomic test, so your treatment, including ooph, does not change the characteristics of the cancer, or the recommendation for ten years of therapy. However, the ooph was more aggressive therapy than tamoxifen alone would have been, so it improved your chances of remaining cancer-free.

Now the question is about the big picture — what course gives you the best overall chance at being healthy going forward? You need the doctors to step up and give you expert advice.

Peregrinelady · May 2020

Thank you so much for responding with such a well thought out reply. I was just thinking along the same lines that I should call my cardiologist tomorrow and say, this is what I have found out about estrogen. Can you find out from your colleagues more about this? If he can’t help me, I will pursue a second opinion. I did see someone who specializes in MVHD on a site called heartsisters.org. I will also call my oncologist to hear what he has to say. Any time I have mentioned heart problems with Arimidex, the answer I get is that it may cause high cholesterol, which I do not have. I don’t think there has been a lot of research for women’s heart disease. I haven’t taken the Arimidex for a couple of days now and already I feel better. If I do continue, I think I am going to letrozole or aromasin, even though they affect estrogen, too. Thanks again.

ShetlandPony · May 2020

You’re welcome. I'll be interested in your update, Peregrinelady. Be well!

Peregrinelady · June 2020

Update: I saw my oncologist yesterday and he gave me 3 options. Quit AI altogether, take a 3 month break then start Anastrozole again, or try a different drug. We settled on 1 month break (I am too nervous to take 3 months off with my high BCI) and trying Letrozole. I have the prescription and will start again in a few weeks. That was the shortest appt. I have ever had. He seemed like he was in a rush and didn’t want to discuss the connection between AI and heart problems. I will post again after I see the cardiologist this week.

Microvascular Heart disease - dilemma

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