Coronary small vessel disease is a condition in which the walls of the small arteries in your heart — the tiny branches off the larger coronary arteries — are damaged and don’t dilate properly.
Your small vessels need to expand to provide oxygen-rich blood to your heart. When they’re damaged, the blood flow to your heart decreases. This can cause serious problems in your heart that can lead to problems in other parts of the body.
It’s also called coronary microvascular disease and small artery disease.
Symptoms of small vessel disease mimic those of heart disease and even heart attack. It can be difficult to diagnose small vessel disease without proper testing to differentiate between it and other heart issues.
If left untreated, small vessel disease can be life threatening.
Small vessel disease symptoms often mimic those of a heart attack. If you have small vessel disease, you may experience symptoms including:
- shortness of breath
- pain in your mandible, neck, left shoulder, arm, back, or abdomen
- anginal chest pain and pressure, typically lasting longer than 10 minutes
If your symptoms get worse, or you experience pain beyond your chest, call your doctor immediately.
Small vessel disease occurs when the inside walls of the small vessels in your heart are damaged, affecting their ability to be able to properly dilate.
This damage may be caused by:
If left untreated, small vessel disease will force your heart to work harder to pump blood to your body. This could trigger coronary artery constriction/spasms, a heart attack, heart failure, or death.
Anyone can develop small vessel disease, but women are at higher risk.
Other risk factors are:
Diagnosing small vessel disease can be difficult. Your doctor will evaluate your medical history, family history, and symptoms.
Diagnostic imaging procedures for small vessel disease are typically the same as those looking for other types of heart disease. These procedures show the structure or function of your larger coronary arteries and other parts of the heart, and may show coronary artery blockages. These tests may include:
- cardiac stress testing with nuclear imaging or transthoracic echocardiogram
- cardiac MRI
- cardiac CT angiography scan
- cardiac PET scan
- coronary artery angiogram, which is invasive and requires left heart catheterization
If there are no significant blockages in your larger coronary arteries, your doctor will use an invasive test, injecting different medications into a coronary artery, to check for blockages in your small arteries during a left heart catheterization. This is called an endothelial dysfunction test. This allows the doctor to measure the blood flow through your small vessels.
Primary treatment options for small vessel disease involve medications that relieve pain, treat risk factors, and manage associated symptoms. These medications can improve arterial blood flow and prevent heart attacks.
Some common medications are:
- Aspirin can help with inflammation and clotting.
- Nitroglycerin can help improve blood flow and relax coronary arteries.
- Beta-blocker therapy can slow the heart rate and decrease blood pressure.
- ACE-inhibitor therapy can help lower blood pressure and open up blood vessels.
- Statin therapy can help treat and relax blood vessels.
- Calcium channel blockers can help relax the muscles surrounding coronary arteries, which can help increase blood flow.
- Ranolazine can help ease chest pain.
At home and lifestyle changes
Some lifestyle changes may help treat and manage small vessel disease:
- maintaining a healthy weight that’s right for you
- getting regular exercise
- quitting smoking if you smoke
- eating a nutrient-dense diet, which includes whole grains, lean proteins, and
lowering salt intake