Microvascular angina is a type of chest pain caused by problems in the heart’s tiny blood vessels rather than blockages in the major coronary arteries. This condition affects women more often than men and can be harder to detect because standard heart tests may look normal. Understanding the symptoms and seeking evaluation early can help improve quality of life and long-term heart health.

What Is Microvascular Angina?

Microvascular angina occurs when the small blood vessels supplying the heart do not widen the way they should during physical or emotional stress. These vessels, called the microvasculature, help deliver oxygen-rich blood to the heart muscle. When they cannot expand properly, the heart does not receive enough oxygen, which can cause chest discomfort and related symptoms.

This is different from typical angina, which is usually caused by plaque buildup or narrowing of the larger coronary arteries. Because microvascular angina affects vessels that are too small to see on a traditional angiogram, diagnosis often requires specialized testing and careful evaluation of symptoms.

Types of Microvascular Problems

Several issues can affect the heart’s small vessels and lead to microvascular angina. These problems can occur alone or together and are more common in women, especially during and after menopause.

• Microvascular dysfunction — The tiny vessels do not widen normally, which limits blood flow.
• Vessel stiffness — The walls of the small arteries become less flexible, which makes it harder for blood to pass through.
• Vessel spasm — The small arteries tighten suddenly, which temporarily reduces oxygen delivery.
• Endothelial dysfunction — The inner lining of the vessels does not work correctly, which affects blood flow and vessel relaxation.

Symptoms of Microvascular Angina

Symptoms of microvascular angina can resemble traditional angina but often last longer or feel different. Many women describe symptoms that are subtle or not centered in the chest, which can make them easier to overlook.

• Chest pressure — A feeling of tightness, heaviness, or discomfort in the chest.
• Shortness of breath — Trouble catching your breath during mild activity or at rest.
• Fatigue — Unusual tiredness that makes daily tasks feel harder.
• Radiating pain — Discomfort that spreads to the jaw, neck, shoulder, back, or arm.
• Nausea — An upset stomach or queasiness that may occur with chest discomfort.
• Lightheadedness — A feeling of dizziness or faintness, especially during activity.

Causes of Microvascular Angina

Microvascular angina usually develops due to a combination of vessel changes and risk factors that affect the inner lining and function of the small arteries. Over time, these changes limit how well the vessels can relax and increase blood flow when the heart needs more oxygen.

• Hormonal changes — Lower estrogen levels after menopause can affect blood vessel flexibility and function.
• Chronic inflammation — Ongoing inflammation can damage the vessel lining and interfere with normal blood flow.
• High blood pressure — Increased pressure inside the arteries can strain and injure small vessels.
• High cholesterol — Elevated cholesterol can affect vessel health even without major blockages.
• Diabetes — High blood sugar over time can injure the inner lining of blood vessels.
• Smoking — Tobacco use damages blood vessels and reduces the amount of oxygen in the blood.
• Stress — Emotional stress can trigger vessel tightening and chest discomfort.

Risk Factors

You may be more likely to develop microvascular angina if you have one or more risk factors. Knowing your risks can help you and your care team focus on prevention and early treatment.

• Gender — Women experience microvascular angina more often than men.
• Menopause — Hormonal changes around and after menopause increase vulnerability.
• Family history — Relatives with heart disease raise your risk of related conditions.
• High blood pressure — Unmanaged blood pressure can damage and stiffen small vessels.
• Diabetes — Poorly controlled blood sugar can harm the vessel lining over time.
• High cholesterol — Elevated cholesterol affects vessel function and circulation.
• Obesity — Excess weight increases the workload on the heart and blood vessels.
• Smoking — Tobacco use increases the risk of vessel damage and heart problems.

Diagnosis of Microvascular Angina

Because traditional tests often look for blockages in the larger arteries, microvascular angina can be challenging to diagnose. Your cardiologist may use a combination of tests to look for signs of reduced blood flow in the small vessels and to rule out other causes of chest pain.

• Stress testing — A test that shows how your heart responds to exercise or medicine that mimics exercise.
• Coronary angiography — A procedure that uses dye and X-rays to look for major artery blockages.
• Coronary flow reserve testing — A measurement of how well the small vessels increase blood flow during stress.
• Cardiac MRI — A detailed imaging study that shows blood flow and structure in the heart muscle.
• PET imaging — A scan that measures blood flow through both large and small heart vessels.
• Advanced ultrasound — A specialized echocardiogram that can provide information about vessel function.

Treatment for Microvascular Angina

Treatment of microvascular angina focuses on improving blood flow in the small vessels, reducing symptoms, and lowering the risk of future heart problems. Your care plan may include medications, lifestyle changes, and close follow-up with your cardiology team.

Medications

Several medicines can help reduce chest pain, improve blood flow, and protect your heart over time.

• Beta-blockers — Medicines that help the heart use oxygen more efficiently and reduce symptoms.
• Calcium channel blockers — Drugs that relax small arteries and improve blood flow to the heart muscle.
• Nitrates — Medicines that help widen blood vessels and relieve chest discomfort.
• ACE inhibitors or ARBs — Medications that support vessel health and blood pressure control.
• Statins — Medicines that lower cholesterol and reduce inflammation in blood vessels.
• Ranolazine — A medication that can help reduce ongoing angina symptoms when other treatments are not enough.

Lifestyle Modifications

Healthy habits play a key role in the treatment of microvascular angina and overall women’s heart health. Your care team can help you create a plan that fits your life and health goals.

• Regular exercise — Moderate physical activity most days of the week improves vessel function and fitness.
• Heart-healthy diet — Eating more fruits, vegetables, whole grains, and lean proteins supports heart and vessel health.
• Weight management — Maintaining a healthy weight reduces strain on the heart and circulation.
• Blood pressure control — Keeping blood pressure in the recommended range helps protect small vessels.
• Blood sugar control — Managing diabetes lowers the risk of vessel damage over time.
• Smoking cessation — Quitting tobacco improves circulation and lowers heart-disease risk.
• Stress management — Relaxation, mindfulness, or counseling can help reduce stress-related symptoms.

Women-Focused Care

Microvascular angina affects women in unique ways, and symptoms may differ from the classic signs of heart disease. Baptist Health offers heart-care services tailored to women, with an emphasis on early diagnosis and personalized treatment.

• Personalized risk assessments — Evaluations that consider age, hormones, lifestyle, and family history.
• Menopausal heart-health evaluation — Care that addresses heart risks around and after menopause.
• Stress-related angina assessment — Evaluation of symptoms that are triggered or worsened by stress.
• Coordinated specialty care — Team-based care that connects women with heart and wellness experts.

When to See a Doctor

Do not ignore chest discomfort or new symptoms, especially if you have risk factors for heart disease. Early evaluation can lead to effective treatment and better long-term outcomes.

• Persistent chest discomfort — Pain, pressure, or tightness that lasts more than a few minutes.
• Shortness of breath — Breathing trouble during light activity or when lying down.
• Unexplained fatigue — Tiredness that makes normal routines feel unusually difficult.
• Radiating pain — Discomfort in the jaw, neck, back, or arm without a clear cause.
• Symptoms with stress — Chest discomfort or breathlessness that appears during emotional stress.

Heart Care at Baptist Health

Baptist Health provides advanced diagnostic tools and personalized treatment for microvascular angina and other types of heart disease. Our cardiologists understand how women’s heart health can differ from men’s and offer care tailored to each patient’s needs.

If you have questions about your heart health, please call 1.855.358.0152 or visit our provider directory to find a Baptist Health cardiologist near you. Take our heart Health Risk Assessment to learn more about your individual heart health.