Microvascular coronary disease is a heart condition that affects the tiny blood vessels branching off from the main coronary arteries. These small vessels carry oxygen rich blood to the heart muscle. When they are damaged or do not work as usual, less blood flows to the heart. This can cause chest pain and other symptoms.

You may also hear this condition called coronary microvascular disease, small vessel disease or microvascular coronary heart disease. It is different from classic coronary artery disease, where larger arteries get blocked by plaque. In microvascular coronary disease, the main arteries often look normal on standard tests.

The condition is more common in women, especially during and after menopause. It can be frustrating to live with, since symptoms are real but the usual heart tests may come back clear. Baptist Health heart care providers understand this challenge and can help diagnose the condition and create a personalized treatment plan for you.

Symptoms

The main symptom is chest pain, also called angina. The pain may feel like pressure, tightness or a squeezing sensation. It often shows up during daily activities or stress and tends to ease when you rest.

Other common symptoms include:

• Shortness of breath
• Fatigue
• Dizziness
• Trouble sleeping
• Neck pain
• Jaw pain
• Arm pain
• Low energy

Chest pain from microvascular coronary disease can last longer than chest pain from a blocked artery. It may stick around for 10 minutes or more. Some people also notice that symptoms show up during normal daily tasks, like making the bed or walking up a short flight of stairs. If you have chest pain that is new, severe or does not go away, call 911 right away. It could be a heart attack.

Causes and Risk Factors

The exact cause of microvascular coronary disease is not fully understood. Many of the same risk factors that lead to plaque buildup in larger arteries can play a role. Over time, these factors can damage the inner lining of the small vessels. They may also cause the small vessels to spasm or stop relaxing.

Common risk factors include:

• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• Smoking
• Low estrogen levels
• Autoimmune conditions
• Family history of heart disease

Autoimmune conditions might be lupus or rheumatoid arthritis. Women are more likely than men to develop microvascular coronary heart disease. The drop in estrogen during menopause is thought to play a part. People who have been treated for blocked arteries with a stent or angioplasty can also develop the condition.

Diagnosis

Diagnosing microvascular coronary disease can be tricky. The usual tests for heart disease may come back normal, even when something is clearly wrong. Your Baptist Health cardiologist will start by reviewing your symptoms and medical history. They will also do a physical exam and ask about your risk factors.

From there, your provider may order several tests, including:

• Stress test. These tests check how your heart responds to activity or medication that mimics exercise.
• Coronary angiogram. Uses dye and X rays to look for blockages in the main arteries.
• Cardiac MRI. This imaging test creates detailed images of your heart muscle and blood flow.
• PET scan. A PET scan measures blood flow to the heart muscle using a small amount of tracer.
• Coronary function testing. A special test during catheterization that checks how well the small vessels are working.

Coronary function testing is considered the most accurate way to diagnose the condition. It measures something called coronary flow reserve, which tells your provider how well your small vessels open when your heart needs more blood.

Treatment

There is no cure for microvascular coronary disease, but there are good ways to manage it. Treatment has two main goals: relieve your chest pain and lower your risk of a heart attack or other heart problems. Most people do well with a mix of medication and lifestyle changes.

Medication

Your Baptist Health provider may prescribe one or more medications to protect your heart and ease symptoms. Common options include:

• Aspirin to help prevent blood clots.
• Statins to lower cholesterol and calm inflammation in the blood vessels.
• ACE inhibitors or ARBs to lower blood pressure and help the small vessels work better.
• Beta blockers to ease the heart's workload.
• Calcium channel blockers to help the small vessels relax.
• Nitroglycerin to relieve chest pain when it happens.

Lifestyle Changes

Daily habits play a big role in managing microvascular coronary disease. Your provider may recommend that you:

• Quit smoking and avoid secondhand smoke.
• Eat a heart healthy diet with plenty of fruits, vegetables, whole grains and lean protein.
• Get regular physical activity.
• Keep blood pressure, blood sugar and cholesterol under control.
• Maintain a healthy weight.
• Manage stress through relaxation and support from loved ones.

Cardiac rehabilitation may also be part of your care plan. These supervised programs help you build strength and learn how to live with a heart condition.

When to See a Baptist Health Provider

If you have ongoing chest pain, shortness of breath or other symptoms that worry you, schedule a visit with a Baptist Health cardiologist. This is especially important if past tests have not explained your symptoms. Getting the right diagnosis is the first step toward feeling better. If you think you are having a heart attack, call 911 right away.