To diagnose small vessel disease, your health care provider will usually do a physical exam and ask questions about your medical history and family history of heart disease. He or she will likely listen to your heart with a stethoscope.

The tests used to diagnose small vessel disease are similar to those used to diagnosis other types of heart disease and include:

  • Stress test with imaging. A stress test measures how the heart and blood vessels respond to activity. You may be asked to walk on a treadmill or pedal a stationary bike while connected to a heart monitor. Or you may be given an IV drug to stimulate the heart in a way similar to exercise. Blood flow to the heart muscle is measured with ultrasound images (echocardiogram) or with nuclear imaging scans.
  • Coronary angiogram. This test helps determine if the main arteries to the heart are blocked. A long, thin flexible tube (catheter) is inserted into a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter to arteries in the heart. The dye makes the arteries easier to see on X-ray images and video.

    Additional tests may be done during an angiogram to measure blood flow through the heart.

  • CT coronary angiogram. This other type of angiogram uses a powerful X-ray machine to produce a series of images of the heart and its blood vessels. You'll lie on a long table that slides through a short, tunnel-like machine (CT scanner). Dye injected through an IV in the arm or hand makes blood vessels easier to see on the CT images.
  • Positron emission tomography (PET). This test uses a radioactive tracer and medication to measure blood flow to the heart muscle. After the tracer is injected, you usually lie in a doughnut-shaped machine to have images taken of the heart.


The goals of treatment for small vessel disease are to control the narrowing of the small blood vessels that can lead to a heart attack and to relieve pain.

Medications for small vessel disease may include:

  • Nitroglycerin (Nitrostat, Nitro-Dur). Nitroglycerin tablets, sprays and patches can ease chest pain by relaxing the coronary arteries and improving blood flow.
  • Beta blockers. These drugs slow the heart rate and decrease blood pressure.
  • Calcium channel blockers. These drugs relax the muscles around the coronary arteries and cause the blood vessels to open, increasing blood flow to the heart. Calcium channel blockers also help control high blood pressure and coronary artery spasms.
  • Statins. These medications help lower bad cholesterol, which contributes to the narrowing of the arteries. Statins also help relax the blood vessels of the heart and treat blood vessel damage.
  • ACE inhibitors and ARBs. Drugs called angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) help open blood vessels and lower blood pressure. This makes it easier for the heart to pump blood.
  • Ranolazine (Ranexa). This medication eases chest pain by altering sodium and calcium levels.
  • Aspirin. Aspirin can limit inflammation and prevent blood clots.
  • Metformin. This drug is typically prescribed to lower blood sugar in people with diabetes, but it can improve blood vessel health even in those who don't have diabetes.

If you're diagnosed with small vessel disease, you'll need regular checkups with your health care provider.

Self care

Heart-healthy lifestyle changes can help prevent and manage small vessel disease. Lifestyle changes may include:

  • Losing weight if you're not at a healthy weight
  • Getting regular physical activity
  • Eating a healthy diet that's low in salt and rich in fruit, vegetables, lean protein and whole grains
  • Quitting smoking or tobacco use

Alternative medicine

Sometimes, the dietary supplement L-arginine may benefit people with small vessel disease who haven't been helped by other medications. L-arginine is an amino acid that helps relax blood vessels.

Talk to your health care provider before taking any supplements to make sure that they won't interact with other medications that you take.

Preparing for your appointment

If you've had chest pains or other symptoms of heart disease, your primary care provider will likely refer you to a doctor trained in heart diseases (cardiologist).

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as avoiding food or drinks before a specific test.

Before your appointment, make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment
  • Important personal information, including major stresses and recent life changes
  • Any personal and family medical history of heart disease, high blood pressure, diabetes or high cholesterol
  • All medications, vitamins or other supplements you take, including the doses
  • Questions to ask your care provider

For small vessel disease, basic questions to ask your health care provider include:

  • What's causing my symptoms?
  • Are there other possible causes for my symptoms?
  • What tests do I need?
  • What treatments are available and which do you recommend for me?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Should I see a specialist?
  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

  • When did your symptoms begin?
  • Do you always have symptoms or do they occur occasionally?
  • How severe are your symptoms?
  • What, if anything, makes your symptoms worse?
  • Do your symptoms get worse when you're active?
  • What, if anything, makes your symptoms better?

Nov 09, 2021

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