Small vessel disease is a condition in which the walls of the small arteries in the heart aren't working properly. This reduces the flow of oxygen-rich blood to the heart, causing chest pain (angina), shortness of breath, and other signs and symptoms of heart disease.
Small vessel disease
Small vessel disease may also be called:
- Coronary microvascular disease
- Microvascular endothelial dysfunction
Small vessel disease is treatable but may be difficult to detect. The condition is typically diagnosed after a health care provider finds little or no narrowing in the main arteries of the heart despite the presence of symptoms that suggest heart disease.
Small vessel disease is more common in women and in people who have diabetes or high blood pressure.
Small vessel disease signs and symptoms include:
- Chest pain, squeezing or discomfort (angina), which may get worse with activity or emotional stress
- Discomfort in the left arm, jaw, neck, back or abdomen along with chest pain
- Shortness of breath
- Tiredness and lack of energy
If you've been treated for coronary artery disease with angioplasty and stents and your signs and symptoms haven't gone away, you might also have small vessel disease.
When to see a doctor
Seek emergency medical care if you're having chest pain and other signs and symptoms such as shortness of breath, sweating, nausea, dizziness, or pain that spreads beyond your chest to one or both of your arms or to your neck.
It might be hard to tell if some symptoms are due to small vessel disease, especially if you don't have chest pain. See your health care provider to determine the cause of your symptoms.
If you have new or unexplained chest pain or think you're having a heart attack, call 911 or emergency medical assistance immediately.
In coronary small vessel disease, the small arteries don't relax (dilate) as usual. As a result, the heart doesn't get enough oxygen-rich blood.
Experts think that the causes of small vessel disease are the same as the causes for diseases affecting the larger vessels of the heart, such as high blood pressure, high cholesterol, obesity and diabetes.
Small vessel disease is more common in women than in men. Risk factors for small vessel disease include:
- Body mass index (BMI) of 30 or higher (obesity)
- Family history of the disease, especially in women
- High blood pressure
- Inactive lifestyle
- Increasing age: older than 45 in men and older than 55 in women
- Insulin resistance
- Polycystic ovary syndrome
- Tobacco use
- Unhealthy cholesterol levels
- Unhealthy diet
Small vessel disease can make it harder for the heart to pump blood to the rest of the body. A possible complication of small vessel disease is a heart attack.
Things you can do that might reduce your risk of small vessel disease include:
- Don't smoke or use other tobacco products. If you smoke or use tobacco, stop. Talk to your health care provider if you have trouble quitting.
- Eat a heart-healthy diet. Choose a diet rich in whole grains, lean meat, low-fat dairy, and fruits and vegetables. Limit salt, sugar, alcohol, saturated fat and trans fats.
- Exercise regularly. Regular exercise helps improve heart muscle function and keeps blood flowing through the arteries. Aim for at least 150 minutes a week of moderate activity such as walking.
- Maintain a healthy weight. Excess weight strains the heart and can contribute to high cholesterol, high blood pressure and diabetes.
- Manage cholesterol. Ask your health care provider how often you should have your cholesterol numbers checked. If your bad cholesterol (low-density lipoprotein cholesterol) levels are high, your health care provider may prescribe changes to your diet and medications to help lower your cholesterol levels and protect your cardiovascular health.
- Control blood pressure. Ask your health care provider how frequently you should have your blood pressure measured. He or she might recommend more-frequent checks if you have high blood pressure or a history of heart disease.
- Control blood sugar. Work with your health care provider to establish blood sugar goals that are right for you.
- Manage stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness, listening to music and connecting with others in support groups are some ways to reduce stress.
Nov 09, 2021
- Coronary heart disease. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease. Accessed June 14, 2021.
- Chaudhary I. Microvascular angina: Angina pectoris with normal coronary arteries. https://www.uptodate.com/contents/search. Accessed June 14, 2021.
- Selke FW, et al. Coronary artery endothelial dysfunction: Basic concepts. https://www.uptodate.com/contents/search. Accessed June 14, 2021.
- Ahmed B, et al. Alternative causes of myocardial ischemia in women: An update on spontaneous coronary artery dissection, vasospastic angina and coronary microvascular dysfunction. Vascular Medicine. 2017; doi:10.1177/1358863X16686410.
- Kaski JC, et al. Reappraisal of ischemic heart disease. Circulation. 2018; doi:10.1161/CIRCULATIONAHA.118.031373.
- Ong P, et al. International standardization of diagnostic criteria for vascular angina. International Journal of Cardiology. 2018; doi: 10.1016/j.ijcard.2017.08.068.
- Hoffmann U, et al. Cardiac imaging with computed tomography and magnetic resonance in the adult. https://www.uptodate.com/contents/search. Accessed June 14, 2021.
- Coronary microvascular disease. American Heart Association. https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/coronary-microvascular-disease-mvd. Accessed June 14, 2021.
- Ong P, et al. Epicardial coronary spasm in women with angina pectoris and unobstructed coronary arteries is linked with a positive family history: An observational study. Clinical Therapeutics. 2018; doi:10.1016/j.clinthera.2018.07.015.
- Berry C, et al. Small-vessel disease in the heart and brain: Current knowledge, unmet therapeutic need, and future directions. Journal of the American Heart Association. 2019; doi:10.1161/JAHA.118.011104.
- Prevent heart disease. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/prevention.htm. Accessed June 14, 2021.
- Toya T, et al. Assessment of peripheral endothelial function predicts future risk of solid-tumor cancer. European Journal of Preventive Cardiology. 2020; doi:10.1177/2047487319884246.
- Groepenhoff F, et al. Evaluation of non-invasive imaging parameters in coronary microvascular disease: A systematic review. BMC Medical Imaging. 2021; doi:10.1186/s12880-020-00535-7.
- Mankad R (expert opinion). Mayo Clinic. Oct. 5, 2021.
- Chareonthaitawee P (expert opinion). Mayo Clinic. Nov. 8, 2021.