Overview
Small vessel disease, also known as coronary microvascular disease, is a condition where the walls of the small arteries in the heart do not function properly, leading to reduced blood flow to the heart. This can cause symptoms such as chest pain, shortness of breath, and other signs of heart disease. Small vessel disease may be difficult to detect and is more common in individuals with diabetes, high blood pressure, or a history of smoking. Treatment options include lifestyle changes, medications, and in some cases, surgery.
Understanding the disease
Symptoms
The symptoms of small vessel disease include chest pain or discomfort (angina), which may worsen with physical activity or emotional stress. Other signs and symptoms may include shortness of breath, fatigue, and lightheadedness. Small vessel disease is often difficult to detect and may be diagnosed after a healthcare provider finds no narrowing in the main arteries of the heart despite the presence of symptoms. It is more common in women and people with diabetes or high blood pressure. If you have chest pain or other symptoms that suggest heart disease, consult a healthcare provider to determine the cause. In cases of severe symptoms such as chest pain, shortness of breath, sweating, nausea, or pain radiating to the arms or neck, seek emergency medical care immediately.
Risk Factors
The risk factors for developing small vessel disease include smoking or chewing tobacco, diabetes, insulin resistance, obesity, inflammation from an unknown cause or from diseases such as arthritis, lupus, psoriasis, or inflammatory bowel disease. Aging is also a risk factor for developing small vessel disease. Other factors that may increase the risk of small vessel disease include a family history of early heart disease, an unhealthy diet, high blood pressure, high cholesterol, high levels of C-reactive protein (CRP), lack of exercise, sleep apnea, and smoking and other tobacco use.
Development
Small vessel disease, including coronary microvascular disease and microvascular endothelial dysfunction, develops when the walls of the small arteries in the heart are not working properly. This reduces the flow of oxygen-rich blood to the heart, causing symptoms such as chest pain (angina), shortness of breath, and other signs of heart disease. The condition is often diagnosed when a healthcare provider finds little or no narrowing in the main arteries of the heart despite the presence of symptoms. The causes of small vessel disease are similar to those of diseases affecting the larger vessels of the heart, including high blood pressure, high cholesterol, obesity, and diabetes. Certain risk factors increase the likelihood of developing small vessel disease. These include being female, having diabetes or high blood pressure, a family history of the disease, insulin resistance, and a history of tobacco use, unhealthy cholesterol levels, and an unhealthy diet.
Assessment and Diagnosis
Triage
You should see a doctor if you experience symptoms of small vessel disease, such as chest pain, shortness of breath, or other signs and symptoms of heart disease. Seek emergency medical care if you're having chest pain along with symptoms like shortness of breath, sweating, nausea, dizziness, or pain that spreads beyond your chest to one or both arms or your neck. If you have new or unexplained chest pain or suspect you're having a heart attack, call 911 or emergency medical assistance immediately. Consulting your healthcare provider can help determine the cause of your symptoms and guide appropriate treatment.
Diagnosis
To diagnose small vessel disease, your health care provider will typically perform a physical exam and ask questions about your medical history and family history of heart disease. They may also listen to your heart with a stethoscope. The tests used to diagnose small vessel disease include stress tests with imaging, ultrasonography, and positron emission tomography (PET). These tests are similar to those used to diagnose other types of heart disease. Blood tests may also be performed to check for signs of inflammation or anemia.
Management and Treatment
Complications
Small vessel disease can make it harder for the heart to pump blood to the rest of the body, potentially leading to complications such as a heart attack. Other possible complications may include chest pain (angina), shortness of breath, and other signs and symptoms of heart disease.
Prevention
Small vessel disease can be prevented by adopting a healthy lifestyle. The same healthy lifestyle changes recommended to treat atherosclerosis also help prevent it. These lifestyle changes include quitting smoking, eating healthy foods, exercising regularly, maintaining a healthy weight, checking and maintaining a healthy blood pressure, and checking and maintaining healthy cholesterol and blood sugar levels. By adopting these healthy habits, you can help keep the arteries healthy and reduce your risk of developing small vessel disease.
Home Remedies
Home remedies for small vessel disease may include the following:
- Eating a heart-healthy diet: Focus on consuming foods that are rich in whole grains, lean meat, low-fat dairy, fruits, and vegetables. Limit intake of salt, sugar, alcohol, saturated fat, and trans fats.
- Exercise regularly: Engage in physical activities that you enjoy, such as walking, cycling, or swimming. Regular exercise helps improve blood flow and overall cardiovascular health.
- Maintain a healthy weight: Losing excess weight or maintaining a healthy weight can reduce the risk of small vessel disease and other related health issues.
- Quit smoking and avoid tobacco use: Smoking and tobacco use can increase the risk of small vessel disease and worsen its symptoms. Seek support from a healthcare provider if you need help quitting.
- Manage stress: Practice stress-relieving techniques such as deep breathing exercises, meditation, or yoga to help reduce stress levels and improve overall heart health.
- Get enough sleep: Aim for 7-9 hours of quality sleep per night to help maintain overall health and well-being. It is essential to consult with a healthcare provider for personalized advice and to manage any underlying conditions that may contribute to small vessel disease.
Treatment
Treatments for small vessel disease typically involve managing risk factors and addressing underlying health conditions. Here are some approaches to treating small vessel disease:
- Lifestyle modifications: Adopting a healthy lifestyle can help manage the risk factors and improve overall cardiovascular health. This includes:
- Quitting smoking and avoiding exposure to secondhand smoke
- Engaging in regular physical activity
- Maintaining a heart-healthy diet, low in salt, sugar, saturated fat, and trans fats, and rich in whole grains, lean meat, low-fat dairy, and fruits and vegetables
- Managing stress through relaxation techniques or therapies
- Maintaining a healthy weight
- Medications: Depending on the underlying health conditions and risk factors, your healthcare provider may prescribe medications such as:
- Antiplatelet agents or anticoagulants to prevent blood clots
- Statins or other cholesterol-lowering medications to manage cholesterol levels
- Blood pressure-lowering medications (antihypertensive drugs) to control high blood pressure
- Medications for diabetes management, if applicable
- Procedures and surgical interventions: In some cases, procedures or surgeries may be necessary to treat small vessel disease. These may include:
- Angioplasty and stenting: A minimally invasive procedure to widen narrowed or blocked arteries using a balloon catheter and a small mesh tube (stent) to keep the artery open.
- Bypass surgery: A surgical procedure to redirect blood flow around a narrowed or blocked artery using a graft from another part of the body or a vein. It is important to consult with a healthcare provider for a proper diagnosis, as the treatment plan will depend on the individual's specific condition and underlying health factors.
Preparing for medical consultation
To prepare for an appointment for small vessel disease, you should:
- Write down any symptoms you're experiencing, including those that may seem unrelated to the reason for your appointment.
- Make a list of all medications, vitamins, or supplements you're taking, including dosages.
- Write down questions to ask your healthcare provider.
- Ask if there's anything you need to do in advance, such as avoiding food or drinks before a specific test.
- Prepare for a physical exam, including a heart exam with a stethoscope.
- Expect tests to diagnose small vessel disease, which may include stress tests with imaging, echocardiograms, or nuclear imaging scans. Remember to discuss your medical history, family history of heart disease, and any concerns you have with your healthcare provider during the appointment.