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Small vessel disease

Small vessel disease is a condition in which the small arteries in the heart become narrowed. Small vessel disease causes signs and symptoms of heart disease, such as chest pain (angina).

Small vessel disease is sometimes called coronary microvascular disease or small vessel heart disease. It's usually diagnosed after a doctor checks for blockages in the main arteries of the heart but finds little or no narrowing in the large vessels, even though your symptoms persist.

Although anyone can have small vessel disease, it's more common in women and in people who have diabetes or high blood pressure. Small vessel disease is treatable but can be difficult to detect.

Symptoms Causes Risk factors Complications Prevention

Small vessel disease symptoms include:

  • Chest pain, squeezing or discomfort
  • Chest pain associated with discomfort in your left arm or jaw
  • Chest pain that worsens with daily activities and at times of emotional stress
  • Neck, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Unusual fatigue
  • A loss of energy
  • Trouble sleeping

If you've been treated for coronary artery disease with angioplasty and stents and your signs and symptoms haven't gone away, you may also have small vessel disease.

When to see a doctor

If you're having chest pain along with other signs and symptoms — such as shortness of breath, sweating, nausea, dizziness, or pain that radiates beyond your chest to one or both of your arms or your neck — seek emergency medical care immediately.

If you're having symptoms such as fatigue and abdominal pain, it might be difficult to tell if your signs and symptoms are due to small vessel disease, but if you have chest pain, see your doctor to find out the cause.

While the larger arteries in the heart are responsible for pumping blood through your heart, the small vessels expand when you're active and then contract while you're at rest.

The large vessels in your heart can become narrowed or blocked through atherosclerosis, a condition in which fatty deposits build up in the arteries. In small vessel disease, the narrowing of the small vessels in the heart makes it so they can't expand properly when you're active. As a result, you don't get an adequate supply of oxygen-rich blood. This inability to expand is called endothelial dysfunction. This problem may cause your small vessels to actually become smaller when you're active or under emotional stress. The reduced blood flow through the small vessels causes chest pain and other symptoms similar to those you'd have if you were having angina or a heart attack.

Risk factors for small vessel disease include:

  • Tobacco use
  • High cholesterol
  • High blood pressure
  • Obesity (body mass index of 30 or higher)
  • Unhealthy diet
  • Inactive lifestyle
  • Diabetes
  • Insulin resistance
  • Being female
  • An estrogen deficiency, in women
  • Polycystic ovarian syndrome
  • Increasing age, older than 45 in men and older than 55 in women

It's not clear why the same risk factors, such as obesity or an inactive lifestyle, cause some people to develop small vessel disease instead of large vessel coronary artery disease.

Because small vessel disease can make it harder for the heart to pump blood to the rest of the body, small vessel disease can cause serious problems if left untreated, such as:

  • Coronary artery spasm
  • Heart attack
  • Sudden cardiac death
  • Heart failure

There haven't been any scientific studies to show what you can do to prevent small vessel disease, but it seems that controlling the disease's major risk factors — high blood pressure, high cholesterol and obesity — can help. Things you can do that may help reduce your risk include:

  • Don't smoke or use other tobacco products. If you smoke, the most important thing you can do to improve your heart's health is to stop. Quitting other forms of tobacco use can also be helpful. Talk to your doctor if you're having trouble with quitting.
  • Eat a heart-healthy diet. Too much saturated fat and cholesterol in your diet can narrow arteries to your heart. Follow your doctor's and dietitian's advice on eating a heart-healthy diet that includes plenty of whole grains, lean meat, low-fat dairy, and fruits and vegetables. Also, watch your salt and fat intake. Eating too much salt and saturated or trans fats may increase your blood pressure and cholesterol.
  • Exercise regularly. Regular exercise helps improve heart muscle function and keeps blood flowing through your arteries. It can also prevent a heart attack by helping you to achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure. Exercise doesn't have to be vigorous. Walking 30 minutes a day five days a week can improve your health.
  • Check your cholesterol. Have your blood cholesterol levels checked regularly through a blood test. If your bad cholesterol levels are undesirably high, your doctor can prescribe changes to your diet and medications to help lower the numbers and protect your cardiovascular health.
  • Control your blood pressure. Ask your doctor how frequently you need to have your blood pressure checked. Your doctor may recommend more frequent checks if you have high blood pressure or a history of heart disease.
  • Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes. Losing weight can lower your risk of small vessel disease.
  • Manage stress. To reduce your risk of a heart attack, reduce stress in your day-to-day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life.
  • Control blood sugar levels if you have diabetes. If you have diabetes, keeping your blood sugar at appropriate levels can help reduce the risk of complications. Work with your doctor to establish blood sugar goals that are right for you.
  • If you have polycystic ovary syndrome, ask your doctor if metformin could help. Treatment with metformin (Glucophage, Glumetza), a medication that helps reduce insulin resistance, may reduce the risk of small vessel disease in women with polycystic ovary syndrome.
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