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Coronary microvascular disease (MVD), sometimes called small artery disease or small vessel disease, is heart disease in which the walls and inner lining of the heart’s small arteries are damaged. The damage may lead to a tightening (spasm) of the arteries, which causes decreased blood flow to the heart. The tiny arteries of the heart may also have abnormalities that decrease the blood flow to the heart muscle.

MVD is different from traditional heart disease, or coronary artery disease (CAD), in which plaque builds up in the large arteries of the heart. The risk factors for MVD are similar to those for CAD, and microvascular disease is more common in women.

What are the causes?

This condition is caused by damage to the walls and inner lining of the small arteries of the heart. The exact cause of the damage is often not known.

What increases the risk?

Some things that may increase the risk for MVD include:

  • High blood pressure (hypertension).

  • Diabetes.

  • Smoking.

  • Very high cholesterol levels.

  • Being overweight or obese.

  • Inactivity (sedentary lifestyle).

  • An unhealthy diet.

  • A family history of early heart disease.

  • Being a female.

What are the signs or symptoms?

Symptoms of this condition include:

  • Chest pain (angina). The pain can:

    • Feel like a burning, squeezing, or pressure sensation.

    • Spread (radiate) to the neck, arm, back, or jaw.

    • Differ from other angina in these ways:

      • It usually lasts longer than 10 minutes and can last longer than 30 minutes.

      • It may occur along with shortness of breath, sleep problems, fatigue, and lack of energy.

      • It is usually first noticed during routine daily activities or times of mental stress.

  • Nausea.

  • Weakness.

  • Dizziness.

  • Sweating.

  • Fluttering or fast heartbeat (palpitations).

How is this diagnosed?

This condition may be diagnosed based on:

  • Your medical history, including evaluation for risk factors.

  • A physical exam.

  • Tests, such as:

    • Blood tests.

    • Electrocardiogram (ECG). This test checks the electrical activity in the heart.

    • MRI of the heart (cardiac MRI). This imaging test shows the function and structure of the heart and blood vessels (cardiovascular system).

    • An exercise stress test. For this test, your heart function and blood pressure are monitored before, during, and after exercise. An ECG is used during this test.

    • Coronary angiogram with additional blood flow testing. For this procedure, dye is injected into your coronary arteries before X-rays are taken to check blood flow and heart function.

    • PET scan of the heart (cardiac PET scan). This imaging test makes pictures to show healthy and damaged heart muscle.

Sometimes, standard tests do not show MVD. Standard coronary angiogram only shows blockages in the large arteries. You may still be diagnosed with MVD, even if the angiogram results are normal.

How is this treated?

This condition is managed with medicines, such as medicines to:

  • Control cholesterol levels (statin medicines).

  • Lower blood pressure (ACE inhibitors).

  • Prevent blood clots or control inflammation.

  • Treat angina and improve blood flow to the heart (nitroglycerin).

  • Relax blood vessels (beta blockers or calcium channel blockers).

Follow these instructions at home:

Lifestyle

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  • Be physically active every day. Ask your health care provider how much physical activity you need and what types of exercise are best for you.

  • Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.

  • Follow a heart-healthy diet. A dietitian can help you learn about healthy food options and changes. In general, eat plenty of fruits and vegetables, lean meats, and whole grains.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.

  • Maintain a healthy weight or work with your health care provider to lose weight safely if needed.

  • Manage any other health conditions that affect your heart, such as hypertension and diabetes.

  • Keep all follow-up visits. This is important.

Contact a health care provider if:

  • You have trouble doing your daily activities.

  • You feel nauseous.

  • You feel light-headed.

  • You have a fever or chills.

Get help right away if:

  • You have discomfort in the center of your chest that:

    • Lasts for more than a few minutes.

    • Goes away and comes back (recurs).

  • You have shortness of breath.

  • You have pressure, pain, or a sense of fullness or squeezing in your chest.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

  • Coronary microvascular disease (MVD) is heart disease in which the walls and inner lining of the heart’s small arteries are damaged.

  • Symptoms of this condition include chest pain (angina). This usually lasts at least 10 minutes and can last longer than 30 minutes.

  • This condition is diagnosed by your health care provider based on your medical history, a physical exam, and test results.

  • This condition is managed with medicines and other lifestyle changes.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.