Small vessel disease

Description

Small vessel disease is a condition in which 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 chest pain (angina), shortness of breath, and other signs and symptoms of heart disease.

Small vessel disease may also be referred to as:

  • The microvascular coronary disease
  • Endothelial dysfunction, Microvascular

Small vessel disease is treatable, but can be difficult to detect. The condition is usually 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.

Symptoms

Small vessel disease signs and symptoms include:

  • Chest pain, tightness or discomfort (angina), which may get worse with activity or emotional stress
  • Discomfort in the left arm, jaw, neck, back, or abdomen, with pain in the chest
  • Shortness of breath
  • Tiredness and lack of energy

If you've been treated for coronary artery disease with angioplasty and stents and their signs and symptoms have not disappeared, you could also have small vessel disease.

When to see a doctor

Seek emergency medical attention if you have chest pain and other signs and symptoms such as shortness of breath, sweating, nausea, dizziness, pain extending beyond your chest to one or both arms or your neck.

It can be difficult to know whether some of the symptoms are due to disease of the small blood vessels, especially if you have no pain in the chest. Consult your health care provider to determine the cause of your symptoms.

If you have new or unexplained chest pain or think they are having a heart attack, call 911 or emergency medical assistance immediately.

Causes

In coronary small vessel disease, small artery does not relax (dilate) as usual. As a result, the heart does not receive enough oxygen-rich blood.

Experts believe that the cause of small vessel disease are the same as the causes of the diseases that affect the large vessels of the heart, such as high blood pressure, high cholesterol, obesity and diabetes.

Risk factors

Small vessel disease is more common in women than in men. Risk factors for small vessel disease include:

  • The body mass index (BMI) of 30 or greater (obesity)
  • Diabetes
  • The family history of the disease, especially in women
  • High blood pressure
  • Inactive lifestyle
  • The increase of the age: over 45 years in men and older than 55 years in women
  • Insulin resistance
  • Polycystic ovary syndrome
  • The consumption of tobacco
  • Unhealthy cholesterol levels
  • Unhealthy diet

Complications

Small vessel disease may make it more difficult for the heart to pump blood to the rest of the body. A possible complication of small vessel disease is a heart attack.

Prevention

Things that you can do that may reduce your risk of disease of the small blood vessels include:

  • Do not smoke or use other tobacco products. If you smoke or use tobacco, stop. Talk with your health care provider if you have trouble quitting smoking.
  • Eating a heart-healthy diet. Choose a diet rich in whole grains, lean meats, low-fat dairy, fruits and vegetables. Limit salt, sugar, alcohol, saturated fats and trans fats.
  • Exercise regularly. Regular exercise helps to improve the function of the heart muscle and keeps the flow of blood through the arteries. Try to do at least 150 minutes per week of moderate activity, like walking.
  • Maintain a healthy weight. Excess weight strains the heart, and can contribute to high cholesterol, high blood pressure and diabetes.
  • Controlling cholesterol. Ask your doctor how often you should have your cholesterol checked. If your bad cholesterol (low-density lipoprotein cholesterol) levels are high, your health care provider may prescribe changes in your diet and medications to help reduce your cholesterol levels and protects your cardiovascular health.
  • Control of blood pressure. Ask your doctor how often you should have your blood pressure checked. He or she may recommend more frequent checks if you have high blood pressure or a history of heart disease.
  • The Control of sugar in the blood. Work with your health care provider to set goals for blood glucose levels that are suitable for you.
  • Manage stress. Find ways to help reduce emotional stress. Do more exercise, the practice of mindfulness, listening to music and connecting with others in support groups are some of the ways to reduce stress.

Small vessel disease

Diagnosis

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

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

  • Stress test with imaging techniques. A stress test measures such as the heart and blood vessels respond to the activity. You may be asked to walk on a treadmill or pedaling a stationary bike while connected to a heart monitor. Or you may be given an INTRAVENOUS injection of drugs to stimulate the heart in a way similar to exercise. The flow of blood to the muscle of the heart is measured with ultrasound imaging (echocardiogram) or with imaging scans.
  • The coronary angiography.This test helps to determine if the main arteries of the heart are blocked. A long, thin, flexible tube (catheter) that is inserted into a blood vessel, usually in the groin or the wrist, and guided to the heart. Contrast dye flows through the catheter into the arteries in the heart. The dye makes the arteries more easily seen on X-ray images and video. Additional tests may be done during an angiogram to measure the flow of blood through the heart.
  • CT coronary angiography. This type of angiography is used a powerful X-ray machine to produce a series of images of the heart and its blood vessels. You lie down on a long table that slides through a short tunnel-like machine (TC). Contrast medium is injected through an IV in the arm or in the hand causes the blood vessels easier to see on the CT images.
  • Positron emission tomography (PET). This test uses a radioactive tracer and the medication to measure the flow of blood to the heart muscle. After the tracer is injected, usually found in the form of a donut machine to have images taken of the heart.

The coronary angiography. This test helps to determine if the main arteries of the heart are blocked. A long, thin, flexible tube (catheter) that is inserted into a blood vessel, usually in the groin or the wrist, and guided to the heart. Contrast dye flows through the catheter into the arteries in the heart. The dye makes the arteries more easily seen on X-ray images and video.

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

Treatment

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

Medications for the disease of the small vessels may include:

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

If you are diagnosed with small vessel disease, you will need regular check-ups with your health care professional.

Self-care

Heart-healthy lifestyle changes can help prevent and control the disease of the small vessels. Lifestyle changes may include:

  • Weight loss if you are not at a healthy weight
  • Regular physical activity
  • Eating a healthy diet, low in salt and rich in fruits, vegetables, lean proteins and whole grains
  • Stop smoking or tobacco use

Alternative medicine

Sometimes, the dietary supplement of L-arginine may benefit people with small vessel disease who have not been helped by other medicines. L-arginine is an amino acid that helps to relax the blood vessels.

Talk with your health care provider before taking any supplements to make sure that they are not going to interact with other medicines that you take.

Preparing for your appointment

If you have had chest pains or other symptoms of heart disease, your primary care provider is likely that you consult a doctor trained in heart disease (cardiologist).

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

What you can do

When you make the appointment, ask if there is something that 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 changes in life
  • Any personal and family medical history of heart disease, high blood pressure, diabetes, or high cholesterol
  • All medications, vitamins or supplements that you are taking, including dose
  • Questions to ask your care provider

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

  • What is the cause of my symptoms?
  • There are other possible causes of the symptoms?
  • What tests do I need?
  • What treatments are available and what 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?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not 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 occur from time to time?
  • How severe are the symptoms?
  • What, in any case, it makes your symptoms worse?
  • Do your symptoms get worse when you are active?
  • What, in any case, it makes your symptoms better?
Symptoms and treatment of Small vessel disease