Microvascular Coronary Disease

Overview

What is microvascular coronary disease?

Microvascular Coronary disease (MCD) is the narrowing of the small blood vessels that branch off the coronary arteries and send oxygen-rich blood to the heart muscle. This decreases the amount of blood that goes to the heart muscle, which leads to chest pain (angina). The condition is also called microvessel disease or small vessel heart disease. These narrowings are in arteries too small to see with routine coronary angiography during heart catheterization.

Symptoms and Causes

What are the symptoms of microvascular coronary disease?

The most common symptom of MCD is chest pain (angina) that often lasts at least 10 minutes and up to an hour. The chest pain usually occurs with exercise or stress, but can happen any time.

Microvascular Coronary Disease increases your risk of heart attack.

If you have chest pain:

Call 911 or go to the closest emergency room immediately if:

  • Your chest pain does not go away after taking two doses of nitroglycerin
  • You are having other heart attack symptoms
  • You feel like you're going to pass out

What causes of microvascular coronary disease?

Microvascular coronary disease involves damage to the walls of the affected arteries (referred to as endothelial dysfunction). This damage causes narrowing which may be aggravated by further spasms. The condition is most common among women, especially after menopause, but men can also have MCD.

Unlike coronary artery disease, MCD is not caused by “clogged arteries” (arteries with a build-up of plaque). However, both conditions have many of the same risk factors.

Risk factors for MCD include:

  • Smoking
  • High cholesterol
  • Diabetes
  • High blood pressure (hypertension)
  • Lack of exercise
  • Being overweight or obese
  • Eating an unhealthy diet
  • Rheumatologic disorders such as systemic lupus erythematosus or rheumatoid arthritis

Diagnosis and Tests

How is microvessel coronary disease diagnosed?

A major NIH study called the WISE Study, found that about 50 percent of women who had angina substantiated by abnormal nuclear stress test but no blockages in large coronary blood vessels had MCD. It is important to see a doctor who has experience treating patients with MCD. Making the right diagnosis can be tricky, and many patients do not get the right diagnosis, and are instead sent to a gastroenterologist or told they are imagining the symptoms.

If you have chest pain that lasts 10 minutes or longer or other symptoms of MCD, you should see your doctor for an exam and testing.

Tests include:

  • Sestamibi Nuclear Stress Test. A test that involves walking on a treadmill, using a stationary bike or getting medication to make your heart work harder. Your doctor uses information from the test to check the blood supply to your heart when it is under stress. It is most helpful to assess blood flow to the heart from the larger coronary arteries.
  • Catheterization with coronary flow reserve (CFR). This is the gold standard of testing for MCD. A long, thin tube called a catheter is guided through your coronary arteries to check for blockages. You will get medications and your doctor will take measurements to see how well your coronary vessels are working. Only 7 hospitals in the U.S. have this technology; however, Cleveland Clinic has been using this test for more than 20 years.
  • Cardiac perfusion MRI or PET scans. This scan creates detailed pictures of your heart and blood vessels. A contrast liquid is used to show how well the blood vessels are working. These tests can confirm MCD once atherosclerosis or the larger vessels has been excluded, but only if MCD affects just part of the heart or if absolute blood flow can be assessed using 15O-water PET or other means. Not all major hospitals have access to special type of PET scan.

Management and Treatment

What treatments are available for patients with MCD?

Treatment for MCD involves relieving symptoms and helping the blood vessels work better. This involves medications and lifestyle changes.

Common medications used for MCD treatment are:

  • Aspirin
  • Calcium Channel Blockers
  • Ace inhibitors
  • Cholesterol-lowering medications (statins)
  • Long-acting nitrates

Lifestyle changes included in treatment for MCD are:

  • Getting regular exercise
  • Controlling high blood pressure
  • Controlling diabetes
  • Not smoking or using tobacco/nicotine products
  • Eating a healthy diet
  • Reaching and staying at a healthy weight

Cleveland Clinic doctors carefully evaluate every patient and develop a plan of care to achieve the best possible results. It is important to follow your treatment plan and see your doctor for follow-up visits as recommended.

Resources

Make an Appointment:

Main Heart, Vascular & Thoracic Institute number: 800.659.7822 or Submit an online request

Choose a doctor

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart, Vascular & Thoracic Institute Outcomes.

The Miller Family Heart, Vascular & Thoracic Institute offers specialty centers and clinics for patients whose treatment requires the expertise of a group of doctors and surgeons who focus on a specific condition.

Center for Complex Interventions offers comprehensive treatment for patients with microvascular disease.

Women’s Cardiovascular Center provides comprehensive cardiovascular medical care to women, with a special focus on prevention of cardiovascular disease.

See About Us to learn more about the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute.

Contact for more information

If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Last reviewed by a Cleveland Clinic medical professional on 11/28/2018.

References

  • Coronary Microvascular Disease, NHBLI, Accessed 10/18/2018https://www.nhlbi.nih.gov/health-topics/coronary-microvascular-disease (https://www.nhlbi.nih.gov/health-topics/coronary-microvascular-disease)
  • Coronary Microvascular Disease (MVD), American Heart Association, Accessed 10/18/2018http://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/coronary-microvascular-disease-mvd (http://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/coronary-microvascular-disease-mvd)
  • Alrifai A, Kabach M, Nieves J, Pino J. Microvascular Coronary Artery Disease: Review Article. USC - Volume 12 Issue 1 Spring 2018 Accessed 10/18/2018https://www.uscjournal.com/articles/microvascular-coronary-artery-disease-review-article. (https://www.uscjournal.com/articles/microvascular-coronary-artery-disease-review-article)
  • Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease: The iPOWER Study. _Journal of the American Heart Association_Vol. 5, No. 3. Accessed 10/18/2018https://www.ahajournals.org/doi/10.1161/JAHA.115.003064 (https://www.ahajournals.org/doi/10.1161/JAHA.115.003064)
  • Gulati M, Shaw L, Merz CN. Myocardial Ischemia in Women - Lessons from the NHLBI WISE Study. _Clin Cardiol. _2012 Mar; 35(3): 141–148.
    doi: 10.1002/clc.21966 Accessed 10/18/2018https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3297966/ (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3297966/)

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