Small Vessel Disease

Small vessel disease is a problem with blood flow in small blood vessels that branch off of large vessels. It occurs due to narrowing, blockage or rupture of vessels that are as big around as a strand of hair. This condition limits the amount of blood that can reach your heart, brain or other organs.

Damage to the inner walls of small vessels affects the smooth muscle function of your smallest arteries. This smooth muscle can’t narrow and widen to keep up with an organ’s changing needs. This microvascular dysfunction (small vessels not working right) can cause spasms that disrupt blood flow.

When organs can’t get the blood they need, they also can’t get the oxygen the blood carries. This is why you can call this condition chronic small vessel ischemic disease. Ischemia is a lack of blood flow.

When the condition affects your heart, the opening in the vessels becomes more narrow, which can cause chest pain and raise your heart attack risk. If it affects the small vessels in your brain, it can cause memory issues.

Medications and lifestyle changes help many people get symptom relief and avoid complications.

Small vessel disease is also known as:

• Small artery disease
• Coronary microvascular disease
• Cardiac syndrome X
• Microvessel disease

Types of this condition

Small vessel disease can happen in your heart, brain and possibly other places. Researchers are studying this disease as a condition that affects several organs. There may be a link between coronary microvascular disease (in your heart) and small vessel disease in your kidneys and brain.

Symptoms of small vessel disease

In your heart, the main symptom is a type of chest pain called microvascular angina that usually lasts 15 minutes or longer. You may notice this while you’re doing daily tasks, but it can happen even when you’re resting. Pain may increase with mental stress and, less often, with physical exertion.

Other small vessel disease symptoms may include:

• Fatigue
• Shortness of breath
• Trouble sleeping

With cerebral (brain) small vessel disease, you may not have symptoms for many years. Then, you may have symptoms like:

• Problems with memory or thinking (like processing information slowly)
• A movement disorder
• A nervous system issue

Small vessel disease causes

Causes of small vessel disease include:

• Hardening of your arteries
• Inflammation in the affected vessels
• Buildup of abnormal proteins in your brain’s blood vessels

Risk factors

Small vessel disease of the heart is more likely to affect women than men — especially women who have low estrogen levels from menopause. The chances of any small vessel disease go up as you age.

Other risk factors include having:

• Autoimmune disease, including vasculitis and lupus
• Overweight/obesity
• Diabetes
• High blood pressure
• High cholesterol
• Heart valve or heart muscle problems
• Chronic kidney disease
• Obstructive sleep apnea
• Certain habits or routines, like smoking, eating processed foods or not getting enough physical activity

Complications of this condition

Small vessel disease may lead to:

• Depression
• Anxiety
• Heart attack
• Heart failure
• Lacunar stroke
• Brain bleed
• Brain atrophy (loss of brain cells and the links between them)

How doctors diagnose small vessel disease

A healthcare provider will do a physical exam and review your medical history. They’ll also order tests.

Cardiac catheterization with coronary flow reserve (CFR) is the gold standard for diagnosing small vessel disease in your heart. This test measures how well a vessel can quickly expand and deliver more blood based on your body’s needs.

Other tests may include:

• Nuclear cardiac stress test (PET scan)
• Heart MRI
• Coronary angiogram
• CT or MRI of your brain
• Stress test
• Echocardiogram

Larger vessels may look fine in standard heart tests, but small vessels are too small to check with those. This is why you need other tests to explain the symptoms you have.

How is it treated?

Treatment for small vessel ischemic disease often involves medicines to help blood vessels work better, keep symptoms from getting worse and lower the risk of complications.

Medicines may include:

• Aspirin or other medicines that prevent blood clots
• Blood pressure medicines, like ACE inhibitors
• Nitroglycerin
• Statins
• Other cholesterol-lowering medications
• Beta-blockers
• Calcium channel blockers

Medicines like these help manage conditions that make it harder for your small vessels to work well. These conditions include high blood pressure, high cholesterol and diabetes. Changes to your daily routine help, too — like being more physically active and eating heart-healthy foods.

If you have coronary artery disease in your large vessels, too, you may also need a procedure to improve blood flow, like angioplasty or bypass surgery.

When should I see my healthcare provider?

Contact your provider if you have chest pain or shortness of breath. Chest pain can also be a symptom of a heart attack.

Get emergency treatment if:

• You have chest pain that doesn't go away or gets worse.
• You have other symptoms, like difficulty breathing or pain that runs down your back, neck or arm.

You should also contact your provider if you have problems with your memory or thinking.

Questions to ask your provider may include:

• Which tests do I need?
• How do I prepare for the tests?
• When will I get the results?
• What can I do in the meantime?

What can I expect if I have small vessel disease?

This disease is a long-term condition that progresses (gets worse). That’s why people may call it chronic small vessel disease. But with successful treatment, many people feel better and get back to their usual daily tasks. You may need ongoing follow-up care to make sure treatments are working.

Taking medications and making lifestyle changes can take some getting used to. Some drugs cause unpleasant side effects, like feeling dizzy. It’s important to discuss these with your healthcare provider. They can suggest other medicines to help you get the most out of treatment.

Can this be prevented?

Taking good care of your heart can help you feel your best and lower the risk of complications. This includes:

• Being more physically active
• Eating heart-healthy foods
• Keeping blood pressure and cholesterol within a healthy range
• Maintaining a weight that's healthy for you
• Quitting smoking
• Reducing high blood sugar