Coronary microvascular disease affects tiny vessels that deliver blood to heart tissue. When these small blood vessels are damaged, they can spasm, decreasing blood flow to your heart. Microvascular coronary disease causes lasting chest pain and can raise your heart attack risk.
Microvascular disease affects arteries that branch off from your heart’s main blood vessels (coronary microvasculature).
It’s also known as:
The coronary microvasculature is a network of tiny blood vessels in your heart. Many of them are the size of a few human hairs. These vessels control blood flow and capillary exchange within your heart.
Capillary exchange is a complex process during which tiny vessels deliver oxygen-rich blood and receive oxygen-poor blood from nearby tissue. The exchange also involves gases, nutrients and waste products.
Both conditions raise your risk of a heart attack. But the ways they affect your heart are different:
Small vessel disease is more likely to affect women than men. This is especially true in people with low estrogen levels, which occurs around menopause.
Other risk factors for include:
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
The condition affects the smooth muscle function of your heart’s smallest arteries. In a healthy heart, these muscles narrow and widen to keep up with your heart’s changing needs. With coronary microvascular disease, damage occurs to the inner walls of small vessels. This damage can cause spasms that disrupt blood flow to your heart.
The primary symptom is a type of chest pain called angina that lasts 10 minutes or longer, even when resting. Pain may increase with mental stress and, less often, with physical exertion. Microvascular coronary disease symptoms can make it challenging to go about daily life.
Symptoms may also include:
Chest pain can also be a symptom of a heart attack. Dial 911 or go to the closest emergency room if:
Diagnosing microvascular heart disease is challenging because microvessels are too small to assess using standard heart tests. Seeing a cardiologist who specializes in small vessel disease can help you receive an accurate diagnosis and timely care.
Cardiac catheterization with coronary flow reserve (CFR) is the gold standard for diagnosing microvascular coronary disease. This sophisticated test measures the microvessel’s ability to quickly expand and deliver more blood based on your body’s needs.
Additional tests to measure coronary blood flow may include:
Treatment often involves medications to help blood vessels work more effectively and lower the risk of complications.
Care may include:
Taking good care of your heart can help you feel your best and lower the risk of complications. This includes:
With successful treatment, many people feel better and resume daily activities. You may need ongoing follow-up care to make sure therapies are working as they should.
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 challenges with your healthcare provider. They can make recommendations or use other medications to help you get the most out of treatment.
Your healthcare provider may recommend keeping a daily record of symptoms and vital signs, like blood pressure. This information makes it easier to adjust treatments to your needs and preferences.
A note from Cleveland Clinic
Coronary microvascular disease happens when there’s a disruption of blood flow through the heart’s smallest blood vessels. Unlike coronary artery disease, which is due to a blockage, microvascular heart disease (small vessel disease) occurs when there’s blood vessel damage. The condition causes lasting chest pain and raises your heart attack risk. Medications and lifestyle changes help many people get symptom relief and avoid complications.
Last reviewed by a Cleveland Clinic medical professional on 07/11/2022.
Learn more about our editorial process.