Microvascular Disease: How Your Small Vessels Can Cause A Threatening Problem To Your Heart

Overview

At the center of the body, the heart carries out a series of steps and vital processes to ensure all body parts, organs, and tissues receive adequate nourishment with nutrient- and oxygen-rich blood through the circulatory system.

While most people associate heart diseases and dysfunctions with big arteries, microvascular disease is a heart condition that flies under the radar for a long time due to subtle and vague symptoms.

Learn about the basics of microvascular disease, including definition, causes, symptoms, diagnosis, treatments, and prevention.

Microvascular Disease | What It Is, Causes, Symptoms, And Treatment

What Is A Microvascular Disease?

Microvascular disease, or small vessel disease, is a chronic heart condition characterized by abnormalities in the inner wall of tiny arteries. Other names for microvascular disease include nonobstructive coronary heart disease, cardiac X syndrome, and small vessel disease.

Contrary to the common belief that all types of heart disease is the consequence of damage and malfunction of the largest vessels, such as the aorta and superior vena cava, such abnormalities can also occur in much smaller blood vessels (coronary microvasculature) stemming from the heart’s main arteries.

Unlike regular heart-associated dysfunctions impeded by atherosclerosis, microvascular disease adversely affects blood flow when smaller blood vessels twitch uncontrollably. Despite approximating the size of the hair, blockages in coronary microvasculature can lead to disrupted blood flow and associated physical symptoms.

Causes of Microvascular Disease

Based on dysfunctional muscle contraction of small vessels, many scientists estimate that diseases and risk factors affecting larger arteries have something to do with microvascular disease. They even believe that what causes plaque buildup may give rise to malfunctioning small vessels in one way or another.

Although a great deal of research is still underway to determine the causes of microvascular disease, some possible factors contribute to its development include the following:

• Inflammation: Acute and chronic inflammation, like systemic lupus erythematosus, can damage the artery walls by stiffening the blood vessels, affecting their ability to contract and dilate properly.
• Lack of Nitric Oxide: Nitric oxide is a physiological compound that significantly contributes to arterial and vascular health by relaxing arteries, capillaries, and veins. As a vasodilator, the molecule ensures blood vessels are dilated enough for the blood to flow freely. Low nitric oxide can lead to endothelial dysfunction. This condition occurs when the inner wall of blood vessels becomes constricted, eventually diminishing blood circulation.
• Microvascular Spasms: Tiny blood vessels can experience spasms, much like larger coronary arteries. Twitching blood vessels can reduce blood circulation and lead to pressure and stabbing pain in the chest, known as angina.
• Changes in Microvascular Structure: The artery wall becoming thicker, stiffer, or narrower can all prevent small blood vessels from delivering an adequate supply of blood.
• Autoimmune Disease: Autoimmune conditions like scleroderma can make blood vessels more likely to spasm.
• Imbalanced Hormones: Decreased or imbalanced hormone levels can lead to malfunctioning blood vessels, especially in women going through menopause.
• Risk Factors: Much like other heart diseases, high blood pressure, high cholesterol levels, old age, diabetes, obesity, smoking, drinking, unhealthy diet, and inactive lifestyle can all increase the risk of coronary microvascular disease. Other risk factors include estrogen deficiency in women, polycystic ovarian syndrome, and insulin resistance.
• Genetic Factors: Some individuals with a family history of microvascular disease are at higher risk of developing the condition.

Symptoms of Microvascular Disease

Many describe that the symptoms of microvascular disease in the heart are the same as traditional coronary artery disease (CAD). This means that most people with microvascular disease report experiencing symptoms like shortness of breath and tightened feelings in their chest.

These symptoms can be upsetting and interfere with a person’s ability to lead a normal life, as they can appear when they hardly engage in physical activities, such as exercises and workouts.

Some common symptoms of coronary microvascular disease are as follows:

• Chest Pain: Chest pain is a well-known symptom of microvascular disease, where a person experiences tightness, pressure, or heavy sensations in their chest for about 10 minutes or longer when they are not physically active.
• Discomfort in the Upper Body: When a person has coronary microvascular disease, they might experience pain, discomfort, numbness, or tingling in their arms, nape, neck, jaw, or back.
• Irregular Heartbeat: Rapid heartbeat, or heart palpitations, is one of the symptoms of microvascular disease. However, it’s often mistaken as a sign of anxiety.
• Short Breath: Although shortness of breath frequently occurs when a person is physically active, the symptom emerges even when at rest.
• Persistent Fatigue: Coronary microvascular disease can cause prolonged fatigue.

Diagnosis of Microvascular Disease

Due to vague symptoms, detecting microvascular heart disease can be a challenge. Thus, there are no standard tests designed for diagnosing microvascular disease because most developed heart tests only aim to detect dysfunction in larger arteries. As chest pain is a relatively common symptom of many heart conditions, including small vessel disease, conventional tests may not help diagnose microvascular heart disease much, even if nothing’s wrong with the arteries.

Regardless, meeting a cardiologist is necessary when you experience pressure in the chest and fatigue that doesn’t go away even after resting. They will perform a step-by-step examination and other measures to evaluate the current situation and rule out other causes to determine whether a person may have small vessel disease. Some steps vascular doctors may use during a diagnosis include:

• Conducting A Physical Examination: A comprehensive physical examination is crucial for assessing and identifying the underlying causes of the discomfort experienced. A family record of the microvascular disease may also help a vascular doctor assess your risk if any family member has been previously diagnosed with a similar disease.
• Assessing The Symptoms: The assessment of symptoms is pivotal in many diagnoses. It supports doctors in further proving their speculation following the prior examination. In a microvascular disease diagnosis, a cardiologist calculates the risk of small vessel disease by having deep observations into the frequency and severity of discomfort and pain experienced by the patient and whether they may follow a fixed pattern.
• Diagnostic Tests: Cardiologists will use a variety of tests and measures to diagnose small vessel disease, such as cardiac stress tests, coronary flow reserve measurement, coronary angiography, cardiac MRI, and tests to detect heart rhythm disorders and other cardiac conditions.
• Investigating Risk Factors: As discussed above, people with diabetes, obesity, hypertension, or high cholesterol levels are at a heightened risk of developing coronary microvascular disease.

Treatment of Microvascular Disease

Treating microvascular diseases focuses on alleviating pain and discomfort and making much-needed lifestyle adjustments to control the risk factors. Microvascular disease treatment may include the following:

• Nitroglycerine: to reduce chest pain.
• Calcium channel and beta blockers: to relax blood vessels.
• Antihypertensive medications: to control blood pressure.
• Antiplatelet medication: to prevent the formation of blood clots.
• Antidiabetic medication: to maintain blood sugar levels.
• Cholesterol-lowering medication: to prevent plaque and substance from building up inside the artery and manage blood lipids.

How to Prevent Microvascular Disease

In addition to medications, controlling risk factors and making lifestyle changes help minimize the risk of microvascular disease in the long term. Some valuable tips to help prevent the condition include:

• Move Your Body: Inactive lifestyle is a leading risk factor for various conditions and diseases. Engaging in physical activities and sticking to an exercise routine help improve heart function and get the blood circulating well throughout the body. Try to get up and move at least 30 minutes a day. It doesn’t have to be strenuous workouts. Any form of exercise is beneficial, such as walking, cycling, swimming, and hiking.
• Eat Healthy: Loading more heart-healthy foods onto your plate is another great way to ensure optimal heart health. Aim for low-fat dairy products, lean proteins, whole grains, vegetables, and fruits. Drinking plenty of water helps remove excess waste from the bloodstream. To keep the heart healthy, stop smoking and drinking completely is another way to go, and limit your consumption of processed and sugary foods.
• Watch Out Your Weight: Being overweight or obese can increase health risks, so it’s always best to watch your body weight closely. As mentioned above, regular exercise can do wonders for your heart health, but it also helps you shed extra weight, mitigating the risks of high blood pressure and high cholesterol.
• Reduce Stress: Stress and anxiety can cause a surge in heart rate, leading to heart-associated implications over time. Choose the best stress-busting strategies to elevate your moods, such as exercising, practicing mindfulness, meditating, and participating in recreational activities.
• Keep Cholesterol Levels At Bay: Detecting abnormally high cholesterol in the bloodstream as early as possible protects you from the risks of developing small vessel disease and other heart complications. Consult your doctor to discuss your annual checkups to ensure bad cholesterol levels are under control, especially if you have an unhealthy diet.
• Control Blood Pressure: Measure your blood pressure frequently if you have a medical history of heart disease.

References

• Lusis AJ. (2000). Atherosclerosis. Nature.
• Sorriento D, Iaccarino G. (2019). Inflammation and Cardiovascular Diseases: The Most Recent Findings. International Journal of Molecular Science.
• Raddino R, Caretta G, Teli M, Bonadei I, Robba D, Zanini G, Madureri A, Nodari S, Dei Cas L. (2007). Nitric oxide and cardiovascular risk factors. Heart International.
• Manfredi R, Verdoia M, Compagnucci P, Barbarossa A, Stronati G, Casella M, Dello Russo A, Guerra F, Ciliberti G. (2022). Angina in 2022: Current Perspectives. Journal of Clinical Medicine.
• Durante A, Bronzato S. (2015). The increased cardiovascular risk in patients affected by autoimmune diseases: review of the various manifestations. Journal of Clinical Medicine Research.
• Giordano S, Hage FG, Xing D, Chen YF, Allon S, Chen C, Oparil S. (2015). Estrogen and Cardiovascular Disease: Is Timing Everything? The American Journal of The Medical Sciences.
• Ashley EA, Niebauer J. (2004). Chapter 5, Coronary Artery Explained. Cardiology Explained.
• Ghobrial M, Haley HA, Gosling R, Rammohan V, Lawford PV, Hose DR, Gunn JP, Morris PD. (2021). The new role of diagnostic angiography in coronary physiological assessment. Heart.
• Boden WE, Padala SK, Cabral KP, Buschmann IR, Sidhu MS. (2015). Role of short-acting nitroglycerin in the management of ischemic heart disease. Drug Design, Development, and Therapy.

If you have questions about microvascular disease or any health problems discussed here, contact us and learn more. 

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