Coronary Microvascular Disease and Chest Pain

Cardiovascular disease is the leading cause of death in the United States, resulting in nearly a million deaths annually. It’s also the No. 1 cause of death worldwide and a leading cause of disability.

When it comes to cardiovascular disease, most of us likely think of coronary artery disease (CAD) or heart failure, two common types of heart disease. Less well known is microvascular disease (MVD), but it can be just as serious — and it’s more common than you might think.

Ashish Pal, MD, and the team at Vein & Cardiovascular Center use advanced screening and diagnostic methods to identify MVD in patients in Orlando, Sebring, and Davenport, Florida.

They offer patient-centered, custom treatment options to relieve symptoms and improve cardiovascular health. Here’s what you should know about MVD and its symptoms.

The ABCs of MVD

Microvascular disease is a type of cardiovascular disease — that is, a disease that affects the vessels associated with the heart’s blood supply. 

Coronary artery disease is another type of cardiovascular disease, and the one most of us are familiar with. CAD is the most common type of heart disease, associated with nearly 400,000 deaths in the U.S. each year. 

MVD is similar in that it involves the blood vessels. But while CAD affects the larger arteries that supply the heart with blood, MVD affects the small vessels in the heart, including the small branch arteries (arterioles) and capillaries. Another name for MVD is small vessel disease.

Another difference: CAD happens when sticky plaque builds up inside the larger arteries, interfering with the normal flow of blood to the heart. With MVD, the walls and inner linings of the tiny arteries are damaged or weakened by disease, not plaque buildup.

MVD and chest pain

With CAD, chest pain happens when the heart’s supply of oxygen-rich blood is blocked by plaque buildup in the arteries. When your heart doesn’t get enough oxygen, it gets stressed and sends out pain signals. The narrowing can be seen on diagnostic imaging tests like angiography.

But with MVD, the arteries aren’t obstructed — they’re diseased or weakened. MVD causes chest pain (or angina) when these small vessels have a spasm — kind of like a charley horse inside the vessels. This type of chest pain is called microvascular angina. 

Microvascular angina (or cardiac syndrome X) is broadly defined as chest pain that happens even though the larger coronary arteries aren’t blocked by plaque. 

Diagnosing MVD

With CAD, artery blockages show up on angiography, a special test that uses a dye to identify areas of blockage or narrowing in the larger arteries. Since MVD isn’t associated with arterial blockage or narrowing, Dr. Pal uses a different test called CPET to help diagnose the condition.

CPET stands for cardiopulmonary exercise testing. Dr. Pal uses an advanced type of testing that offers a lot more detail about your heart, your lungs, and your chest muscles, too. 

CPET can identify many problems that can’t be identified with a traditional stress test, including MVD, heart failure, and circulation and breathing disorders. CPET also allows Dr. Pal to diagnose these problems early, when treatment is most effective.

If Dr. Pal determines that MVD is causing your chest pain, he develops a treatment regimen based on your health history and other factors to help you relieve chest pain symptoms and improve your overall cardiovascular health. 

Don’t ignore chest pain

The key to achieving the best results is early treatment, ideally at the first sign of chest pain. If you’re having chest pain or any type of unusual heart-related symptoms, call the office or book an appointment online, so you can get the treatment you need to stay healthy.

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