What is small vessel disease?

Small vessel disease, which is also called coronary microvascular disease, is a disease that affects the small arteries in the heart. These small arteries normally expand to provide extra blood to your heart when you are exercising or exerting yourself. They contract when you are at rest. Small vessel disease is caused by a narrowing of these tiny arteries. This narrowing can be caused by spasms in the artery, damage to the artery walls or a build-up of a fatty substance (called plaque) in the artery.

Small vessel disease is not the same as coronary artery disease. Coronary artery disease affects the large arteries in the heart. These large arteries are responsible for carrying oxygen-rich blood to your heart all the time. When these arteries are blocked or narrowed, your heart muscle doesn't get the blood and oxygen it needs to work properly. This can cause a heart attack.

What are the symptoms of small vessel disease?

The most common symptom of small vessel disease is angina (say: "ann-ji-na"). Angina often feels like a squeezing pain or a pressing feeling in the chest. The pain of angina may make you sweat or make it hard to catch your breath. You may feel pain in your arm, neck, jaw or shoulder as well as in your chest. It is like the symptoms of a heart attack, but it usually happens when you are exercising or being active.

Other symptoms of small vessel disease can include:

• Fainting
• Feeling dizzy or lightheaded
• Fatigue
• Shortness of breath

If left untreated, small vessel disease can make your heart work harder to pump blood. This can put you at risk for heart attack and heart failure.

Am I at risk for small vessel disease?

Women are at higher risk for small vessel disease. This may be because of hormone levels, and the risk increases after menopause. Other risk factors include:

• Obesity
• High blood pressure
• High cholesterol levels
• Lack of exercise
• Diabetes
• Smoking

How will my doctor know if I have small vessel disease?

If you have any of the symptoms of small vessel disease, talk to your doctor. Your doctor will perform tests to determine that your symptoms are not being caused by a blockage in your large coronary arteries.

If you are having chest pain that extends from your chest into the jaw, left arm or left shoulder, get medical help immediately.

How is it treated?

If you have small vessel disease, your doctor may prescribe medicine to help control your symptoms or keep your arteries from narrowing. Because the arteries are so small, surgery is not an option. Your doctor will talk to you about which medicine is best for you. Your doctor will also want to schedule regular check-ups with you to monitor how you are doing.

How can I prevent small vessel disease?

The best way to prevent small vessel disease is by controlling your risk factors. This may include:

• Lose weight if you are overweight.
• Don't smoke. Nicotine raises your blood pressure because it causes your body to release adrenaline, which makes your blood vessels constrict and your heart beat faster. If you smoke, ask your doctor to help you make a plan to quit.
• Control your blood pressure. If you have high blood pressure, your doctor can suggest ways to lower it. If you're taking medicine for high blood pressure, be sure to take it just the way your doctor tells you to.
• Improve your cholesterol levels. A healthy diet and exercise can lower your “bad” cholesterol levels and improve your “good” cholesterol levels. If that doesn’t help, your doctor may talk to you about medicines to help improve your levels.
• Exercise. Regular exercise can make your heart stronger and reduce your risk of heart disease. Exercise can also help if you have high blood pressure. Before you start, talk to your doctor about the right kind of exercise for you. Try to exercise at least 4 to 6 times a week for at least 30 minutes each time.
• Eat a healthy diet. Add foods to your diet that are low in cholesterol and saturated fats, because your body turns saturated fats into cholesterol.
• If you have diabetes, make sure that you keep your blood sugar under control.

• What is the likely cause of my small vessel disease?
• What lifestyle changes do I need to make at home to help relieve my symptoms?
• Is it safe for me to exercise? How do I get started?
• What treatment option is best for me? Will I need medicine?
• Will the medicine you’re prescribing interact with medicine(s) I already take?
• What symptoms will indicate that my condition is getting worse?
• Does small vessel disease put me at risk for any long-term problems?