Small blood vessels, big heart problems: microvascular disease

If you always think that a woman’s heart is different from men when coming to heart disease, you are right. Women do not experience heart problems like men do. Some serious heart conditions, in fact, affect women more than men, such as coronary microvascular disease (CMD).

That is why understanding the differences and seeking special heart care for women is very important, said Patricia Rodriguez-Lozano, MD, Heart Expert and Director of Women’s Heart Health Care Program at UVA Health.

“Encourage yourself is very important because cardiovascular disease in women is often not diagnosed, underestimated, or wrongly diagnosed,” he said. “Many are told ‘just stress’ or ‘there is nothing wrong,’ even when a serious heart condition is present.”

What is coronary microvascular disease?

CMD (also called coronary microvascular dysfunction or microvascular disease) is a type of small blood vessel disease, which occurs when small blood vessels in your heart do not work as they should. That means they do not open wide when your heart needs more oxygen, such as during training or events that make stress.

This can happen for several reasons, such as:

• Problems with a layer of blood vessels, called the endothelium
• The vessels that become rigid or narrow due to inflammation or stress
• Hormone changes, especially around menopause or after pregnancy
• Stress response that is too active or nervous system signals

Although large arteries may look really normal in a typical heart test, if you have CMD, it can still cause symptoms (such as chest pain).

And CMD can increase your risk for future heart problems. “CMD is real and serious-significantly can damage the quality of life and is associated with an increased risk for harmful cardiovascular events,” said Rodriguez-Lozano.

What are the symptoms of CMD?

CMD symptoms often include:

• Fatigue
• Hard to breathe
• Chest pressure

These symptoms can be worse with emotional or mental stress, Rodriguez-Lozano’s notes. They are also quite common to suggest less serious conditions that are not related to the heart. And traditional stress and imaging tests do not always capture CMD. That’s because the blood vessels affected are too small for the usual heart test.

“I hope that more women know that having a normal arteries in standard angiograms does not mean their hearts are fine,” said Rodriguez-Lozano. “CMD affects the small heart vessels that do not appear in most routine imaging tests. This is the main cause of chest pain in women and is often wrongly classified as ‘non-cardiac’ because traditional diagnostics are not equipped to detect it.”

Get the right treatment for your heart

If you have ongoing symptoms that are of concern to you, it is important to find a heart team who understands CMD and has a tool to diagnose it correctly. That often includes further testing such as the heart MRI, PET scan, and invasive coronary physiology, said Rodriguez-Lozano.

CMD must also be treated holistically, he added. That means not only with drugs, but also through access to a team of diet experts, sports physiologists, social workers, and pharmacists who can help overcome the scope of your health.

“Remember that your symptoms are important, even if the test returns to normal,” said Rodriguez-Lozano. “If you experience chest pain that cannot be explained, fatigue, or shortness of breath and told, ‘it’s just stress’ or ‘your heart is good,’ it’s time to ask a deeper question.”