How Is Coronary Microvascular Disease Diagnosed?
First, your doctor will take your medical history
and do a physical exam to diagnose coronary microvascular disease (MVD). The
doctor will check to see if you have any risk factors for heart disease. You
will be weighed to check for
obesity,
and your cholesterol will be tested. You also will be tested for
metabolic
syndrome and
diabetes.
Your doctor may ask you to describe any chest pain,
including when it started and how it changed during physical activity or
periods of stress.
Other symptoms such as fatigue (tiredness), lack of
energy, and shortness of breath will be noted. Women will be asked about their
menopausal status. Your doctor may order blood tests, including a test for
anemia.
Specialists Involved
Doctors who diagnose and treat coronary MVD are most
often specialists in cardiology (heart disease), family medicine, and internal
medicine.
Diagnostic Tests
The risk factors for traditional
coronary
artery disease (CAD) and coronary MVD are often the same. Therefore, your
doctor will use tests to help show if you have traditional CAD. These tests may
include:
- Coronary
angiography (an-jee-OG-ra-fee). This test is a special x-ray exam of the
heart and blood vessels. It shows plaque buildup in the large coronary
arteries. This test is often done during a
heart
attack to help locate blockages.
- A
stress
test. This test provides your doctor with information about blood flow
through the coronary arteries to your heart muscle during physical stress.
During stress testing, you exercise (or are given medicine if you're unable to
exercise) to make your heart work hard and beat fast while heart tests, such as
nuclear
heart scanning and
echocardiography,
are performed. If coronary angiography doesn't show plaque buildup in the large
coronary arteries, a stress test may still show abnormal blood flow. This may
be a sign of coronary MVD.
- A magnetic resonance imaging (MRI) cardiac stress
test. This test is being used more widely to evaluate women with chest
pain.
Unfortunately, standard tests for CAD don't always
detect heart disease in women. Standard tests look for blockages that affect
blood flow in the large coronary arteries. However, the
WISE Study showed
that, in women, damage to the heart's smallest coronary arteries may affect
blood flow.
This damage occurs when plaque forms in arteries,
when the arteries spasm (tighten), or when the walls of the arteries are
damaged or diseased.
In coronary MVD, plaque can scatter, spread out
evenly, or build up into blockages in the tiny coronary arteries. Plaque
narrows the coronary arteries and reduces blood flow to the heart muscle.
Spasms of the small coronary arteries prevent enough
oxygen-rich blood from moving through the arteries.
Changes in the arteries' cells and the surrounding
muscle tissues may, over time, damage the arteries' walls.
The standard tests for CAD can't detect these types
of problems in the tiny coronary arteries. Therefore, standard tests may show
that a woman doesn't have heart disease, even if she does. (Fifty percent of
women who have the standard CAD tests show normal coronary arteries compared to
17 percent of men.)
If test results show you don't have CAD, you can
still be diagnosed with coronary MVD if evidence shows that not enough oxygen
is reaching the small arteries in your heart.
Since symptoms of coronary MVD often first appear
during routine daily tasks, you may be asked to fill out a questionnaire called
the Duke Activity Status Index (DASI). The questionnaire will ask you how well
you're able to do daily activities such as shopping, cooking, and going to
work. The results of this survey will help doctors decide on the kind of stress
test you should have. It will also give them some information about how well
the blood is flowing through your coronary arteries.
Research continues to improve ways to detect and
diagnose heart disease caused by coronary MVD. |