Key Points

• Coronary microvascular disease (MVD) affects the heart's smallest coronary arteries. Coronary MVD occurs when plaque forms in the arteries, when the arteries spasm (tighten), or when the walls of the arteries are diseased or damaged.
• In coronary MVD, plaque can scatter, spread out evenly, or build up into blockages in the small coronary arteries. Plaque reduces the flow of oxygen-rich blood to the heart muscle. Spasms also prevent enough oxygen-rich blood from getting to the heart muscle. Changes in the arteries' cells and the surrounding muscle tissues may, over time, damage the arteries' walls.
• In coronary MVD, plaque doesn't always lead to blockages as it does in traditional coronary artery disease (CAD). For this reason, coronary MVD is called nonobstructive CAD.
• Coronary MVD is a new concept. It's currently being studied as a possible cause of heart disease in women. Many researchers think that a drop in estrogen levels in women at menopause combined with risk factors for heart disease causes coronary MVD.
• No one knows whether coronary MVD is the same as MVD linked to other diseases, such as diabetes.
• The same cluster of risk factors that cause atherosclerosis and CAD may cause coronary MVD. These include unhealthy cholesterol levels, high blood pressure, smoking, insulin resistance, diabetes, overweight and obesity, lack of physical activity, age, and family history of early heart disease.
• Coronary MVD in women may be linked to low estrogen levels occurring before or after menopause. It also may be linked to anemia or conditions that affect blood clotting.
• Signs and symptoms of coronary MVD often differ from those of traditional CAD. Typical signs and symptoms of CAD include angina (chest pain), feeling pressure or squeezing in the chest, shortness of breath, excessive sweating, and arm or shoulder pain. Many women with coronary MVD have angina, but it may not by "typical."
• Women with coronary MVD may also have shortness of breath, sleep problems, fatigue (tiredness), and lack of energy. In women, symptoms are often first noticed during routine daily activities and times of mental stress.
• Medical history and a physical exam are used to diagnose coronary MVD. Your doctor may also give you tests for traditional CAD. These may include coronary angiography, stress testing, and magnetic resonance imaging cardiac stress testing. You also may be asked to fill out a questionnaire called the Duke Activity Status Index, which measures how well you're able to do your daily activities.
• If test results show you don't have traditional CAD, you can still be diagnosed with coronary MVD if evidence shows that not enough oxygen is reaching the small arteries in your heart.
• Women who have coronary MVD are treated with medicines to control symptoms and risk factors for heart disease. Women diagnosed with coronary MVD who have anemia may benefit from treatment for that condition.
• Women who are diagnosed and treated for coronary MVD should be checked regularly by their doctors.
• No specific studies have yet been done on how to prevent coronary MVD. It's not yet known how or in what way preventing coronary MVD differs from preventing CAD. People can take steps to delay or prevent CAD by making lifestyle changes, taking medicines, and getting regular medical care.
• If you have coronary MVD, you can take steps to stop it from getting worse. These may include lifestyle changes, medicines, and regular medical care.
• If you have symptoms of heart disease, know how and when to seek medical help. Be able to describe your symptoms, and know how to control them. Know which medicines you take and how to take them. Finally, know the limits of your physical activity and how to avoid or cope with stress.
• If you have signs and symptoms of a heart attack, such as chest pain, upper body discomfort, shortness of breath, and nausea, call 9–1–1 right away.