A Different Type of Coronary Disease: Microvascular Disease

By James M. Rippe

Some people who experience reduced flow of blood to the heart do not have narrowings of the larger coronary arteries caused by atherosclerotic plaque. Instead, they have coronary microvascular disease (MVD).

MVD occurs much more often in women than men, particularly in premenopausal or younger women. In MVD, smaller blood vessels in the heart, which range from 100 micrometers (about the size of a human hair) to 200 micrometers constrict, preventing adequate oxygenated blood from reaching the heart muscle.

As a result, people with MVD may have clear larger coronary arteries but still experience the symptoms of chest pain, although the discomfort is usually more diffuse and may last longer than with angina in CHD.

The causes of MVD are not yet clear, but chronic inflammation appears to play an important role. And the risks factors for CHD, such as high blood pressure (particularly before menopause), unhealthy cholesterol levels, smoking, and diabetes appear to contribute. Current research is also looking for possible risk factors unique to MVD as well as for more effective diagnostic techniques.

If you have symptoms of heart disease (see the following bulleted list) but have clear coronary arteries, ask your physician about MVD, particularly if you are a woman.

People with coronary artery disease and angina typically live with this problem for many years and discover how to manage it effectively with appropriate medicines and advice from their physicians. When angina pain changes in character, however, it can signal unstable angina or even heart attack. If you experience any of the following characteristics of chest discomfort, you need to call 911 and be taken to a hospital immediately:

  • Pain or discomfort that is worse than you have ever experienced before

  • Pain or discomfort that is not relieved by three nitroglycerin tablets in succession, each taken five minutes apart

  • Pain or discomfort that is accompanied by fainting or lightheadedness, nausea, and/or cool clammy skin

  • Pain or discomfort lasting longer than 20 minutes

If any of these symptoms occur, you need to call an ambulance and be taken immediately to a hospital. Under no circumstances should you drive yourself to the hospital.