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A Different Type of Heart Disease
Lourdes Health System: Health Talk Online | September 2013

We often think of heart disease as having blood vessels narrowed and clogged with a waxy substance called plaque. But did you know it is possible to have heart disease, yet appear to have healthy coronary arteries?

Coronary microvascular disease (MVD) affects the tiny blood vessels that branch off from the larger coronary arteries. Yet instead of plaque being the culprit, the walls and inner lining of the tiny arteries are diseased or damaged, decreasing blood flow to the heart.

When the heart does not receive enough oxygen-rich blood to meet its need, a person can suffer chest pain (angina) or a heart attack.

"Until recently, patients with symptoms of cardiovascular disease but no evidence of coronary blockages were difficult to diagnose," said Lourdes-affiliated interventional cardiologist Kartik Giri, MD, FACC. "But thanks to advances in diagnostic tools, we are better able to treat these patients."

Causes

Women tend to develop MVD more frequently than men. Researchers believe that lower than normal estrogen levels may play a role.

In younger women, low estrogen levels before menopause can be caused by stress or a problem with the function of the ovaries. Younger women who have high blood pressure also are at higher risk.

After menopause, women tend to have more of the traditional risk factors for atherosclerosis, or hardening of the arteries, said Dr. Giri. They include:

Chest Pain a Common Sign

As with coronary heart disease, chest pain is a common symptom of MVD. With MVD, the chest pain can be more severe and last longer, between 10 and 30 minutes.

"Angina feels like pressure or squeezing in your chest. You also can feel it in your shoulders, arms, neck, jaw or back. It also can feel like indigestion," said Dr. Giri, of The Heart House. "It can be difficult to tell the difference between heartburn, angina or a heart attack. Seek emergency treatment."

Other symptoms of coronary microvascular disease include shortness of breath, problems sleeping, fatigue and lack of energy.

Symptoms are first noticed during routine tasks, such as cooking, cleaning, going to work or during stressful periods. It is less likely to be felt during physical activity.

"That is a key difference between coronary artery disease and coronary MVD," said Dr. Giri. "With coronary artery disease, symptoms often appear while jogging, walking on a treadmill or going up stairs."

Diagnosis and Treatment

Standard tests for artery disease are not designed to detect MVD. If tests such as coronary angiography (a special X-ray to look inside your arteries), a stress test or cardiac MRI come up negative, your doctor may suggest an endothelial dysfunction test. This test measures blood flow by inserting a catheter into the small blood vessels in your heart.

Treatments may include medicines such as:

"If you think you are at risk for heart disease, speak to your doctor about ways to control your risk factors," said Dr. Giri.

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