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Small Vessel Disease: A Comprehensive Overview

Small vessel disease is a condition affecting the small arteries of your heart. Though challenging to diagnose, it’s treatable with certain medications and lifestyle changes. Keep reading for more info on small vessel heart disease, how it happens, and what you can do about it.

It’s a type of blood vessel disease in which the walls of the small arteries located in your heart become damaged. The condition is also known as coronary microvascular or small vessel heart disease. 

Patients start to show symptoms of heart disease, such as chest pain, but display little or no narrowing in their main arteries upon examination. Note that women with high blood pressure or diabetes have a greater chance of developing small blood vessel disease. Once your doctor detects it, however, effective treatment options are available.

Small vessel disease often presents symptoms similar to those of a heart attack ‒ particularly when you’re engaged in physical activity. They include:

  • Angina (e.g., chest pain, discomfort, a squeezing sensation that worsens with stress or activity)
  • Shortness of breath
  • Lack of energy and fatigue
  • Discomfort in your jaw, neck, back, left arm, or abdomen, in combination with chest pain 

Additionally, if you’ve been treated for coronary artery disease with stents and angioplasty but your symptoms didn’t improve, it could point to small vessel disease. 

Scientists believe small vessel heart disease can be attributed to the same factors as conditions that destroy the larger heart vessels. This includes high cholesterol, obesity, diabetes, and high blood pressure. 

While atherosclerosis creates fatty deposits (or plaque) buildup in your arteries, narrowing or blocking large vessels, small vessel heart disease is slightly different. Damage to small vessel walls compromises their ability to expand and receive blood. This is called endothelial dysfunction, and it prevents your heart from getting a sufficient supply of oxygen-rich blood.

Online research into small vessel heart disease is likely to turn up a lot of information on brain-related conditions as opposed to those impacting the heart. 

For instance, cerebral small vessel disease (SVD) is the parent term for a variety of small vessel disorders. These are also referred to as microvascular ischemic or small vessel ischemic diseases and can actually alter the walls of your brain’s smaller vessels.

Women possess a greater likelihood of developing small vessel heart disease, compared to men. Other factors to take into account include:

  • Smoking
  • High cholesterol
  • High blood pressure
  • Body mass index (BMI) of 30 or higher
  • Unhealthy diet
  • Insulin resistance
  • Diabetes
  • Low estrogen levels in women
  • Polycystic ovarian syndrome (PCOS)
  • Chronic inflammation
  • Age (women who are 55 or older and men who are 45 or older are more susceptible)
  • Inactive lifestyle
  • Family history of heart disease

What remains unclear is how obesity and an inactive lifestyle, among other things, can cause two seemingly opposite conditions. While some patients develop small vessel heart disease in response to such factors, others struggle with large vessel coronary artery issues. 

Your doctor will prescribe medication for small vessel heart disease in order to control the narrowing of small blood vessels. It also helps relieve pain and reduces your chances for a heart attack. Drugs commonly prescribed for small vessel disease include:

  • Nitroglycerin

It comes in tablet, patch, or spray form and serves to alleviate chest pain by improving blood flow and relaxing your coronary arteries. 

  • Beta blockers

They slow down your heart rate and lower blood pressure.

  • Angiotensin-converting enzyme (ACE) inhibitors

This class of drugs opens up your blood vessels and regulates blood pressure.

  • Angiotensin II receptor blockers (ARBs)

By relaxing your blood vessels, these also decrease blood pressure and aid your heart in pumping blood.

  • Statins

They bring your cholesterol levels down (stopping artery narrowing), relax the blood vessels in your heart, and treat prior damage. 

  • Calcium channel blockers

By relaxing the muscles surrounding coronary arteries, they allow blood vessels to open up and increase blood flow, while also battling high blood pressure. 

Keep in mind that your doctor may recommend taking aspirin, which is a blood thinner, to prevent blood clots and reduce inflammation. A diagnosis of small vessel disease means regular checkups; however, their frequency will depend on its severity. 

Small vessel heart disease is usually diagnosed via the same methods as other heart conditions. More common disorders affecting your main arteries would have to be excluded before your doctor considers the possibility of small vessel disease. Diagnostic tests could include:

  • Electrocardiogram (ECG or EKG)
  • CT scan (or CAT scan)
  • Cardiac MRI
  • CT angiography scan
  • Exercise stress test
  • Positron emission tomography (PET)

Although there’s no definitive research on how to avoid developing small vessel heart disease, it’s still beneficial to monitor and control its contributing factors. Reducing high cholesterol and blood pressure, not to mention weight loss (if you’re obese), may prove helpful in the long run. 

Also try taking the following preventive measures against small vessel heart disease.

  • Completely give up cigarettes and any products containing tobacco.
  • Exercise regularly to boost arterial blood flow and improve heart function. It also manages diabetes and maintains a healthy weight, all while battling high blood pressure/high cholesterol, and reducing your chances of a heart attack. Consider walking just 30 minutes a day, five times a week!  
  • Eat a heart-healthy diet full of low-fat dairy, lean meats, fruits, vegetables, and whole grains. Eliminate or cut back on sugar, salt, saturated and trans fats, and alcohol whenever possible. 
  • Get frequent cholesterol tests to keep tabs on your number. If it’s elevated, your doctor can prescribe medications and suggest dietary adjustments. 
  • Keep a close eye on your blood pressure. If you have a history of heart disease or hypertension, these numbers will require careful monitoring. 
  • Maintain a healthy body mass index. When you’re overweight, you become more susceptible to diabetes, high cholesterol, high blood pressure, and having a weakened heart. 
  • Control blood sugar, especially if you’re struggling with diabetes. Ask your doctor about your ideal blood sugar level and adjust accordingly. Steer clear of sugary foods and drinks to keep it in check. 
  • Minimize stress by re-evaluating work priorities, relationships, and daily habits. Practice relaxation techniques and hobbies like yoga and meditation. 

If you experience chest pain with nausea, dizziness, sweating, shortness of breath, or pain that seeps into your arms and neck, seek emergency care. Even if the diagnosis isn’t small vessel heart disease, it might be a symptom of another heart issue, like triple vessel disease. 

Small vessel disease affects your heart, while cerebral small vessel disease affects your brain. Both conditions have a detrimental impact on the small arteries of your primary organs. Note that small vessel disease is prevalent among older individuals and those leading an unhealthy lifestyle.  



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