What is small vessel disease?

Small vessel disease is a condition in which the walls of the small arteries in the heart are damaged. The condition causes signs and symptoms of heart disease, such as chest pain (angina).

Small vessel disease is sometimes called coronary microvascular disease or small vessel heart disease. It’s often diagnosed after a doctor finds little or no narrowing in the main arteries of your heart, despite your having symptoms that suggest heart disease.

How common is small vessel disease?

Small vessel disease is more common in women and in people who have diabetes or high blood pressure. Please discuss with your doctor for further information.


What are the symptoms of small vessel disease?

The common symptoms of small vessel disease are:

  • Chest pain, squeezing or discomfort (angina), which may worsen during daily activities and times of stress
  • Discomfort in your left arm, jaw, neck, back or abdomen associated with chest pain
  • Shortness of breath
  • Tiredness and lack of energy

If you’ve been treated for coronary artery disease with angioplasty and stents and your signs and symptoms haven’t gone away, you might also have small vessel disease.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor? 

You should contact your doctor if you have any of the following:

If you’re having chest pain and other signs and symptoms — such as shortness of breath, sweating, nausea, dizziness, or pain that radiates beyond your chest to one or both of your arms or to your neck — seek emergency medical care.


What causes small vessel disease?

A narrowing of your heart arteries leads to small vessel disease. This can be caused by:

  • Spasms in your arteries
  • Damage to your artery walls
  • Diseased arteries.

Small vessel disease is not the same as coronary artery disease (CAD). CAD affects the large vessels in your heart. They carry oxygen-rich blood to your heart. CAD is caused by a build-up of a fatty substance (plaque) in your large vessels. When your heart lacks blood and oxygen, you can have a heart attack.

Risk factors

What increases my risk for small vessel disease?

There are many risk factors for small vessel disease, such as:

  • Being female
  • Tobacco use
  • Unhealthy cholesterol levels
  • High blood pressure
  • Obesity (body mass index of 30 or higher)
  • Unhealthy diet
  • Inactive lifestyle
  • Diabetes
  • Insulin resistance
  • Estrogen deficiency, in women
  • Polycystic ovarian syndrome
  • Increasing age, older than 45 in men and older than 55 in women
  • Chronic inflammation

It’s not clear why the same risk factors, such as obesity or an inactive lifestyle, cause some people to develop small vessel disease instead of large vessel coronary artery disease.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is small vessel disease diagnosed?

Because large vessel coronary artery disease and small vessel disease have the same signs and symptoms, it’s likely your doctor will check the main arteries in your heart first. If no problems are found, then your doctor might test for small vessel disease.

To diagnose small vessel disease, your doctor will also ask you about your medical history and family history of heart disease. During your exam your doctor will likely check for high cholesterol and diabetes.

The tests for small vessel disease are similar to those for other types of heart disease and include:

  • Stress test with imaging. You’ll either exercise on a treadmill or a bike or take a medication that raises your heart rate to mimic the effect of exercise.

Images will be taken of your heart using ultrasound images (echocardiogram) or with nuclear imaging scans to assess the blood flow to your heart muscle.

  • Coronary angiogram. This test helps doctors determine if the main arteries to your heart are blocked. A liquid dye is injected into the arteries of your heart through a catheter — a long, thin tube that’s fed through an artery, usually in your groin, to arteries in your heart. As the dye fills your arteries, they become visible on X-ray and video.
  • Positron emission tomography (PET). This test, which uses a radioactive dye and medication, can show your heart’s blood flow to other parts of your body. After the dye is injected, you lie in a doughnut-shaped machine to have images taken of your heart.
  • CT scan or CT angiography (CTA) scan. A CT scan combines a series of X-rays taken from different angles with computer processing to create detailed images. A CTA scan uses a contrast dye injected through a line in your arm or hand to assess your blood vessels.
  • In a cardiac MRI, you lie on a table inside a long tubelike machine that produces a magnetic field. MRI produces images of your heart that enables your doctor to see blockages.

If your doctor can’t find blockages in your main arteries based on these tests, you might have an additional test to check for blockages in the smaller arteries of your heart:

  • Endothelial dysfunction test. The endothelium is a layer of cells that line all of your blood vessels. When the endothelium isn’t functioning well, the blood vessels can’t expand properly.

To test endothelial function, a wire is threaded through a catheter inserted in one of your coronary arteries and a medication is injected into the artery that causes the small vessels in your heart to open. Then the blood flow through those vessels is measured.

This invasive test is the surest way to detect small vessel disease. Researchers are looking at noninvasive methods of endothelial function.

How is small vessel disease treated?

The treatment for small vessel disease involves medications to control the narrowing of your small blood vessels that could lead to a heart attack and to relieve pain. Your doctor could prescribe:

  • Nitroglycerin tablets, sprays and patches can ease chest pain by relaxing your coronary arteries and improving blood flow.
  • Beta blockers. These drugs, such as propranolol (Inderal, Innopran XL, others) and bisoprolol (Zebeta), slow your heart rate and decrease your blood pressure.
  • Calcium channel blockers. Drugs such as verapamil (Verelan, Calan, others) and diltiazem (Cardizem, Diltzac, others) relax the muscles around your coronary arteries and cause the vessels to open, increasing blood flow to your heart. They also control high blood pressure.
  • Medications such as atorvastatin (Lipitor) and simvastatin (Zocor) help lower cholesterol, which contributes to the narrowing of your arteries. Statins also help relax the blood vessels of your heart and treat blood vessel damage.
  • Angiotensin-converting enzyme (ACE) inhibitors. Medications such as benazepril (Lotensin) and lisinopril (Prinivil, Zestril) help open your blood vessels and lower your blood pressure.
  • Angiotensin II receptor blockers (ARBs). Medications such as azilsartan (Edarbi) and losartan (Cozaar) relax your blood vessels, which lowers your blood pressure and makes it easier for your heart to pump blood.
  • Ranolazine (Ranexa). This medication eases chest pain by altering sodium and calcium levels.
  • Aspirin can limit inflammation and prevent blood clots.

If you’re diagnosed with small vessel disease, you’ll need to see your doctor regularly for checkups. Your doctor will determine how often you’ll need to be examined, depending on the severity of your condition.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage small vessel disease?

The following lifestyles and home remedies might help you cope with small vessel disease:

  • Lose weight. If you are overweight, create a weight loss plan with your doctor.
  • Don’t smoke. Nicotine raises your blood pressure by causing your body to release adrenaline. It constricts your blood vessels and makes your heart beat faster. If you smoke, ask your doctor for help to quit.
  • Control your blood pressure. If you have high blood pressure, your doctor can suggest ways to lower it. Take medicines to treat high blood pressure should be taken with caution, per your doctor’s orders.
  • Improve your cholesterol levels. A healthy diet and exercise can balance your cholesterol levels. They lower your “bad” cholesterol (LDL) and raise your “good” cholesterol (HDL). LDL blocks your blood vessels and increases your risk of developing heart disease. Medicine also can help with this.
  • Regular exercise strengthens your heart and reduces your risk of heart disease. Before you start, talk to your doctor about the right kind of exercise for you. Try to exercise at least 4 to 6 times a week for at least 30 minutes each time.
  • Eat a healthy diet. Add foods to your diet that are low in cholesterol and saturated fats. Foods that are low-fat and raise your HDL levels help reduce your risk of heart disease.
  • Manage diabetes. Work with your doctor to keep your blood sugar under control.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.


Review Date: September 28, 2017 | Last Modified: September 28, 2017

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