As the name indicates, small vessel disease is a condition that affects the small blood vessels in the heart. Small vessel disease is also called as coronary microvascular disease or small vessel heart disease. In this condition, the minute arteries in the heart are narrowed down resulting in symptoms of heart disease like chest pain (angina). Small arteries in the heart function to deliver extra blood to the heart when a person is exercising and it contracts when the person is resting. Small vessel disease is treatable, if detected on time.
Causes
Small vessel disease is caused by narrowing of the tiny arteries. The narrowing may be caused by spasms (sustained involuntary muscular contraction) in the artery, damage to the walls of the artery or building up of plaque (fatty substance) in the artery, a condition called atherosclerosis. Small vessel disease is different from coronary artery disease, which is caused by blockage in the larger arteries of the heart.
Risk factors
Some people are at high risk of being affected by small vessel disease. The risk factors include
- High level of blood cholesterol (>240 mg/dL)
- High blood pressure over 140/90 mm Hg
- Diabetes
- Insulin resistance
- Obesity
- Sedentary mode of life
- Being female
- Deficiency of estrogen hormone in females
- Tobacco smoking
- Age above 45 years in men and above 55 years in women
These risk factors may also cause coronary artery disease but why cause small vessel disease in few is unclear. As small vessel disease is common in women, it is predicted that the condition might be associated with other female medical conditions like polycystic ovaries (cyst in ovaries), rheumatoid arthritis, lupus (chronic skin disease), migraine with aura that are common in women.
Symptoms
Symptoms of small vessel disease include chest pain with feeling of squeezing or discomfort over the left side of the chest. There may be discomfort in the jaw and left arm. The chest pain worsens with activity, and is accompanied by excess sweating, shortness of breath, fainting or light headedness, and discomfort in the neck, shoulder, upper back, and abdomen. The person may complain of fatigue or lack of energy.
Complications
Blockage in the small arteries can make the heart pump harder to supply blood to other parts of the body. If left untreated, small vessel disease can lead to complications like coronary artery spasms, heart attack, heart failure, and sudden cardiac death.
Diagnosis
Small vessel disease may be diagnosed when the doctor looks for any blockage in the larger arteries of heart that cause coronary heart disease, but do not find any narrowing or blockage of the larger arteries, though the patient complaints of chest pain and other symptoms. Diagnosis of small vessel disease is done by physical examination, previous medical history, and family history of heart disease. Diagnostic procedures include checking blood cholesterol level, to see whether cholesterol is blocking the small artery. ECG detects the electric pulse that heart makes. This helps to diagnose any irregularity in heart beat and heart structure that might be because of narrowed arteries. The heart rate and the blood flow to the heart is measured by echocardiogram that takes images of the heart while the person is exercising on a treadmill or stationary bike/cycle. Computerized tomography (CT) helps the doctor to see whether there is any blockage in the larger arteries. A cardiac MRI captures images of the heart from which the doctor look for any blockage in the arteries. Positron emission tomography (PET) helps to detect the flow of blood from heart to other parts of the body. Coronary angiogram is done to check whether the main arteries in the heart is narrowed or blocked.
If the above tests do not show any blockage in the larger arteries then the doctor will perform endothelial dysfunction test to determine blockage in the smaller arteries. Endothelial dysfunction test is an invasive but very effective test where the doctor threads a wire through catheter into one of the coronary artery. A small amount of medication that opens the small vessel is injected into the arteries, which allows measuring the blood flow through the small vessels.
Treatment
Immediate treatment is very essential for small vessel disease as this can make the heart pump harder and lead to fatal complications. Surgery is not an option as the arteries are very small. Doctor will prescribe medicines that will keep the symptoms at bay and prevent narrowing of the arteries. Some medicines that may be prescribed are
- Nitroglycerin tablets, spray or patches reduces chest pain by opening the coronary artery
- Calcium channel blockers relaxes the muscles surrounding the coronary arteries and increase the blood flow to heart thereby decreasing blood pressure
- Beta blockers slows the heart rate and decreases blood pressure
- Statins changes the way body uses cholesterol, it also relaxes blood vessels of the heart
- Angiotensin II receptor blockers are prescribed to relax the blood vessels and decrease blood pressure
- Angiotensin-converting enzyme inhibitors opens up the blood vessels and increases blood flow and decreases blood pressure
Regular check-ups are essential for small vessel disease; frequency of check-ups will be decided by the doctor depending on the severity of the disease.
Prevention
Controlling the risk factors is the best way to prevent small vessel disease. People who smoke should quit smoking, as smoking constricts blood vessels and increases blood pressure. Obese people should try to reduce weight. Regular exercise can lower cholesterol level, help to maintain body weight, lower blood pressure, and make the heart stronger and reduce the risk of heart disease. Blood pressure should be kept under control by taking proper prescribed medications. Cholesterol levels should also be kept close to normal by exercising and eating healthy. Maintaining blood glucose level close to normal is important. People with small vessel disease should learn to manage stress, as it can increase the risk of complications.
Outlook
Heart disease should always be dealt with utmost seriousness, as any delay can prove fatal. In case of small vessel disease, only the name sounds non-serious but it is a condition that can result in very serious complication if ignored. Any signs of chest pain along with pain in the jaw and left arm should be immediately given medical attention. Two things that every person should follow in order to stay healthy are – healthy diet and regular exercise.
