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Coronary Microvascular Disease

Coronary microvascular disease is a condition that affects the walls and lining of the tiny blood vessels that branch off of the larger coronary arteries.

Damage to the walls and lining of the blood vessels can reduce blood flow to the heart, as well as lead to spasms.

Risk factors

Women develop coronary microvascular disease more frequently than men. The disease also occurs more frequently in young women.

Both men and women with coronary microvascular disease often have an accompanying condition, such as diabetes.

Other risk factors for coronary microvascular disease include:

  • High cholesterol
  • High blood pressure
  • Smoking
  • Obesity
  • Sedentary lifestyle
  • Poor, unhealthy diet
  • Age
  • Family history

In women, there are additional risk factors for coronary microvascular disease:

  • Lower estrogen levels
  • Low estrogen before menopause
  • High blood pressure before menopause
  • Low iron levels in the blood


Although there are several symptoms that can be a sign of coronary microvascular disease, there are a few that are specific to women, including:

  • Shortness of breath with exertion
  • Unusual, unexplained fatigue
  • Nausea
  • Pain in the jaw or left arm


Diagnosing coronary microvascular disease requires skill and expertise in recognizing the symptoms.

  • Stress test. When you experience symptoms of heart disease, the first step to identify the problem is a stress test. Stress tests do not always diagnose coronary microvascular disease, however. If symptoms continue, the patient undergoes the next diagnostic test.
  • Endothelial function test. This test checks the function of endothelial cells in the smallest arteries of the heart. If the small arteries don't open or close properly, it is a sign of coronary microvascular disease.
  • Coronary reactivity testing. A coronary reactivity test is similar to the endothelial function test, although it checks the function of larger arteries.


Treatment and prevention of coronary microvascular disease focuses primarily on controlling risk factors and symptoms.

Prevention strategies may include:

  • Lifestyle changes
  • Blood pressure medications
  • Nitroglycerin to relax blood vessels
  • Cholesterol medications

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