Small Vessel Disease

Diagnosis

To diagnose small vessel disease, a health care provider typically begins with a physical exam and a discussion about your medical and family history, especially any history of heart disease. Your provider may listen to your heart with a stethoscope to check for signs of cardiovascular issues.

Several tests used for diagnosing other types of heart disease may also be recommended. A stress test with imaging evaluates how the heart responds to physical activity. You may walk on a treadmill or use a stationary bike while connected to a heart monitor. In some cases, an IV medication is used to mimic the effects of exercise. Blood flow to the heart is measured using an echocardiogram or nuclear imaging.

A coronary angiogram may be performed to see whether the main arteries supplying the heart are blocked. During this test, a catheter is carefully guided through a blood vessel in the groin or wrist to the heart. Dye is injected to highlight the arteries on X-ray images, allowing the provider to see how blood moves through the vessels. Additional measurements can be taken during the procedure to assess blood flow.

A CT coronary angiogram is another option that uses a CT scanner to create detailed images of the heart and its blood vessels. Dye injected through an IV highlights the vessels during imaging. For some people, a PET scan may be used to measure blood flow to the heart muscle. After a radioactive tracer is injected, images are taken using a doughnut-shaped scanner.

More information: Coronary angiogram, MRI, Nuclear stress test, Positron emission tomography scan

Treatment

The main goals of treatment for small vessel disease are to manage the narrowing of the small arteries and reduce the risk of complications such as a heart attack. Treatment also focuses on relieving chest pain and improving overall heart function.

Medications commonly used to treat small vessel disease include:

• Nitroglycerin, available as tablets, sprays or patches, which helps relax coronary arteries and improve blood flow.
• Beta blockers to reduce heart rate and lower blood pressure.
• Calcium channel blockers that relax the muscles around the arteries, ease spasms and improve circulation.
• Statins to lower cholesterol and help repair blood vessel damage.
• ACE inhibitors or ARBs, which relax and open blood vessels, making it easier for the heart to pump.
• Ranolazine to help manage chest pain by affecting sodium and calcium levels.
• Aspirin to reduce inflammation and help prevent clot formation.
• Metformin, which is usually used to lower blood sugar but may also improve blood vessel health even in people without diabetes.

Regular follow-ups with a health care provider are important for monitoring symptoms, adjusting medicines and tracking overall heart health.