Q. I have been diagnosed with microvascular heart disease, which I was told mostly affects women and is not considered “serious” in and of itself. How long can it exist before it turns into serious heart disease?
A. Microvascular heart disease affects about four times as many women as men and “is serious, actually,” said Dr. Stacey Rosen, a cardiologist and spokeswoman for the American Heart Association’s Go Red For Women campaign, since it can lead to heart attacks, heart failure and death.
“It is not a benign diagnosis, and it absolutely can be treated and needs to be treated,” Dr. Rosen said. “Decades ago, when we didn’t understand this, we told women they didn’t have heart disease and they should take a Maalox or anti-anxiety medication, when in fact this was a form of ischemic heart disease that was poorly understood.”
While traditional coronary heart disease involves the buildup of plaque and resulting blockages in the large arteries that feed the heart muscle, microvascular heart disease affects the tiny branches or tributaries of these large vessels. Abnormalities in the endothelium, or inner lining, of these smaller vessels can cause spasms, resulting in pain and diminished blood flow to the heart.
Standard tests, such as angiograms, that are routinely used to detect coronary artery disease cannot detect abnormalities in these smaller vessels, so more specialized diagnostic tests may be required for a diagnosis. Treatment typically involves use of medications that keep cholesterol and blood pressure in check, aspirin to prevent blood clots, and nitroglycerin to relax the blood vessels and assuage chest pain.
Physicians also strongly recommend lifestyle changes, encouraging patients to quit smoking, since tobacco damages the endothelium, and to exercise within limits, since physical activity has a beneficial effect on the endothelium. It is also important to mitigate other risk factors for heart disease and to keep medical conditions like Type 2 diabetes in check.
If you have been given a diagnosis of microvascular heart disease, you should see your doctor regularly, be scrupulous about taking your medications, and be prepared to call for help if you think you may be having a heart attack. Shortness of breath, fatigue or pain in the jaw, left arm, back or neck may be warning signs of microvascular dysfunction or an imminent heart attack. Breaking out in a cold sweat, or feeling nausea or lightheadedness, may also be warning signs of a heart attack.