Coronary Microvascular Disease: Symptoms, Risk Factors, and Prevention

  • Coronary microvascular disease refers to a heart condition in which the small blood vessels within the organ become damaged and narrow, leading to potential complications.

  • Risk factors for developing this disease include being overweight, having type 2 diabetes, and leading a sedentary lifestyle.

  • To diagnose coronary microvascular disease, healthcare professionals conduct tests that generate images of the heart’s blood vessels and arteries.

  • Certain steps can be taken to prevent this condition, such as exercising regularly, consuming a heart-healthy diet, and managing chronic conditions.

About two in every five people currently have coronary microvascular disease (CMD). If you or someone you know has this condition, you’re not alone.

If you are diagnosed with CMD, understanding its causes, symptoms, and available treatment options is important.

Being informed allows you to manage this condition effectively and improve your quality of life.

In this article, we will discuss what coronary microvascular disease is, its risk factors, and the symptoms associated with the condition.

Coronary Microvascular Disease Explained

Within the heart, there are large blood vessels called coronary arteries. These arteries are connected to smaller vessels responsible for delivering blood to the heart muscle.

This blood carries oxygen and nutrients to the heart so that it can function effectively.

But if you have coronary microvascular disease (CMD), these small vessels become damaged and narrowed. This is why the condition is often referred to as small vessel disease (SVD).

Damaged and narrowed vessels may go into a spasm, meaning the heart can’t get the blood, oxygen, and nutrients it needs to function efficiently.

This can lead to several complications, including chest pain, increased risk of a heart attack, and abnormal heart rhythms — also known as arrhythmias.

How is Coronary Microvascular Disease Different from Coronary Artery Disease (CAD)?

Both CMD and coronary artery disease are cardiovascular conditions that could cause a heart attack. However, they impact your heart differently.

With coronary microvascular disease, fatty deposits called plaques form inside the larger vessels that overlay your heart — known as coronary arteries. This blocks blood flow completely.

By comparison, in cases of CMD, it's the small blood vessels, specifically the microvasculature, that can obstruct blood flow to the heart tissue, rather than a buildup of plaque.

The Risk Factors for Coronary Microvascular Disease

Certain people are more at risk of developing this condition than others. Factors that increase your susceptibility to CMD include:

Autoimmune disease

Although the connection between autoimmune disease and CMD is not fully understood, it’s possible that the chronic inflammation that occurs when the body mistakenly attacks its own tissue can result in vascular dysfunction.

This inflammation may also impact the inner lining of the blood vessels, called the endothelium.


Type 2 diabetes is primarily characterized by insulin resistance, which occurs when the body’s cells do not respond effectively to insulin.

Insulin resistance can lead to an abnormal level of lipids in the blood and high glucose levels.

High lipid content and elevated blood sugar can contribute to damage in the tiny blood vessels of the heart, potentially leading to CMD.

High blood pressure

Having high blood pressure (hypertension) can narrow and harden the heart’s blood vessels. When these vessels are damaged, the flow of blood becomes obstructed and less efficient, leading to the potential development of CMD.


A diet high in salt, saturated fat, and processed foods can lead to heart disease like CMD.

This is because it can give rise to health conditions like high blood pressure and insulin resistance, which impact the tiny blood vessels in the heart.

High cholesterol

When there is too much cholesterol in the blood, it can start to stick to the walls of the blood vessels.

This results in an accumulation of cholesterol in the blood vessels, potentially causing them to narrow. The blood flow through the vessels Is then reduced, which could lead to CMD.

A sedentary lifestyle

The heart is a muscle that needs to be exercised regularly to keep it healthy. Without doing any physical activity, the heart will grow weaker and become less effective at pumping blood.

Lack of exercise can also harm the flexibility and health of the heart's blood vessels.

Lastly, not including physical activity in your lifestyle can lead to weight gain, obesity, and insulin resistance. As mentioned above, these are all risk factors for CMD.


Smoking can significantly harm the blood vessels in the heart. It can also reduce the oxygen levels in the body and cause high blood pressure. These effects may result in CMD.

Being overweight or obese

Being overweight or obese can lead to:

  • Chronic inflammation

  • Insulin resistance

  • High blood pressure

As mentioned above, these health problems can contribute to the onset or progression of CMD.

The Main Symptoms of Coronary Microvascular Disease

People with CMD may experience the following symptoms:


If you have CMD, the heart struggles to meet the body’s need for oxygen-rich blood. This can result in reduced blood flow and insufficient oxygen supply to the cells in the body.

This extra effort by the heart can result in individuals with CMD feeling tired or fatigued.

Shortness of breath

When the body doesn’t get enough oxygenated blood, it can become more difficult to perform physical activities.

A lack of oxygen can lead to breathlessness as the body tries to take in more oxygen through increased breathing.

Chest pain

Due to the narrowing and damage of the small vessels in the heart and the restriction of blood flow, some patients with CMD may experience chest pain. This is often triggered by physical exertion or stress.

Sleep issues

Reduced oxygen supply to the body caused by CMD can lead to discomfort and restlessness, making it hard to sleep.

The chest pain and discomfort associated with CMD can cause significant sleep disruptions.

Testing for Coronary Microvascular Disease

If a healthcare provider suspects you have coronary microvascular disease, there are three tests they can run to diagnose this condition. These include:

  • A stress test: This determines how well your heart performs during physical exertion. The test can indicate if the blood supply in the heart is reduced.

  • Coronary angiography: An X-ray that shows whether your coronary arteries are narrowed or blocked.

  • Coronary magnetic resonance (CMR) imaging: A noninvasive test that uses magnetic field and radiofrequency waves to give healthcare professionals clear images of your heart and its major and minor arteries.

Treatment Options for Coronary Microvascular Disease

There are several medications that can be used to treat CMD effectively:

  • Angiotensin-converting enzyme (ACE) inhibitors: This medication can help to lower blood pressure, which can relax and widen the blood vessels in the heart, reducing damage.

  • Anticoagulants: In CMD, the damaged blood vessels can lead to the formation of blood clots. Anticoagulants thin the blood, reducing the risk of clotting so that blood can flow normally.

  • Aspirin: This is another option for thinning the blood and preventing clotting, lessening damage to the blood vessels, and improving blood flow.

  • Beta-blockers: This medication blocks the effect of adrenaline on the heart, reducing strain, slowing the heart rate, and improving heart function. It also lowers blood pressure and alleviates chest pain.

  • Calcium channel blockers: This medication relaxes and widens the blood vessels by preventing calcium from entering them. This helps to improve coronary blood flow, ensuring that more oxygen-rich blood can reach the heart muscle, reducing the symptoms of CMD.

  • Diuretics: Often called “water pills,” these medications help the body eliminate excess salt and water. They can help lower blood pressure, easing the heart’s workload. They also help to get oxygen-rich blood to the heart, which the body is unable to do with CMD.

  • Statins: These are medications that lower the amount of cholesterol in the blood. This can prevent the arteries and blood vessels from narrowing or becoming blocked by cholesterol. For people with CMD, it’s crucial to include treatments that prevent narrowed or blocked blood vessels, as this can result in chest pain and breathlessness.

How Can Coronary Microvascular Disease Be Prevented?

If you’re at risk of developing CMD, there are many things you can do to potentially reduce the chances of getting this condition.

Include physical activity in your routine

Regular physical activity can help to improve the health of blood vessels, including the smaller vessels in the heart. It can also assist blood vessels in relaxing and widening, improving blood flow.

Exercise also strengthens the heart muscle, which makes it pump blood more efficiently. A stronger heart can pump with less effort, reducing strain on the blood vessels.

Physical activity can also help reduce many of the risk factors listed above, including type 2 diabetes and high blood pressure.

Finally, this lifestyle modification can help relieve emotional stress, which negatively impacts heart health.

Pay attention to your diet

Eating a heart-healthy diet can potentially lower your risk of this condition.

A diet that supports heart health typically includes plenty of fruits and vegetables, whole grains, healthy fats, and lean protein.

It also means avoiding foods high in salt and saturated fats, such as full-fat dairy products.

Key Point: Other Strategies to Reduce the Risk of CMD

Eliminating risk factors is an effective way to avoid getting CMD. You can do this by:

  • Managing your blood pressure
  • Maintaining a healthy weight
  • Quitting smoking
  • Reducing high blood glucose levels

Where Can I Learn More About Coronary Microvascular Disease?

To learn more about CMD or discuss your symptoms, connect with one of our board-certified physicians or nurse practitioners online.

With LifeMD, you can skip the waiting room and get a same-day appointment. Visit our website to book a telehealth consultation to discuss CMD with a healthcare professional today.

LifeMD makes it easy to stay on top of your health because talking to a doctor, filling your prescriptions, getting your labs done—and more—are all easy and cost-effective. Come discover a healthcare solution built around you and your life.

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This article is intended for informational purposes only and should not be considered medical advice. Consult a healthcare professional or call a doctor in the case of a medical emergency.

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