Small vessel disease

Diagnosis 

Your doctor will often conduct a physical examination, ask you about your medical history, and inquire about any family members who have had heart disease in order to diagnosis small vessel disease. The doctor will use a stethoscope to listen to your heart. 

Tests employed for identifying small vessel disease, akin to those used for detecting other types of heart disease, encompass: 

• Stress test and imaging. A stress test evaluates how the blood vessels and heart react to exertion. You might be asked to use a stationary bike or a treadmill while wearing a cardiac monitor. You may also receive an intravenous medication to stimulate the heart similarly to exercise. Nuclear imaging scans or ultrasound images (echocardiogram) are used to measure the amount of blood flowing to the heart muscle. 
• Coronary angiogram. This examination assists in identifying any heart artery blockages. In order to reach the heart, a long, thin, flexible tube (catheter) is placed into a blood vessel, typically in the groin or wrist. To reach the heart’s arteries, dye passes through the catheter. On X–ray images and video, the dye makes the arteries more visible. 

An angiography may include additional tests to assess the heart’s blood flow. 

• Computed Tomography (CT) coronary angiogram. The heart and its blood vessels are photographed using a strong X–ray machine in this other form of angiogram. As the CT scanner moves through a short, tunnel–like machine, you will be lying on a long table. Blood vessels are more visible on the CT scans due to a dye injection through an IV in the arm or hand. 
• Positron Emission Tomography (PET). In this test, blood flow to the heart muscle is measured using a radioactive tracer and medicine. You typically lie in a doughnut–shaped machine after the tracer injection to have images of the heart taken. 

Treatment 

Controlling the narrowing of the small blood vessels, which can result in a heart attack, and relieving discomfort are the objectives of treatment for small vessel disease. 

Drugs for small vessel disease may consist of: 

• Nitroglycerin. By relaxing the coronary arteries and enhancing blood flow, nitroglycerin tablets, sprays, and patches can reduce chest pain. 
• Calcium channel blockers. These medications allow the blood vessels to open and the muscles surrounding the coronary arteries to relax, increasing the amount of blood flowing to the heart. Calcium channel blockers also aid in the management of coronary artery spasms and high blood pressure. 
• Beta blockers. These medications lower blood pressure and slow the heart rate. 
• Aspirin. Aspirin helps reduce inflammation and prevent blood clots. 
• Statins. These drugs aid in reducing bad cholesterol, which causes artery narrowing. Additionally, statins aid in treating blood vessel damage and relaxing the heart’s blood vessels. 
• ARBs and ACE inhibitors. Angiotensin II receptor blockers (ARBs) and angiotensin–converting enzyme (ACE) inhibitors are medications that help dilate blood arteries and reduce blood pressure. This facilitates the heart’s ability to pump blood. 
• Ranolazine. The sodium and calcium levels are changed by this medicine, which reduces chest pain. 
• Metformin. This medication is frequently recommended to diabetics to help them control their blood sugar levels, but it can also benefit persons without diabetes by promoting the health of their blood vessels. 

If you have been diagnosed with small vessel disease, you will need to undergo regular medical evaluations with your doctor.