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Tests and diagnosis
By Mayo Clinic staffTo diagnose small vessel disease, you'll need a physical exam. Your doctor will also ask you about your medical history and any family history of heart disease. Your doctor will likely check your cholesterol levels to see if high cholesterol could be clogging your arteries and causing chest pain.
The tests for small vessel disease are similar to those for other types of heart disease and include:
- Electrocardiogram (ECG). In this noninvasive test, a technician will place probes on your chest that record the electrical impulses that make your heart beat. An ECG records these electrical signals and can help your doctor detect irregularities in your heart's rhythm and structure that might indicate narrowed or blocked arteries.
- Stress test with imaging. Your doctor may perform an exercise stress test when checking for coronary artery disease, but without any images of the heart, it's usually not enough to diagnose small vessel disease. For this type of stress test, you'll either exercise on a treadmill or a bike, or take a medication that raises your heart rate to mimic the effect of exercise. Then, your doctor will take images of your heart using ultrasound images (echocardiogram) or with nuclear imaging scans to check your heart's function and assess the blood flow to your heart muscle.
- Positron emission tomography (PET). This test can show your heart's blood flow to other parts of your body. In this test, you'll have a radioactive dye injected so that your heart will show on the scan. Then, you'll lie in a doughnut-shaped machine to have images taken of your heart, which will be sent to a computer monitor for your doctor to see. PET scans may help your doctor diagnose small vessel disease, but the test is expensive and not widely used.
- Computerized tomography (CT) angiogram. A CT angiogram allows your doctor to check your large arteries to see if they're narrowed or blocked. In this minimally invasive test, you'll change into a hospital gown and lie on a table that's part of the CT scanning machine. You'll receive an injection of a radioactive dye, and the doughnut-shaped CT scanner will be moved to take images of the arteries in your heart. The images are then sent to a computer screen for your doctor to view.
- Magnetic resonance imaging (MRI). In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. Images of your heart are created from these signals, which your doctor will look at to determine if the main arteries in your heart are blocked.
- Coronary angiogram. This test helps doctors determine if the main arteries to your heart are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a catheter — a long, thin tube that's fed through an artery, usually in your groin, to arteries in your heart. As the dye fills your arteries, they become visible on X-ray and video.
If your doctor can't find any blockages in your main arteries based on these tests, you'll have an additional test to check for blockages in the smaller arteries of your heart:
- Endothelial dysfunction test. In this test, a wire will be threaded through a catheter inserted in one of your coronary arteries. Your doctor will then inject a medication into the artery that causes the small vessels in your heart to open and let blood rush through, and then the blood flow through those vessels is measured. Although this test is invasive, it's a good way to detect small vessel disease.
References
- Lanza GA, et al. Primary coronary microvascular dysfunction: Clinical presentation, pathophysiology, and management. Circulation. 2010;121:2317.
- What is coronary microvascular disease? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/cmd/cmd_all.html. Accessed July 10, 2010.
- Beltrame JF, et al. Advances in coronary microvascular dysfunction. Heart, Lung and Circulation. 2009;18:19.
- Camici PC, et al. Coronary microvascular dysfunction. New England Journal of Medicine. 2007;356:830.
- Lakhani K, et al. Microvascular dysfunction in women with polycystic ovary syndrome. Human Reproduction. 2005;20:3219.
- Topcu S, et al. Metformin therapy improves coronary microvascular function in patients with polycystic ovary syndrome and insulin resistance. Clinical Endocrinology. 2006;65:75.
- Foster W, et al. Inflammation and microvascular and macrovascular endothelial dysfunction in rheumatoid arthritis: Effect of treatment. The Journal of Rheumatology. 2010;37:711.
- Kurth T, et al. Migraine and ischaemic vascular events. Cephalalgia. 2007;27:965.
- Coenzyme Q10. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed July 11, 2010.
- Littarru GP, et al. Clinical aspects of coenzyme Q10: An update. Nutrition. 2010;26:250.
- Hamilton SJ, et al. Coenzyme Q10 improves endothelial dysfunction in statin-treated type 2 diabetic patients. Diabetes Care. 2009;32:810.
- L-arginine. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed July 11, 2010.
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