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How is coronary microvascular disease diagnosed?

Diagnosing and treating coronary microvascular disease (MVD) challenges healthcare providers: standard tests used to diagnose coronary heart disease (CHD) focus on identifying blockages and may not always detect coronary MVD. More sensitive tests, such as nuclear scans or magnetic resonance imaging (MRI), can help to diagnose microvascular ischemia.
First, your doctor will take your medical history and do a physical exam to diagnose coronary microvascular disease (MVD). The doctor will check to see if you have any risk factors for heart disease. You will be weighed to check for obesity, and your cholesterol will be tested. You also will be tested for metabolic syndrome and diabetes.
Your doctor may ask you to describe any chest pain, including when it started and how it changed during physical activity or periods of stress.
Other symptoms such as fatigue (tiredness), lack of energy, and shortness of breath will be noted. Women will be asked about their menopausal status. Your doctor may order blood tests, including a test for anemia.
Specialists Involved
Doctors who diagnose and treat coronary MVD are most often specialists in cardiology (heart disease), family medicine, and internal medicine.
Diagnostic Tests
The risk factors for traditional coronary artery disease (CAD) and coronary MVD are often the same. Therefore, your doctor will use tests to help show if you have traditional CAD. These tests may include:
  • Coronary angiography: This test is a special x-ray exam of the heart and blood vessels. It shows plaque buildup in the large coronary arteries. This test is often done during a heart attack to help locate blockages.
  • A stress test: This test provides your doctor with information about blood flow through the coronary arteries to your heart muscle during physical stress. During stress testing, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast while heart tests, such as nuclear heart scanning and echocardiography, are performed. If coronary angiography doesn't show plaque buildup in the large coronary arteries, a stress test may still show abnormal blood flow. This may be a sign of coronary MVD.
  • A magnetic resonance imaging (MRI) cardiac stress test: This test is being used more widely to evaluate women with chest pain.
In coronary MVD, plaque can scatter, spread out evenly, or build up into blockages in the tiny coronary arteries. Plaque narrows the coronary arteries and reduces blood flow to the heart muscle.
Spasms of the small coronary arteries prevent enough oxygen-rich blood from moving through the arteries.
Research continues to improve ways to detect and diagnose heart disease caused by coronary MVD.
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