Understanding Coronary Microvascular Disease (CMD)

(A hidden cause of chest pain and heart disease, especially in women)

What is Coronary Microvascular Disease?

Coronary Microvascular Disease (sometimes called Small Vessel Disease) affects the tiny arteries (microvessels) in the heart. These vessels are too small to see on a standard angiogram but are crucial for delivering blood to the heart muscle.

In CMD, these microvessels don’t relax and dilate properly, leading to reduced blood flow — even when the larger coronary arteries appear normal.

Who Gets CMD?

CMD is more common in:

Women, particularly after menopause

People with high blood pressure, diabetes, or obesity

People with autoimmune or inflammatory conditions

Those with a history of preeclampsia or other pregnancy complications

How is It Detected?

There is no single routine test, but it can be assessed in research or specialized clinics using:

Chest pain, pressure, or discomfort (angina)

Shortness of breath

Fatigue, especially with exertion

Symptoms may come and go, or occur even at rest

CMD often causes angina-like symptoms, but tests for blockages may come back “normal,” which can delay diagnosis.

How is CMD Diagnosed?

Since CMD affects tiny vessels, it requires specialized testing, such as:

Coronary flow reserve (CFR) measurement

PET scan or cardiac MRI

Stress tests with advanced imaging

Invasive coronary reactivity testing

How is CMD Treated?

While CMD has no single “cure,” treatments focus on improving symptoms, vessel health, and reducing cardiovascular risk:

Lifestyle Changes

Stop smoking

Eat a Mediterranean or DASH-style diet

Exercise regularly, as tolerated

Manage stress and get adequate sleep

Maintain a healthy weight

Medications

Nitrates or ranolazine for chest pain

Beta-blockers or calcium channel blockers to improve vessel function

Statins and ACE inhibitors to reduce inflammation and improve endothelial health

Antiplatelet therapy in some cases

Takeaway

CMD is a real and treatable cause of chest pain and heart disease, even when major arteries look clear. If you have ongoing symptoms despite a normal angiogram, schedule an appointment with our team to discuss testing for microvascular disease.