What is Small Vessel Disease?

Small vessel disease (SVD) is a serious medical condition that adversely affects coronary arterial function and jeopardizes heart health. Frequently associated with the onset of atherosclerosis, SVD impacts an artery's ability to expand in order to accommodate proper blood flow. The condition is usually detected in the presence of more pronounced arterial constriction as occurs with atherosclerosis. Treatment for SVD is centered on slowing the progression of arterial narrowing and improving blood flow with the use of medications and supplements.

With normal cardiovascular function, small blood vessels within the heart work alongside the main coronary arteries to circulate oxygenated blood throughout the body. Small blood vessels are designed to expand or contract according to one’s level of activity to accommodate appropriate blood flow. Similar to atherosclerosis in its presentation, small vessel disease manifests as a constriction of the small blood vessels that impairs blood flow, jeopardizing circulation and heart function. Several factors may contribute to small blood vessel constriction and the development of small vessel disease, including plaque buildup, clot formation, and aneurysms.

Endothelial dysfunction often occurs in the presence of SVD, further impairing blood vessel expansion during periods of physical activity which may also contribute to additional vessel damage and constriction. The development of additional, contributory factors in the presence of SVD places the cardiovascular system at a significant risk for oxygen deprivation and permanent damage or dysfunction. Individuals with small vessel disease often experience a variety of signs and symptoms that commonly progress in presentation and severity.

Those with SVD most often develop chest pain, also known as angina, that may manifest as a tightening sensation within the chest area; sometimes central to the left side. Others may experience symptoms that include shortness of breath, pronounced fatigue, or profuse sweating. Sometimes, SVD symptoms may present similar to those associated with the flu, such as nausea, vomiting, and feelings of localized achiness or discomfort in the upper torso and neck.

There are several diagnostic tests that may be performed to confirm a diagnosis of small vessel disease. Individuals may undergo a series of imaging tests that may include a computerized tomography (CT) angiogram, positron emission tomography (PET) scan, and magnetic resonance imaging (MRI) to evaluate the condition of the heart muscle, blood flow, and any existing arterial blockages. An electrocardiogram (ECG) may also be performed to assess the electrical activity of the heart in order to detect any abnormalities indicative of impaired blood flow or arterial obstruction. Additionally, an endothelial dysfunction test may be ordered to evaluate and measure arterial blood flow.

Treatment for small vessel disease is generally centered on reducing arterial constriction, improving blood flow, and decreasing one’s chances for heart attack or other cardiovascular issues. Statins, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) are commonly prescribed to treat SVD-induced arterial constriction, prevent further arterial damage, and regulate blood pressure. Additionally, individuals may be placed on an aspirin regimen to prevent clotting while reducing their risk for heart attack and supplemental amino acid to ease discomfort related to SVD symptoms.

If symptoms are ignored and SVD remains undiagnosed, arterial constriction may worsen, placing the heart under additional stress and forcing it to work harder. The added stress, coupled with the insufficient circulation of oxygenated blood, increases one’s risk for cardiovascular complications, such as heart attack and heart failure. Several behavioral and lifestyle factors may also increase one’s risk for developing small vessel disease, including smoking, obesity, and regularly consuming a diet high in cholesterol. Those who have been diagnosed with certain medical conditions, such as rheumatoid arthritis and diabetes, may be at a greater risk for SVD. Individuals may reduce their risk for small vessel disease by pursuing a healthy lifestyle that includes maintaining a healthy body weight, consuming a balanced diet, and refraining from risky behaviors, such as smoking and excessive alcohol consumption.