What is small vessel disease?

Updated July 18, 2017

Small vessel disease is a cardiovascular condition that causes narrowing of the smaller blood vessels that provide blood flow to the heart. Individuals may experience the same symptoms of angina, or heart pain that accompany blockages in the major arteries of the heart. Small vessel disease is also called coronary microvascular disease. Symptoms of chest pain with exertion, without the presence of plaque or blockage in the large heart arteries can indicate small vessel disease.

Causes of Small Vessel Disease

Women are more prone than men to develop small vessel disease, especially after menopause. Women who have polycystic ovarian disease or autoimmune disorders are more likely to develop disease of the small vessels. Stress, chronic depression, tobacco dependence, lack of exercise, poor sleep quality, sleep apnoea, diabetes, obesity and blood pressure greater than 140/90 are risk factors for small vessel disease.


Narrowing of the small arteries, seen in disease of the small vessels, limits oxygen and blood supply to the heart. The effects can lead to heart failure, heart attack, frequent bouts of angina and sudden cardiac death. Small vessel disease can develop anywhere in the body, leading to diminished blood flow to the eyes, kidneys, heart and nerves. Small vessel disease can also lead to stroke, mini-stroke, dementia and diabetic retinopathy.


Chest pain is the most common symptom of small vessel disease that can occur with activity and even at rest. Coronary spasms can limit blood flow even further. Shortness of breath and fatigue with exercise, accompanied by other symptoms such as jaw pain, left arm pain or pressure in the chest are symptoms. Individuals with known heart disease who have been treated with surgery or stents, and have persistent symptoms of chest pain may be displaying symptoms of small vessel disease. Other symptoms include dizziness or lightheadedness, and swelling of the legs from heart failure.


Medications to reduce inflammation can prevent worsening of small vessel disease. Cholesterol lowering medications, known as statins, aspirin and medications that keep blood sugar levels in normal range may be prescribed. Medications to lower blood pressure, known as ACE inhibitors or ARBs can reduce the workload of the heart for management of symptoms and heart attack prevention. Frequent visits to the doctor for lab tests, blood pressure monitoring and medication adjustments are important treatments for small vessel disease.


L-arginine can help relax the blood vessels, and may be recommended by your doctor to help manage small vessel disease. Co-enzyme Q has been found to improve blood flow and help lower blood pressure. It is naturally produced in the body, but declines as people age. Co-enzyme Q in doses of 100 to 200 mg daily might be of benefit if you have been diagnosed with small vessel disease

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About the Author

Kathleen Blanchard is a registered nurse, with more than 10 years of experience in cardiovascular health, emergency room and ICU. She writes professionally for and Blanchard is currently employed as a senior case manager and has held certification as a critical care registered nurse (CCRN), advanced trauma life support (ATLS), and advanced cardiac life support (ACLS).