It is common in the world of cardiology, when artery health is discussed, to focus on the main, larger arteries. If those arteries become damaged or clogged, serious health issues can happen fast.

But the walls of the heart’s smaller arteries also can become damaged because of coronary microvascular disease.

Large arteries are just half the story

“The main, big arteries that may require stents or bypass surgeries when there is a problem receive a great deal of attention in the medical community,” said Dr. Shereif Rezkalla, a Marshfield Clinic cardiologist. “But that is only half the story. Taking care of the small blood vessels is critical, too.”

Unlike clogs in larger arteries, microvascular disease is not a result of plaque buildup. Rather, the walls of these tiny arteries can be damaged or spasm, which reduces blood flow to the heart.

Microvascular issues can result in something called no reflow phenomenon. This occurs when a coronary artery blockage is removed, but blood flow does not return to normal because of microvascular damage. In the case of a heart attack that is followed by no reflow phenomenon, medications can be injected that help restore microvascular function.

Protecting against coronary microvascular disease

Risk factors for coronary microvascular disease are similar to those for atherosclerosis – obesity, diabetes, smoking and lack of physical activity.

“Usually cholesterol affects the large arteries, but the smaller vessels are affected by other factors, such as diabetes,” Dr. Rezkalla said. “It’s very important to realize whenever you see a patient with chest pain and shortness of breath, but you do an angiogram and the big arteries look clear, that this may not be the end of the story.”

The way to protect against coronary microvascular disease is similar to any heart-protection plan. You need to eat well, exercise regularly and avoid smoking.

“Usually, the same things that protect the large arteries will also be what protects the microvascular arteries,” Dr. Rezkalla said.

If you have concerns about chest pain or your heart function, talk with your provider.