Small vessel disease occurs when the heart's small arteries narrow. The small vessels in the heart expand when you’re physically active and need additional oxygen in the blood. When they narrow due to small vessel disease, they don’t expand with activity.

Causes of small vessel disease

Risk factors for small vessel disease include:

  • Tobacco use
  • Diabetes
  • A sedentary lifestyle
  • Insulin resistance
  • Obesity
  • High cholesterol
  • High blood pressure
  • Estrogen deficiency in women

Many of these risk factors can be reduced or eliminated by changing your lifestyle. Researchers believe women are more likely than men to develop small vessel disease. Patients with diabetes are also known to develop small vessel disease.

Symptoms of small vessel disease

Small vessel disease can cause chest pain and symptoms similar to a heart attack, including:

  • Discomfort in the neck, shoulder, back or abdomen
  • Nausea
  • Fatigue
  • Dizziness
  • Sweating
  • Difficulty catching your breath

The chest pain often occurs during activity.

How Ohio State diagnoses small vessel disease

Diagnosis is typically made if you have ongoing symptoms and significant disease in the main arteries has been excluded. Tests to diagnose small vessel disease are similar to those for other types of heart disease:

  • Electrocardiogram (EKG or ECG) – A test that records the electrical activity of the heart.
  • CT scan (computed tomography scan, also called CAT scan) – An imaging procedure that uses X-rays and computer technology to produced cross-sectional, detailed images of the body, including bones, muscles, fat and organs.
  • Cardiac MRI (cardiac magnetic resonance imaging or CMR) – A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of the structure and function of the heart while it is beating.
  • CT angiogram (CTA - computed tomography angiogram) – An imaging procedure that uses CT technology to produce cross-sectional, detailed images of blood vessels.
  • Exercise stress test – A test performed on a treadmill or stationary bicycle to measure heart, lung and muscle function during physical activity. You are attached to an electrocardiogram (EKG/ECG) to record electrical activity of the heart.
  • Positron emission tomography (PET) – A nuclear medicine procedure to measure metabolic activity of cells of body tissues. A tiny amount of a radioactive substance is used to evaluate information about the function and structure of the organ or tissue.

How Ohio treats small vessel disease

Small vessel disease is treated with medication to halt narrowing of the small blood vessels. Because these vessels are so small, surgery is not usually an option.

Studies have shown that women with ongoing chest pain (even with normal main heart arteries) have a higher incidence of cardiac events than those without chest pain. These women are often undiagnosed and untreated for small vessel disease.


Angiotension-converting enzyme (ACE) inhibitors, angiotension II receptor blockers (ARBS), statins, beta-blockers and aspirin therapy may be prescribed to treat small vessel disease.

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