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Treating microvascular dysfunction

By Tim Callahan05 Apr 2023



Cardiac microvascular dysfunction is a condition affecting the small blood vessels of the heart. It usually consists of abnormal vessel dilation or constriction, but with the right treatment, it's possible to improve microvascular flow and reduce the risk of associated health problems.

Microvascular dysfunction is different from the more common, large-vessel blockages which necessitate bypass surgery.

A patient with cardiac microvascular dysfunction may present with chest pain, but upon medical evaluation, may not present blockages in the arteries. Microvascular dysfunction is more common in younger women, according to the American Heart Association.

Older data suggested that chest pain with ischemia and non-obstructive coronary artery disease was innocuous. However, newer research reveals that these patients may have microvascular dysfunction and could be at risk for adverse events.

Treatments & Solutions For Microvascular Dysfunction

Cardiac microvascular dysfunction can lead to a range of health problems, including heart disease, diabetes and stroke, which is why it’s so critical to ensure swift treatment.

Here are some of the most common microvascular dysfunction treatments that your medical provider may mention.

Anti-atherosclerosis treatment

Anti-atherosclerosis treatments and low-dose aspirin are sometimes used to address the symptoms of microvascular dysfunction. These treatments are anti-inflammatory, combat oxidative stress and improve microvascular function.

C Noel Bairey Merz, et al, note that anti-atherosclerosis treatments “improve angina, stress testing, myocardial perfusion, coronary endothelial function, and microvascular function in small-size trials.”

Anti-anginal treatment

Anti-anginal treatments may prevent epicardial coronary vasospasm.

Merz, et al, again note “nebivolol improved left ventricular (LV) filling pressure and CFR in uncomplicated arterial hypertension suggesting myocardial stimulation of NO release and improvement in coronary microvascular function.”

Other therapies and novel treatments

Exercise training can have benefits for patients with microvascular dysfunction because it modulates nitric oxide pathways and adrenergic pathways, however, patient compliance as well as expense can be hindrances to implementation.

Medication therapy may also be a possibility in some cases.

Novel therapies of microvascular dysfunction include ACE-1s, which significantly improved cardiac flow reserve in a double-blind placebo controlled trial. The improvement of cardiac flow reserve greatly improved symptoms of angina.  

Nervous system agents have been considered in patients who experience ischemia and transient cardiac constriction with mental stress.

Other medications that have effects on the nervous system have been proposed for treatment. Preliminary findings are encouraging and support the need for additional larger, randomized, double-blind trials.

Lifestyle adjustments

In addition to medication, lifestyle adjustments can be used to treat microvascular dysfunction.

  • Losing weight if at an unhealthy weight
  • Getting enough physical activity
  • Quitting tobacco products
  • Having a healthy diet
  • Stress management

Microvascular surgery

In some cases, surgery may be required to treat microvascular dysfunction. This can include procedures like angioplasty, which is a procedure to open up blocked or narrow blood vessels.

During microvascular surgery, confirming patency of the vessels can be a challenge for surgeons.

Transit-time flow measurement can be a vital tool for surgeons during these procedures by providing immediate, quantitative data that help surgeons assess the quality of an anastomosis, reconstruction or replantation.

Learn more about how Transonic’s transit-time flow supports microvascular surgeons.