ABOUT CORONARY MICROVASCULAR DYSFUNCTION
When the tests say normal, but the symptoms don’t stop
Coronary microvascular dysfunction (CMD) is one of the most common and least recognized causes of chest pain.
Millions of people have CMD, and most still do not have clear answers.
What Is Coronary Microvascular Dysfunction?
The heart relies on more than just its main arteries. A large network of tiny blood vessels, known as the coronary microcirculation, controls blood flow and oxygen delivery to the heart tissue.
When these smaller vessels fail to function properly, the result can be ongoing chest pain and related symptoms, even when the large coronary arteries appear completely normal.
Standard angiograms are designed to detect blockages in the major arteries. They cannot detect abnormalities in the microcirculation.
For many people, this leads to years of symptoms, repeated tests, and no clear answers.
Who Is Affected?
CMD can affect both men and women, but it is disproportionately common in women. Women with reduced coronary flow reserve have a two to four times higher risk of serious heart problems compared to others.¹
In one patient survey, more than three-quarters of respondents were told their symptoms were not cardiac in origin.
Many lived with symptoms for three or more years before receiving a diagnosis.²
ABOUT CORONARY MICROVASCULAR DYSFUNCTION
When the tests say normal, but the symptoms don’t stop
Coronary microvascular dysfunction (CMD) is one of the most common and least recognized causes of chest pain.
Millions of people have CMD, and most still do not have clear answers.
What Is Coronary Microvascular Dysfunction?
The heart relies on more than just its main arteries. A large network of tiny blood vessels, known as the coronary microcirculation, controls blood flow and oxygen delivery to the heart tissue.
When these smaller vessels fail to function properly, the result can be ongoing chest pain and related symptoms, even when the large coronary arteries appear completely normal.
Standard angiograms are designed to detect blockages in the major arteries. They cannot detect abnormalities in the microcirculation.
For many people, this leads to years of symptoms, repeated tests, and no clear answers.
Who Is Affected?
CMD can affect both men and women, but it is disproportionately common in women. Women with reduced coronary flow reserve have a two to four times higher risk of serious heart problems compared to others.¹
In one patient survey, more than three-quarters of respondents were told their symptoms were not cardiac in origin.
Many lived with symptoms for three or more years before receiving a diagnosis.²
Symptoms
Patients with CMD often experience these symptoms:
Chest pain or pressure
Shortness of breath
Tiredness or trouble exercising
Symptoms even while resting
The impact extends well beyond physical health. Patients report significant effects on work, daily activity, relationships, and mental health.²
For many, the hardest part is not the symptoms themselves, but the experience of not being seen.
Diagnosis
CMD cannot be diagnosed with a standard angiogram alone. Doctors need to do special tests during a heart catheterization, such as measuring coronary flow reserve (CFR) and the index of microvascular resistance (IMR).
Access to these tools is increasing, and recent clinical guidelines recommend this type of testing in patients with angina and no obstructive coronary artery disease.³
Abnormal results on these tests are linked to a higher risk of cardiovascular events, even in patients with no other risk factors.⁴
Current Management
Medical management remains the primary treatment approach, including anti-anginal medications and risk factor modification.
For many patients, symptoms persist despite optimal medical therapy. Interventional treatment options remain limited.
VahatiCor is developing the A-FLUX Reducer System® to help fill this treatment gap.
Footnotes
1. Bairey Merz CN, et al. Circulation. 2017;135:1075–1092.
2. Gulati M, et al. Int J Cardiol. 2023;371:28–39.
3. Kunadian V, et al. Eur Heart J. 2020;41:3504–3520.
4. Kelshiker MA, et al. Eur Heart J. 2022;43:1582–1595.
Diagnosis
CMD cannot be diagnosed with a standard angiogram alone. Doctors need to do special tests during a heart catheterization, such as measuring coronary flow reserve (CFR) and the index of microvascular resistance (IMR).
Access to these tools is increasing, and recent clinical guidelines recommend this type of testing in patients with angina and no obstructive coronary artery disease.³
Abnormal results on these tests are linked to a higher risk of cardiovascular events, even in patients with no other risk factors.⁴
Current Management
Medical management remains the primary treatment approach, including anti-anginal medications and risk factor modification.
For many patients, symptoms persist despite optimal medical therapy. Interventional treatment options remain limited.
VahatiCor is developing the A-FLUX Reducer System® to help fill this treatment gap.
Footnotes
1. Bairey Merz CN, et al. Circulation. 2017;135:1075–1092.
2. Gulati M, et al. Int J Cardiol. 2023;371:28–39.
3. Kunadian V, et al. Eur Heart J. 2020;41:3504–3520.
4. Kelshiker MA, et al. Eur Heart J. 2022;43:1582–1595.