Comprehensive Invasive Microvascular and Coronary Spasm Program

The Comprehensive Invasive Microvascular and Coronary Spasm Program at Cleveland Clinic Abu Dhabi’s Heart, Vascular & Thoracic Institute treats patients with microvascular disease and coronary spasm.

Microvascular dysfunction and coronary spasm are often misdiagnosed and not treated properly, because special procedures are needed to ensure a correct diagnosis. At Cleveland Clinic Abu Dhabi, our specialized interventional cardiologists use sophisticated testing methods and advanced equipment which can accurately screen for abnormalities which indicate the presence of these conditions.

Without the availability of such sophisticated testing, the conditions remain undetected by standard coronary artery angiograms, and patients experience recurrent chest pain that is incorrectly attributed to conditions such as stress and anxiety.

What We Treat

Microvascular dysfunction is a condition which affects the very small vessels that deliver blood to your heart tissue. If they become damaged, they can over constrict or not relax properly, which alters the pressure in the heart, leading to chest pain and an increased risk of heart disease.

Coronary spasm is a condition which can affect either the large arteries or the very small arteries of the heart. If they become damaged, they can result in the arteries squeezing significantly leading to either decreased blood flow to the heart or altering the pressures of the arteries of the heart, leading to chest pain and an increased risk of heart disease.

These conditions appear to be potentially more common in women than men in some cultures. People who smoke, have diabetes or hypertension are also more likely to have microvascular dysfunction and/or coronary spasm, which puts them at a higher risk of having a cardiac event.

Microvascular dysfunction can be caused by:

• Diabetes
• High blood pressure
• High cholesterol
• Family history of heart disease
• Lack of physical activity
• Obesity and being overweight
• Older age
• Smoking
• Unhealthy diet.

Coronary spasm can be caused by:

• High blood pressure
• High cholesterol
• Atherosclerosis
• Smoking
• Stress
• Exposure to the cold.

Diagnosis of Microvascular Dysfunction

People with microvascular disease often first notice symptoms during daily activities and times of mental stress. They occur less often during physical activity or exertion. This differs from disease of the major coronary arteries and main branches, in which symptoms usually first appear during physical activity. If you have microvascular dysfunction, learn the warning signs of a heart attack and the warning signs of a heart attack in women.

Other signs and symptoms of microvascular disease include:

• Fatigue
• Lack of energy
• Shortness of breath
• Sleep problems.

To accurately diagnose microvascular dysfunction, sophisticated testing methods and advanced equipment are used which detect abnormalities and indicate the presence of the condition. These tests not only detect abnormalities in the large coronary arteries, but also the extremely minute arteries that are undetectable to the human eye. Without sophisticated testing, this condition cannot be detected by a standard coronary artery angiogram.

Treating Microvascular Dysfunction

Treatment for microvascular dysfunction usually involves medication which helps the small blood vessels to relax and reduces the risk of complications associated with the condition.

Adopting a healthier lifestyle can also reduce the risk of complications. This includes:

• Eating a healthy, heart-friendly diet
• Exercising regularly
• Lowering blood sugar levels
• Lowering high blood pressure
• Maintaining a healthy weight
• Quitting smoking.

Diagnosis of Coronary Spasm

Coronary spasm presents as either exertional or non-exertional chest pain or pressure. It differs from blockages in the heart in that symptoms can often happen at rest as opposed to just during exercise. In severe cases of spasm, it can lead to a heart attack or cardiac arrest. It is common for chest pain to happen in the early morning. Coronary spasm is diagnosed with invasive functional testing by injecting a specialized medication into the heart’s arteries to look for spasm during a coronary angiogram. This test is only performed at specialized centers with trained Interventional Cardiologists. To diagnose the condition, a doctor will check the health of your heart and may perform:

• An echocardiogram
• An electrocardiogram
• A coronary angiography
• Remote monitoring (a monitor is given to wear at home)
• Invasive functional testing during a coronary angiography (can only be performed at specialized centers)

Treating Coronary Spasm

If you experience coronary spasm, a medication may be given which aims to alleviate chest pain, widen the arteries and increase blood flow. Medications, called calcium channel blockers, may be given to relax the arteries long term.

Reducing cholesterol levels and avoiding triggers such as smoking and being exposed to very cold temperatures, can reduce the risk of coronary spasms.