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Microvascular Ischemic Disease - Symptoms, Causes, Risk Factors, Diagnosis, Treatment, and Prevention

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Microvascular Ischemic Disease - Symptoms, Causes, Risk Factors, Diagnosis, Treatment, and Prevention

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Microvascular ischemic diseases are a group of diseases that affect the small blood vessels in the body. Read this article to know more.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At November 5, 2019
Reviewed AtApril 4, 2024

What Is Microvascular Ischemic Disease?

The group of diseases that result from changes to the small blood vessels in the brain is known as microvascular ischemic disease or small vessel ischemic disease or cerebral small vessel disease. If it affects the small blood vessels of the heart, it is called coronary microvascular disease.

Such changes can damage the white matter of the brain, which contains nerve fibers that connects other parts of the brain. This condition is common in older adults, and if left untreated, it can lead to memory problems, balance problems, and stroke.

In the heart, this disease damages the walls of the small arteries, which results in signs and symptoms of heart disease like chest pain, dyspnea.

The blood flow in the small blood vessels of other organs like kidneys, eyes can also get blocked and can lead to microvascular ischemic disease.

What Are the Signs and Symptoms of Microvascular Ischemic Disease?


Milder forms of this disease do not produce any signs or symptoms, even if they damage a small part of the heart or brain. This is the reason it is called “silent” disease. In severe cases, the following signs and symptoms are seen:


  • Cognitive impairment (loss of the ability to think).

  • Walking and balance issues.

  • Depression.

  • Weakness on one side of the body.

  • Confusion.

  • Speaking problems.

  • Loss of vision.

  • Dizziness.

  • Severe headache.


  • Chest pain.

  • Left-arm pain.

  • Jaw and neck pain.

  • Dyspnea (shortness of breath).

  • Lack of energy.

Get immediate medical help if one notices these symptoms, as it is a medical emergency.

What Causes Microvascular Ischemia?


The cause of microvascular ischemic disease is believed to be the result of atherosclerosis, which is caused by plaque buildup and hardening that damages the blood vessels. This narrowing of blood vessels can result in stroke and heart attacks.

This damage to the blood vessel can block blood flow and deprive the brain or heart cells of oxygen, or the blood vessels can break and bleed.

What Are the Risk Factors for Microvascular Ischemic Disease?

The factors that increase the risk of microvascular ischemic disease are:

  • Hypertension (high blood pressure).

  • High cholesterol.

  • Smoking.

  • Obesity.

  • Diabetes (high blood sugar).

  • Aging.

  • Atherosclerosis.

  • Atrial fibrillation.

  • Inactive lifestyle.

  • Unhealthy dietary habits.

  • Chronic inflammation.

  • Polycystic ovarian syndrome (PCOS).

What Are the Complications of Microvascular Ischemic Disease?

If left untreated, and if the blood flow is blocked or the blood vessel ruptures, severe complications can result. The common complications include:



How Is Microvascular Disease Diagnosed?

If one has symptoms that point towards microvascular ischemic disease, then the doctor will suggest to get the following tests:


  • MRI Scan - This diagnostic test uses strong magnetic and radio waves to form a detailed image of your brain. Microvascular ischemic disease can appear as small strokes (lacunar infarcts) or white matter lesions (white matter hyperintensities) or bleeding from small blood vessels (cerebral microbleeds).


  • Treadmill Test or Stress Test - The heart rate is monitored while you exercise on a treadmill or a bike.

  • Coronary Angiogram - To check if the major heart arteries are blocked.

  • Positron Emission Tomography (PET) - It shows heart's blood flow to other parts of the body.

  • CT and MRI Scan - To obtain a detailed image of the heart and blood vessels.

  • Endothelial Dysfunction Test - This test is done if the doctor cannot find any abnormality in the major blood vessels. The blood flow in the small blood vessels is checked.

How Is Microvascular Ischemic Disease Treated?

Treatment is done to manage the risk factors that contribute to this condition. It includes:

  • Treating hypertension with the help of diet, exercise, and medication.

  • With diet, exercise, and medicines, the cholesterol level is reduced.

  • Taking medicine to lower homocysteine levels.

  • To use blood-thinning drugs to prevent strokes.

  • Quitting smoking.

The medications used are:

  • Nitroglycerin to ease chest pain.

  • Beta-blockers like Propranolol Bisoprolol to treat hypertension.

  • Angiotensin II receptor blockers (ARBs) such as Azilsartan help relax your blood vessels and lowers blood pressure.

  • Calcium channel blockers like Verapamil and Diltiazem to increase blood flow to the heart and control high blood pressure.

  • Ranolazine helps relieve chest pain by regulating the sodium and calcium levels.

  • Aspirin to prevent blood clots.

  • Statins like Atorvastatin and Simvastatin to lower cholesterol.

  • Angiotensin-converting enzyme (ACE) inhibitors like Benazepril and Lisinopril for hypertension.

What Are the Ways to Prevent Microvascular Ischemic Disease?

Some tips to prevent this condition are:

  • Avoid smoking and using other tobacco products.

  • Eat a healthy and balanced diet.

  • Exercise regularly.

  • Check the cholesterol levels at regular intervals.

  • Keep monitoring your blood pressure.

  • Maintain a healthy weight.

  • Prevent and manage all kinds of stress.

  • Keep the blood sugar level under control.

  • Limit the intake of alcohol.

What Is the Prognosis for Microvascular Ischemic Diseases?

Microvascular ischemic disease can have major, potentially fatal consequences if left untreated. Stroke and significant cognitive decline are two of these. Individuals may be able to lead an active, independent life and delay the advancement of their condition if they adhere to a customized treatment plan.


Microvascular ischemic disease can lead to stroke, heart attack, dementia, and even death. It does not cause any symptoms in the early stages, so the best way to prevent these complications is by preventing damage to small blood vessels. Follow the above preventive measures, which will not only prevent this disease but most of the chronic and life-threatening diseases. For more information on this condition, consult a doctor online.

Frequently Asked Questions


Can Microvascular Illness Be Cured?

Yes, it can be cured by managing the risk factor associated with microvascular illness. It includes:
- Use diet, exercise, and medicine to treat hypertension.
- The cholesterol level is decreased by diet, exercise, and medications.
- Using medication to reduce homocysteine levels.
- To prevent strokes by using blood-thinning medication.
- To stop smoking.


What Is the Severity of Microvascular Disease?

It is a serious illness that can become fatal if not treated in a timely manner and if the blood vessel ruptures or the blood flow is obstructed. The following are the serious complications of the disease:
- Dementia.
- Stroke.
- Cardiac arrest.
- Angina.
- Chronic heart failure.


Is Heart Failure a Possible Result of Microvascular Disease?

Heart failure risk was higher in people with a microvascular illness. Microvascular ischemic illness is thought to develop from atherosclerosis, which harms blood arteries by causing plaque formation and stiffening. A stroke or a heart attack may arise from this blood artery narrowing.


How Widespread Is Microvascular Illness?

A microvascular ischemic condition may result in a heart attack, stroke, dementia, or even death. The easiest strategy to avoid these consequences is to avoid harm to small blood vessels because it does not exhibit any signs in the early stages. Angina is present in 30 percent of patients and is linked to higher morbidity and mortality rates.


How Long Can Someone With Small Vessel Disease Survive?

A microvascular ischemic condition may result in a heart attack, stroke, dementia, or even death. Angina is present in 30 percent of patients and is linked to higher morbidity and mortality rates.


Can COVID Result in Microvascular Illness?

Older people, diabetics, hypertensives, patients with atherosclerosis (clinical or subclinical), and people with established cardiovascular disease may all share an underlying medical condition that compromises innate immunity. There is a good chance that the patients with higher COVID-19 mortality rates have a microvascular disease.


What Is the Ideal Ischemia Treatment?

The following treatment modalities are used to treat ischemia:
- To reduce chest pain, take Nitroglycerin.
- Propranolol Bisoprolol and other beta-blockers are used to treat hypertension.
- Angiotensin II receptor blockers like Azilsartan block the angiotensin II receptor, aid in blood vessel relaxation, and reduce blood pressure.
- Verapamil and Diltiazem are calcium channel blockers that improve blood flow to the heart and lower blood pressure.
- Ranolazine controls sodium and calcium levels, which relieves chest discomfort.
- Taking Aspirin to avoid blood clots.
- Atorvastatin and Simvastatin are two statins that reduce cholesterol.
- ACE inhibitors, such as Lisinopril and Benazepril, are used to treat hypertension.


Does Microvascular Illness Run in Families?

Small arteries do not normally relax (dilate) when coronary microvascular ischemia occurs. The outcome is that the heart does not receive enough blood that is rich in oxygen. According to experts, disorders affecting the bigger vessels of the heart, such as high blood pressure, excessive cholesterol, obesity, and diabetes, share the same root causes as small vessel disease. Another important element, particularly for women, is a family history of the illness.


How Is Microvascular Angina Tested For?

If the patient exhibits signs of microvascular ischemic illness, the doctor may advise getting the following tests:
- Brain
- MRI (Magnetic Resonance Imaging)Scan - Diagnostic procedure that creates a precise image of the brain using powerful magnetic and radio waves. Small strokes (lacunar infarcts), white matter lesions (white matter hyperintensities), or bleeding from small blood vessels can all be symptoms of ischemic microvascular illness (cerebral microbleeds).
- Heart
- Heart rate is tracked when exercising on a treadmill or bike during a treadmill test or stress test.
- To determine whether the main cardiac arteries are obstructed, undergo coronary angiography.
- Positron emission tomography (PET): It depicts the heart's blood flow to various bodily components.
- Use a CT (Computed Tomography) or MRI (Magnetic Resonance Imaging) scan to get a precise picture of the heart and blood vessels.
- Test for endothelial dysfunction - This test is performed if the doctor cannot detect any abnormalities in the major blood vessels. The tiny blood arteries' blood flow is examined.


What Are the Symptoms of Microvascular Angina?

- Heart
- Chest pain.
- The ache in left arm.
- Neck and jaw ache.
- Dyspnea (shortness of breath) (shortness of breath).
- Lacking in energy.
- Brain
- Cognitive dysfunction (loss of the ability to think).
- Difficulties with balance when walking.
- Depression.
- A physical weakness on one side.
- Confusion.
- Speaking difficulties.
- Absence of vision.
- Dizziness.
- A terrible headache.


What Should a Person With Ischemia Avoid Eating?

After consuming large amounts of salt, sugar, processed carbohydrates, and saturated fat over a long period of time, switching to a healthy diet might be difficult. The following foods should be avoided if the patient has coronary artery disease:
- Whole milk.
- Bacon.
- Sausages made with butter.
- Biscuits.
- Cream.
- A fried dish.
- Food prepared with cheese, butter, or cream sauce.
- Packaged food.
- Eggs whole or egg yolks.
- Icy dessert.
- Animal organs.


Does Exercising Relieve Ischemia?

It is crucial for those with heart disease to exercise regularly. Exercise can strengthen the heart muscle. The patient could become more active as a result of it without experiencing any symptoms like chest pain. Patient blood pressure and cholesterol may be reduced by exercise.
Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)


cognitive difficultyhypertensiondepressionmicrovascular complicationsatherosclerosis
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