Your doctor will diagnose coronary microvascular disease (MVD) based on your medical history, a physical exam, and the results from tests. He or she will check to see whether you have any risk factors for heart disease.
For example, your doctor may measure your weight and height to check for overweight or obesity and test your cholesterol levels. You also may be tested for metabolic syndrome and diabetes.
Your doctor may ask you to describe any chest pain, including when it started and how it changed during physical activity or periods of stress. Other symptoms, such as fatigue (tiredness), lack of energy, and shortness of breath, will be noted. Women may be asked about their menopausal status.
Your doctor may recommend blood tests, including a test for anemia.
Cardiologists and doctors who specialize in family and internal medicine may be involved in the diagnosis and treatment of coronary MVD. Cardiologists are doctors who specialize in diagnosing and treating heart diseases and conditions.
The risk factors for traditional coronary heart disease (CHD) and coronary MVD often are the same. Thus, your doctor may recommend tests to help show whether you have traditional CHD. These tests may include:
- Coronary angiography (an-jee-OG-ra-fee) - This test uses dye (contrast material) and special x rays to show the insides of your coronary arteries. Coronary angiography can show plaque buildup in the large coronary arteries. This test often is done during a heart attack to help locate blockages.
- A stress test - This test shows how blood flows through your heart during physical stress. During stress testing, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast while heart tests are done. If coronary angiography doesn't show plaque buildup in the large coronary arteries, a stress test may still show abnormal blood flow. This may be a sign of coronary MVD.
- A cardiac MRI (magnetic resonance imaging) stress test - This test may be used to evaluate women who have chest pain.
Unfortunately, standard tests for CHD don't always detect coronary MVD. These tests look for blockages that affect blood flow in the large coronary arteries. However, coronary MVD affects the heart's smallest coronary arteries.
If test results show that you don't have CHD, you can still be diagnosed with coronary MVD if evidence shows that not enough oxygen is reaching the small arteries in your heart.
Symptoms of coronary MVD often first occur during routine daily tasks. Thus, you may be asked to fill out a questionnaire called the Duke Activity Status Index (DASI). The questionnaire will ask you how well you're able to do daily activities, such as shopping, cooking, and going to work.
The results of the DASI questionnaire will help your doctor decide which kind of stress test you should have. The results also give your doctor some information about how well blood is flowing through your coronary arteries.
Research is ongoing for better ways to detect and diagnose coronary MVD. Currently, no consensus has been reached on how best to diagnose the disease.
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