Coronary Microvascular Disease

Coronary Microvascular Disease (CMD) is an underrecognized cause of chest pain and ischemia, often seen in women—particularly postmenopausal women—with non-obstructive coronary arteries on angiography. CMD arises from structural remodeling or functional endothelial dysfunction in the coronary microvasculature, leading to reduced coronary flow reserve (CFR) and increased resistance.

Patients may present with recurrent chest pain, exertional dyspnea, or symptoms mimicking non-cardiac causes. Diagnosis relies on noninvasive imaging (such as CFRV or MPRI on echo, PET, or MRI) or invasive coronary angiography showing no significant obstruction but abnormal coronary physiology. Management includes long-acting nitrates, beta blockers, and calcium channel blockers, with second-line agents like ranolazine or ivabradine for persistent symptoms.

Produced by: Carla Rodriguez, MD
Graphic by: @CarlaRod0715 | Original Post

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