When it comes to chest pain associated with cardiovascular problems, most people think of coronary artery disease (CAD), the most common type of heart disease in the United States.

But there’s another type of chest pain caused by problems with much tinier blood vessels in your chest. It’s called microvascular angina, and it affects as many as 4 million Americans.

Microvascular angina (MVA) can be more difficult to diagnose than other types of chest pain, but there are things you can do to prevent it and treat it.

Ashish Pal, MD, and his team at Vein & Cardiovascular Center use advanced techniques to accurately diagnose MVA, along with a custom approach to relieve symptoms and improve cardiovascular health.

Understanding microvascular angina

With microvascular angina, also called microvascular disease or small vessel disease, the small coronary blood vessels malfunction, interfering with normal heart circulation.

Normally, these tiny arteries contract and relax (or dilate) rhythmically to keep blood flowing. With MVA, the blood vessels spasm, tightly contracting so blood flow is wholly or partially blocked. Other times, they may simply not dilate enough to support normal circulation.

Some people with MVA have a combination of these two issues.


Unlike CAD, MVA isn’t associated with plaque buildup in the arteries. That makes it a lot harder to detect using traditional techniques. It also means chest pain is more likely to be attributed to another cause, like stress or anxiety.

Until recently, many researchers believed MVA was relatively benign, occurring mostly in postmenopausal women.

Data now show that’s not the case: About 8% of MVA patients go on to experience a major adverse cardiac event, like a heart attack or stroke — especially patients with high blood pressure or a history of CAD.

In the same study, researchers also found that while MVA does occur much more frequently among women, the dangers of MVA are the same regardless of gender. They also found women tend to have a lower quality of life as a result of the disease.

Risk factors and symptoms

Chest pain is the most common symptom of microvascular disease — angina means chest pain caused by blood flow problems. Other possible symptoms include:

  • Pressure or squeezing in the chest
  • Pain in the neck, arm, or jaw
  • Shortness of breath
  • Fatigue, especially during exercise or activity

The risk factors for MVA are similar to those for CAD and include:

  • High blood pressure
  • High cholesterol
  • Obesity
  • Sedentary lifestyle
  • Diabetes
  • Insulin resistance
  • Family history of MVA
  • Smoking
  • Unhealthy diet

Age is also a factor, with men 45 and older and women 55 and older at greater risk.

Diagnosis and treatment

Dr. Pal is skilled in state-of-the-art techniques for diagnosing the cause of chest pain, including MVA. If you have chest pain, he may prescribe cardiopulmonary exercise testing (CPET).

This type of test uses a stationary bicycle and diagnostic devices to evaluate the complete function of your heart, along with your veins, muscles and lungs.

CPET technology allows Dr. Pal to diagnose all types of chest pain, including problems like MVA that are hard to diagnose using standard technology.

If your evaluation indicates you have MVA, he works with you to develop a treatment plan focused on your needs and lifestyle to reduce your risks of serious complications.

Your plan might include lifestyle changes such as:

  • Losing excess pounds
  • Eating a healthy diet and limiting unhealthy fats and sugars
  • Being physically active on a regular basis
  • Quitting smoking
  • Learning to manage stress

You may also need medications to control high blood pressure or high cholesterol.

To learn more about MVA and its treatment at our practices in Orlando, Sebring, and Davenport, Florida, call or book an appointment online at Vein & Cardiovascular Center today.

Visit Us

Our goal is for you to leave our office with a memorable and enjoyable experience, which is why our welcoming and compassionate staff will do everything they can to make you feel right at home.

Text Us
Skip to content