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Recent advances in diagnostic technology are providing answers for patients with the mysterious heart condition “chest pain syndrome X”—a frustratingly common condition that we used to know little about.
As many as 50% of patients with chest pain do not have blockages in their large coronary arteries—are usually called coronary artery disease and can explain chest pain. Thanks to new technology, we can now identify, name, and treat this disease: coronary microvascular dysfunction (CMD).
For many years, we have known and realized that the small arteries (microcirculation) of the heart muscle is responsible for approximately 80% of its circulation. These small arteries dilate (relax) and respond to changes similarly to how large arteries do. Therefore, they can lead to symptoms that could occur during daily activities, times of mental stress, or physical activity.
Symptoms of CMD can include:
- Chest pain
- Discomfort in the left arm, jaw, neck, back or abdomen
- Fatigue
- Shortness of breath
- Trouble sleeping
CMD may or may not be caused by plaque obstructing the vessels. It can result in spasms and decreased blood flow to the heart, which can lead to heart attack and heart failure over time. Everyone with chest pain should seek medical care—symptoms of CMD and heart attack can be similar.
Studies estimate that 3 to 4 million people in the United States have CMD, and that 60-75% of them are women. CMD is more common in young women. Because CMD has been difficult to diagnose, patients often endure in recurring visits to the cardiologist or emergency room in search of answers. This results in frustration and a high economic burden for both patients and caregivers.
With this new technology, we’re leading the way to understanding that CMD is not a disease of narrowing but a disease of resistance—reduced blood flow to the heart. More importantly, we can now precisely give patients a clear diagnosis—and a straighter path from symptoms to effective treatment.
Quick, safe, reliable diagnosis.
For decades, doctors have used a device called a Doppler wire to help understand and measure the rate of blood flow in coronary arteries without the ability to measure the actual resistance in the microvascular circulation. With this new technology—and as the only center in the region with this type of technology—we are using a device with pressure and temperature sensors to measure flow across the coronary arteries and, most importantly, resistance in the microcirculation.
With tools we know are safe, and measurements we know are reliable, we can quickly give many patients an accurate reason for their chest pain. For others, we can effectively rule out heart-related causes for their discomfort.
For patients who have been struggling to understand their symptoms, just putting a name to that pain can be a significant relief.
A 2017 CorMica trial published in the Journal of the American College of Cardiology found that patients who were diagnosed with CMD using the new technology showed notable improvements in their chest pain and quality of life compared to patients who were not given a diagnosis, even though they received the same treatment.
That said, MedStar Health offers proven, effective treatments for CMD.
The treatment: Medication and lifestyle changes.
CMD is a disease of the coronary arteries, but unlike other heart problems treatment does not involve heart surgery or stents. Treatment will be based on your overall health and heart disease risk factors
Medications: Patients with no sign of structural blockages of the arteries can take calcium channel blockers to lower blood pressure or long-acting nitrates to help prevent chest pain. Patients who have plaque or obstructions may need alpha receptor beta blockers or other drugs to improve cholesterol, lower blood pressure, prevent blood clots, and help the blood vessels relax.
Lifestyle changes: Making heart-healthy changes to movement and eating habits can benefit heart and vascular health. For example:
- Building and maintaining an exercise routine
- Creating nutritious eating habits
- Managing stress
- Quitting smoking
At MedStar Health, we’re experts in the new diagnostic technology, and we’re breaking ground to help bring more patients answers. We’re contributing data to a large health registry working to understand the impact of this diagnostic procedure. What’s more, we’re taking part in a major clinical trial called the Heart Attack Research Program (HARP), working with medical centers around the country to better understand CMD.
As part of our work, I am a group leader in North America Microvascular Network, a group of 50 interventional and general cardiologists from the U.S. and Canada. I am leading an effort to have this condition be recognized by the Centers for Disease Control and Prevention (CDC) and be granted an ICD-10 code for more streamlined care management.
MedStar Washington Hospital Center has the capacity and robust cardiac imaging program to provide care and search for all types of chest pain. If you are referred to us, we will work with your local cardiologist to create a clear care plan you both are comfortable with.
For patients with undiagnosed chest pain, we know that seeking an explanation for health problems can be frustrating. If you’re looking for answers, don’t give up. We can help.
