If you’ve always thought that women’s hearts are different from men’s when it comes to heart disease, you’re right. Women don’t experience heart problems the same way men do. Several serious heart conditions, in fact, affect women more than they do men, such as coronary microvascular disease (CMD).
That’s why understanding the differences and seeking heart care specific to women is so important, says Patricia Rodriguez-Lozano, MD, cardiologist and director of the Women’s Heart Health Care program at UVA Health.
“Advocating for yourself is critical because cardiovascular disease in women is often underdiagnosed, undertreated, or misdiagnosed entirely,” she says. “Many are told ‘it’s just stress’ or ‘nothing is wrong,’ even when serious heart conditions are present.”
What Is Coronary Microvascular Disease?
CMD (also called coronary microvascular dysfunction or microvascular disease) is a type of small vessel disease, which happens when tiny blood vessels in your heart don’t work like they should. That means they don’t open wide when your heart needs more oxygen, like during exercise or a stressful event.
This can happen for a few reasons, like:
- A problem with the blood vessel lining, called the endothelium
- Vessels that become stiff or narrow because of inflammation or stress
- Hormonal changes, especially around menopause or after pregnancy
- An overactive stress response or nervous system signals
Even though the large arteries may look completely normal on a typical heart test, if you have CMD, it can still cause symptoms (like chest pain).
And CMD can increase your risk for future heart problems. “CMD is real and serious — it can significantly impair quality of life and is associated with an increased risk for major adverse cardiovascular events,” Rodriguez-Lozano says.
Wondering About Your Heart Symptoms?
As a woman with heart disease, you might not be getting the right tests, diagnosis, or treatment. UVA Health’s Women’s Heart Health Care team can help get you on the right track.
What Are Symptoms of CMD?
CMD symptoms often include:
- Fatigue
- Shortness of breath
- Chest pressure
These symptoms can get worse with emotional or mental stress, Rodriguez-Lozano notes. They’re also general enough to suggest less serious conditions unrelated to the heart. And traditional stress and imaging tests don’t always catch CMD. That’s because the affected blood vessels are too small for regular heart tests.
“I wish more women knew that having normal arteries on a standard angiogram does not mean their heart is fine,” Rodriguez-Lozano says. “CMD affects the tiny vessels of the heart that don’t show up on most routine imaging tests. It’s a leading cause of chest pain in women and is often misclassified as ‘non-cardiac’ because traditional diagnostics aren’t equipped to detect it.”
Get the Right Care for Your Heart
If you have ongoing symptoms that concern you, it’s important to find a heart team that understands CMD and has the tools to diagnose it correctly. That often includes advanced testing like cardiac MRI, PET scans, and invasive coronary physiology, Rodriguez-Lozano says.
CMD should also be treated holistically, she adds. That means not only with medicine, but also through access to a team of dietitians, exercise physiologists, social workers, and pharmacists who can help address the full scope of your health.
“Remember that your symptoms matter, even if the tests come back normal,” Rodriguez-Lozano says. “If you’re experiencing unexplained chest pain, fatigue, or breathlessness and are told, ‘It’s just stress’ or ‘Your heart is fine,’ it’s time to ask deeper questions.”