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Diagnosing MCD

Some types of heart disease require special testing

Today’s technology has made great strides in the diagnosis and treatment of heart disease, but until recently it was tricky to diagnose a heart condition called Microvascular Coronary Dysfunction (MCD).

The most common type of heart disease is caused by plaques that clog the large arteries carrying blood to the heart. When the heart gets too little blood to meet its needs, people have chest pain (called angina). If blood flow is restricted even further—usually due to a clot that lodges in the narrowed artery—a heart attack and death may occur.

Plaque is often involved in MCD, too. But instead of plaque accumulating in the larger coronary arteries, MCD occurs when the blood vessels that branch off from the larger coronary arteries do not function normally. 

Standard tests for heart disease, such as stress tests and cardiac catheterizations, don’t detect MCD. That means that you can have a cardiac catheterization that finds no blockages yet still be at high risk for a heart attack.

Sadly, people who have been reassured that “everything is OK” because their cardiac catheterization was clear might not feel the need to make lifestyle changes that would reduce their coronary risk and/or they could ignore warning signs that a heart attack is imminent.

If you have persistent chest pain, see a doctor right away. Your doctor may give you a stress test, which compares coronary circulation while you are at rest with your circulation during exercise. He or she may also recommend a cardiac catheterization, which involves threading a long, thin tube into the heart to look for blockages in your arteries.

But if your catheterization shows no sign of blockages and you are still experiencing chest pain, ask for a coronary reactivity test. Available at specialized centers around the U.S., coronary reactivity testing is the gold standard for diagnosing coronary microvascular disease. 

And always, if you experience severe chest pain, if that pain radiates down your arm or to your back or jaw, and/or you are short of breath, call 911 right away. KL

Dr. Gretchen Wells is director of the Women’s Heart Health Program at the UK Gill Heart & Vascular Institute. 

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