CMD: Uncovering a Hidden Heart Disease

It’s not unusual for many women who experience chest pain to be told their test results are normal. They may hear the same disappointing response: Your heart is fine; it’s probably anxiety or stress. But their symptoms may actually come from a serious heart condition that is too often overlooked — coronary microvascular dysfunction (CMD).

Recognizing this problem, Baptist Health Heart & Vascular Care physicians have developed a way to more accurately diagnose and treat patients with CMD, reducing the risk of serious complications.

What is CMD?

CMD occurs when the tiny blood vessels in the heart become damaged. The small vessels can spasm and reduce blood flow, but standard imaging tests are unable to detect the problem.

While both men and women can have CMD, women are much more likely to develop the condition. Doctors aren’t entirely sure why women are affected more often, but they think hormones may play a role. Coronary microvascular dysfunction is more common in women going through menopause or who have already gone through menopause, when estrogen levels drop.

“Patients come in with classic chest pain or angina symptoms that typically happen during exercise, but when we investigate, we don’t see any major blockages in the heart arteries,” explains interventional cardiologist Carlos Alfonso, M.D., director of chronic total obstruction with Baptist Health Heart & Vascular Care.

Signs and Symptoms of CMD

The most common symptom of CMD is chest pain. This pain often happens during everyday activities and exercise. Usually, it worsens over time, becoming more frequent and lasting longer, sending many patients to the emergency room repeatedly. Other symptoms include:

       ·Shortness of breath

       ·Fatigue

       ·Trouble sleeping

Why CMD is Serious

CMD comes with real risks. “Patients with CMD are at high risk of major heart problems, including heart attack, heart failure and stroke,” Dr. Alfonso says. In fact, 30 to 40 percent of people who have heart attacks don’t have blockages in their major heart arteries.

Tests for CMD

During a patient evaluation, Dr. Alfonso and his team, who treat CMD patients at Baptist Health West Kendall Baptist Hospital, use sophisticated tests to look at how the heart’s smallest blood vessels are working. Special medications are given while the tests are underway to see if the spasms that can occur with CMD can be replicated.

“We want to measure the coronary vascular flow,” Dr. Alfonso says. “It’s a relatively simple procedure and doesn’t require much more testing than a cardiac catheterization. The big benefit is getting a firm diagnosis. We work with the patient’s regular cardiologist to guide treatment.”

How CMD is Treated

Treatment for CMD focuses on managing pain and controlling risk factors and symptoms. This may include medications such as:

       ·Statins (cholesterol medications)

       ·Blood pressure medications

       ·Blood thinners

       ·Heart medications like ACE inhibitors, beta blockers or calcium channel blockers

       ·Nitroglycerin for chest pain

Moving Forward

Dr. Alfonso says there’s a need for doctors to better understand CMD so that patients get proper treatment. “Not all small vessel disease is the same,” he explains. “This is an area we are still studying, and as we learn more about this condition, we can offer our patients the most cutting-edge treatment.”

To learn more about CMD evaluation, call 786-204-4200.

Carlos Alfonso, M.D., cardiologist and director of chronic total obstruction with Baptist Health Heart & Vascular Care