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Cardiolucent

Condition

Microvascular Angina

Chest pain from small-vessel coronary dysfunction, often missed by standard testing.

Microvascular angina is a form of chest pain caused by abnormal function of the heart's tiniest arteries — the microvasculature — rather than blockages in the large coronary vessels. Standard coronary angiograms in these patients often look 'normal,' even though their symptoms are real and recurrent. Microvascular disease disproportionately affects women, patients with diabetes or hypertension, and those with prior chest radiation. Without specific testing, it is one of the most commonly missed diagnoses in cardiology. Dr. Kedan recognizes the pattern and pursues directed evaluation rather than dismissing symptoms as non-cardiac.

What Cardiolucent Evaluates

  • Detailed symptom history with attention to atypical and non-exertional patterns
  • EKG and POCUS at the visit
  • Stress echocardiography or nuclear stress testing to assess functional ischemia
  • Cardiac CT angiography to rule out obstructive coronary disease
  • Endothelial function testing when appropriate
  • Coordination with invasive coronary reactivity testing at Cedars-Sinai when needed
  • Aggressive control of associated risk factors: blood pressure, lipids, glucose

Common Symptoms

  • Chest pressure, tightness, or burning that may last longer than typical angina
  • Symptoms with exertion but also at rest, including with emotional stress
  • Shortness of breath disproportionate to activity
  • Fatigue and reduced exercise tolerance
  • Symptoms that previously prompted a 'normal' angiogram but never went away
  • Often more prevalent in women, especially around and after menopause

Risk Factors

  • Female sex, particularly perimenopausal and postmenopausal
  • Hypertension
  • Diabetes or insulin resistance
  • High cholesterol
  • Smoking history
  • Prior chest radiation
  • Chronic inflammatory or autoimmune conditions
  • Family history of cardiovascular disease

How Cardiolucent Approaches Treatment

Treatment combines control of cardiovascular risk factors with targeted antianginal therapy, often using calcium channel blockers, ranolazine, ACE inhibitors or ARBs, statins, and sometimes nitrates. Lifestyle interventions — aerobic conditioning, stress management, and tobacco cessation — meaningfully improve symptoms in many patients. Dr. Kedan tailors the regimen based on response, recognizing that microvascular angina often requires patience and iterative adjustment to find the combination that works.

Common Questions

Frequently Asked Questions

What is microvascular angina?
Microvascular angina is chest pain that arises when the heart's smallest arteries fail to dilate normally in response to demand, restricting blood flow to the heart muscle even though the large coronary arteries are open. It is sometimes called coronary microvascular dysfunction.
How is it different from typical angina?
Typical angina is caused by plaque narrowing the large coronary arteries and is readily seen on angiography. Microvascular angina involves vessels too small for standard angiography to visualize, so it requires specialized testing to confirm. Symptoms can overlap significantly.
Why has my chest pain not been diagnosed before now?
Many patients with microvascular angina have been told their angiogram or stress test was 'normal' and that there is nothing wrong with their heart. The diagnosis requires either advanced non-invasive testing or invasive coronary reactivity testing, and it is often missed when clinicians are not specifically looking for it.
Who tends to get microvascular angina?
Women, especially around and after menopause, are disproportionately affected, as are patients with hypertension, diabetes, prior chest radiation, and autoimmune disease. It also appears in some patients after a heart attack, particularly when symptoms persist despite open arteries.
How is microvascular angina diagnosed?
Diagnosis usually starts by ruling out obstructive coronary disease with cardiac CT angiography or invasive angiography, then confirming microvascular dysfunction with specialized testing such as stress imaging with coronary flow reserve, PET, or invasive coronary reactivity studies. Dr. Kedan coordinates with subspecialty colleagues at Cedars-Sinai when invasive testing is indicated.
How is it treated?
Treatment combines aggressive risk-factor control with medications that improve microvascular function: calcium channel blockers, ranolazine, ACE inhibitors or ARBs, statins, and selective use of nitrates. Cardiac rehabilitation, stress reduction, and sleep optimization also play meaningful roles.
Will my symptoms ever fully resolve?
Many patients achieve significant symptom relief with a well-chosen regimen, though responses vary. The condition can be persistent, so the goal is meaningful improvement in quality of life and reduction of cardiovascular risk over the long term.
Is microvascular angina dangerous?
It is less immediately threatening than acute coronary blockage, but it is not benign — patients with microvascular dysfunction have a higher long-term risk of cardiovascular events than the general population, especially when other risk factors are not controlled. Treatment is meaningful for both symptoms and prognosis.
What does Cardiolucent do differently for this condition?
Dr. Kedan takes microvascular angina seriously rather than telling patients their tests look fine and dismissing the symptoms. Extended appointments, POCUS at the visit, and same-day diagnostic decisions help clarify what is causing the chest pain and define a plan.
How do I schedule a consultation?
Call (310) 304-5555 or use the contact form to schedule with Dr. Kedan at the Beverly Hills office. Cardiolucent is concierge and does not bill Medicare or insurance; a detailed superbill is provided for any out-of-network reimbursement.

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The information on this site is for general educational purposes only and is not medical advice, diagnosis, or treatment. Reading this site does not create a doctor–patient relationship. Always consult a qualified healthcare professional for personal guidance. If this is an emergency, call 911. Mentions of medications, devices, or procedures are informational and not endorsements. Full medical disclaimer.

†Some listed indications involve investigational/off-label use. Learn more.