Harvard Heart Letter

Big trouble from small arteries

Problems in the heart's tiniest arteries can pose challenges for diagnosing and treating chest pain.

The old adage "Out of sight, out of mind" captures a common response to a seemingly mysterious condition "" frequent chest pain or other telltale signs of poor blood flow to the heart muscle with "clean" coronary arteries. People with this puzzling combination are often told they are "fine" in spite of symptoms every bit as real, and as debilitating, as those caused by a cholesterol-clogged coronary artery. Some struggle with the problem for years, doubted by their doctors, their symptoms chalked up to depression, anxiety, or even hypochondria.

The large coronary arteries don't have a monopoly on heart disease. Research is revealing that trouble in the heart's smallest arteries can cause classic symptoms of heart disease, like chest pain and shortness of breath, along with less well-recognized ones such as diffuse discomfort in the chest or unusual exhaustion.

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