Materiały źródłowe

• #1 Small vessel disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-vessel-disease/symptoms-causes/syc-20352117

  Small vessel disease is treatable but may be difficult to detect. The condition is typically diagnosed after a health care provider finds little or no narrowing in the main arteries of the heart despite the presence of symptoms that suggest heart disease. […] It might be hard to tell if some symptoms are due to small vessel disease, especially if you don’t have chest pain. See your health care provider to determine the cause of your symptoms. […] In coronary small vessel disease, the small arteries don’t relax (dilate) as usual. As a result, the heart doesn’t get enough oxygen-rich blood.

• #1 Small vessel disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-vessel-disease/diagnosis-treatment/drc-20352123

  To diagnose small vessel disease, your health care provider will usually do a physical exam and ask questions about your medical history and family history of heart disease. He or she will likely listen to your heart with a stethoscope. […] The tests used to diagnose small vessel disease are similar to those used to diagnosis other types of heart disease and include: […] Stress test with imaging. A stress test measures how the heart and blood vessels respond to activity. […] Coronary angiogram. This test helps determine if the main arteries to the heart are blocked. […] CT coronary angiogram. This other type of angiogram uses a powerful X-ray machine to produce a series of images of the heart and its blood vessels. […] Positron emission tomography (PET). This test uses a radioactive tracer and medication to measure blood flow to the heart muscle.

• #1 Small vessel disease | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/small-vessel-disease

  Small vessel disease is treatable but may be difficult to detect. The condition is typically diagnosed after a health care provider finds little or no narrowing in the main arteries of the heart despite the presence of symptoms that suggest heart disease. […] To diagnose small vessel disease, your health care provider will usually do a physical exam and ask questions about your medical history and family history of heart disease. He or she will likely listen to your heart with a stethoscope. […] The tests used to diagnose small vessel disease are similar to those used to diagnosis other types of heart disease and include: […] Stress test with imaging. A stress test measures how the heart and blood vessels respond to activity. You may be asked to walk on a treadmill or pedal a stationary bike while connected to a heart monitor. Or you may be given an IV drug to stimulate the heart in a way similar to exercise. Blood flow to the heart muscle is measured with ultrasound images (echocardiogram) or with nuclear imaging scans.

• #1 Coronary Microvascular Disease (Small Vessel Disease): Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21052-microvascular-coronary-disease

  Microvascular coronary disease affects tiny vessels that deliver blood to heart tissue. […] Microvascular coronary disease causes lasting chest pain and can raise your heart attack risk. […] Small vessel disease is more likely to affect women than men. This is especially true in people with low estrogen levels, which occurs around menopause. […] Diagnosing microvascular heart disease is challenging because microvessels are too small to assess using standard heart tests. […] Cardiac catheterization with coronary flow reserve (CFR) is the gold standard for diagnosing microvascular coronary disease. […] Medications and lifestyle changes help many people get symptom relief and avoid complications.

• #1 Small vessel disease | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/small-vessel-disease

  Coronary angiogram. This test helps determine if the main arteries to the heart are blocked. A long, thin flexible tube (catheter) is inserted into a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter to arteries in the heart. The dye makes the arteries easier to see on X-ray images and video. […] Additional tests may be done during an angiogram to measure blood flow through the heart. […] CT coronary angiogram. This other type of angiogram uses a powerful X-ray machine to produce a series of images of the heart and its blood vessels. You’ll lie on a long table that slides through a short, tunnel-like machine (CT scanner). Dye injected through an IV in the arm or hand makes blood vessels easier to see on the CT images. […] Positron emission tomography (PET). This test uses a radioactive tracer and medication to measure blood flow to the heart muscle. After the tracer is injected, you usually lie in a doughnut-shaped machine to have images taken of the heart.

• #1 Coronary Microvascular Disease (MVD) Symptoms and Diagnosis at Emory Heart & Vascular

  https://www.emoryhealthcare.org/services/heart-vascular/conditions/coronary-microvascular-disease

  MVD is also called small vessel disease or microangiopathy. […] Doctors at Emory Healthcare use several tests to diagnose MVD. These include: […] A cardiac MRI looks at blood flow through your microvessels. […] This test measures how well your microvessels respond to stress. […] An echocardiogram is an ultrasound test. This test looks for irregularities and checks how well your heart pumps blood.

• #1 Small Vessel Disease: Symptoms, Causes, Diagnosis, and Treatments

  https://www.healthline.com/health/small-vessel-disease

  Diagnosing small vessel disease can be difficult. Your doctor will evaluate your medical history, family history, and symptoms. […] Diagnostic imaging procedures for small vessel disease are typically the same as those looking for other types of heart disease. These procedures show the structure or function of your larger coronary arteries and other parts of the heart, and may show coronary artery blockages. These tests may include: […] If there are no significant blockages in your larger coronary arteries, your doctor will use an invasive test, injecting different medications into a coronary artery, to check for blockages in your small arteries during a left heart catheterization. This is called an endothelial dysfunction test. This allows the doctor to measure the blood flow through your small vessels.

• #1 Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/microvascular-dysfunction/diagnosis.html

  Microvascular dysfunction is a type of non-obstructive coronary artery disease that causes the small blood vessels feeding the heart muscle to not work as they should. […] Because most diagnostic tests for heart disease cannot detect microvascular dysfunction, people with this disorder may feel frustrated and hopeless. […] We use specific tests to diagnose this condition and finally give women an explanation for their pain. […] Precise diagnosis options including the index of microcirculatory resistance (IMR), which measures blood flow in small arteries and was developed at Stanford. […] We use the most advanced technology to diagnose coronary abnormalities, like microvascular dysfunction, that can be hard to detect on an angiogram or other typical diagnostic tests. […] To determine if you have microvascular dysfunction, we conduct a cardiac catheterization (inserting a small tube into a wrist or groin artery) to perform a test to determine the index of microcirculatory resistance (IMR).

• #1 Cerebral small vessel disease: symptoms, diagnosis, and treatment

  https://www.topdoctors.co.uk/medical-articles/cerebral-small-vessel-disease-causes-symptoms-diagnosis-and-treatment

  Cerebral small vessel disease (CSVD) is a condition where the tiny blood vessels in the brain become narrowed, blocked, or damaged, restricting blood flow to brain tissue. This can lead to tiny strokes (lacunar infarcts), white matter damage, and a higher risk of vascular dementia. […] CSVD is typically detected through brain imaging techniques such as MRI scans: these provide detailed images of the brain, showing white matter damage and small strokes. […] Cognitive assessments: doctors may perform tests to assess cognitive function if memory or thinking skills are affected. […] While the damage caused by CSVD cannot be completely reversed, steps can be taken to slow its progression and reduce the risk of complications.

• #1 Cerebral Small Vessel Disease | Symptoms, Diagnosis, Advice and More | 2024 – Pure Medical

  https://pure-medical.co.uk/cerebral-small-vessel-disease-2

  Cerebral small vessel disease (SVD) includes white matter lesions (WML) and lacunar infarcts and is a frequent finding on computer tomography (CT) and magnetic resonance imaging (MRI) scans of elderly people. […] Cerebral Small Vessel Disease can be diagnosed by talking to you about your symptoms and performing imaging tests. […] The main test used to diagnose this condition is magnetic resonance imaging (MRI). […] Cerebral small vessel disease (SVD) can appear on an MRI in a few different ways: Small strokes (lacunar infarcts), White matter lesions that show up as bright spots on the scan (white matter hyperintensities), Bleeding from small blood vessels in the brain (cerebral microbleeds). […] After taking into account the MRI, your cardiovascular condition, and any symptoms you may be experiencing, your doctor makes the final diagnosis.

• #1 Microangiopathy – Wikipedia

  https://en.wikipedia.org/wiki/Microangiopathy

  NVC has been largely used not only for investigating peripheral microangiopathy, but also as a sort of „window” to systemic microvascular dysfunction. […] Optical coherence tomography angiography (OCTA) is another imaging modality that offers high-resolution visualization of the retinal capillary network and can be used to evaluate microcirculation in conditions such as diabetic retinopathy. […] Unlike the retinal microcirculation, the coronary microvasculature cannot be directly imaged. Instead, a number of different tests can be used to measure how much blood is flowing through the coronary microvasculature. […] Similarly, CSVD is typically recognized on both brain magnetic resonance imaging (MRI) and computed tomography (CT) scans, but MRI has greater sensitivity and specificity.

• #1 Consensus statement for diagnosis of subcortical small vessel disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4758552/

  Measurements of CSF protein levels as reflected in the albumin ratio (albumincsf/albuminblood) can indicate BBB disruption when the albumin ratio is elevated, which makes it more likely for the patient to have VCI than AD. […] The use of a purely descriptive term was to preclude premature presuppositions and encourage the search for causes. […] A potential multimodal approach would include three groups of possible markers: clinical, imaging, and biochemical, which are like three axes with grades of closeness to the full diagnosis of BD at points along each axis.

• #1 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology

  http://www.ajnr.org/content/early/2021/10/07/ajnr.A7302

  Perivascular spaces are extensions of the extracerebral fluid space that are covered by the pia mater, which surrounds cerebral vessels from the brain surface into and through the brain parenchyma. […] CMB are small round or ovoid lesions (10mm in diameter) of marked hypointensity with associated blooming on T2 gradient-echo (T2*) or other sequences that are sensitive to susceptibility effects, especially SWI. […] Total SVD score is a simple and pragmatic way of assessing overall brain health and has been shown to be a prognostic indicator of cognitive decline and recurrent stroke. […] Advanced imaging techniques such as high-field MR imaging, DTI, blood oxygen leveldependent (BOLD) MR imaging, and perfusion imaging show considerable promise. […] Vessel wall imaging has recently been developed to address this limitation, enabling better detection of nonstenotic lesions and better characterization of stenotic lesions.

• #1 Update on cerebral small vessel disease: a dynamic whole-brain disease | Stroke and Vascular Neurology

  https://svn.bmj.com/content/1/3/83

  Cerebral small vessel disease (CSVD) is a very common neurological disease in older people. […] Since it is difficult to visualise CSVD pathologies in vivo, the diagnosis of CSVD has relied on imaging findings including white matter hyperintensities, lacunar ischaemic stroke, lacunes, microbleeds, visible perivascular spaces and many haemorrhagic strokes. […] A standardised use of terms should be encouraged in CSVD research. […] Therefore, in 2013, an expert workgroup on CSVD proposed a list of standard terms to help avoid confusion and suggests that CSVD researchers should be encouraged to apply these terms in future studies. […] Advances in imaging techniques have brought new insights into mechanisms of CSVD. […] In this review, we will summarise findings in recent clinical studies on CSVD, discuss CSVD mechanisms and explore emerging prevention and treatment options.

• #1 Coronary Microvascular Disease | American Heart Association

  https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/coronary-microvascular-disease-mvd

  Your health care professional can diagnose coronary MVD based on your medical history, a physical exam and test results. […] PET scans and other types of imaging can help diagnose coronary MVD. They measure blood flow through the coronary arteries and can find coronary MVD in tiny blood vessels. […] Standard tests for heart disease may not detect coronary MVD. If you have angina but tests show your coronary arteries are normal, you could still have coronary MVD. Additional testing can confirm the diagnosis. […] The DASI results can help decide which additional tests are needed to diagnose coronary MVD.

• #1 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology

  http://www.ajnr.org/content/early/2021/10/07/ajnr.A7302

  While identifying the presence of at least 1 lacune or cerebral microbleed is straightforward in most situations, visual grading of WMH and PVS poses a unique challenge because the rating scales are inherently subjective, with poor agreement among neuroradiologists. […] Small vessel disease is a rising epidemic associated with detrimental brain health. Neuroimaging plays a fundamental role in identifying SVD.

• #1 What is microvascular angina? – BHF

  https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/microvascular-angina

  Microvascular angina refers to disease in the small blood vessels, less than half a millimetre across and therefore too small to be detected using standard tests like angiogram. […] Research from our group and by others in the UK and abroad indicates that small vessel problems may affect at least one third of patients with angina but who have clear heart arteries. […] Research in the UK and abroad has confirmed that patients with microvascular angina are at risk of being admitted to hospital and even experiencing a heart attack. […] Now, enabled by technological advances, we and other groups are assessing the value of new tests of small vessel function in the heart. […] The new tests for small vessel function in the heart are not yet standard in the NHS, mainly because there has never been clear evidence gathered about whether treatment decisions informed by the results of these tests would lead to patient benefits.

• #1 Simple Blood Test Assesses Risk of Cerebral Small Vessel Disease | Technology Networks

  https://www.technologynetworks.com/diagnostics/news/simple-blood-test-assesses-risk-of-cerebral-small-vessel-disease-330254

  A UCLA-led study has found that levels of six proteins in the blood can be used to gauge a person’s risk for cerebral small vessel disease, or CSVD, a brain disease that affects an estimated 11 million older adults in the U.S. […] The hope is that this will spawn a novel diagnostic test that clinicians can start to use as a quantitative measure of brain health in people who are at risk of developing cerebral small vessel disease, said Dr. Jason Hinman, a UCLA assistant professor of neurology and lead author of the paper. […] Typically, doctors diagnose CSVD with an MRI scan after a person has experienced dementia or suffered a stroke. […] The blood test is a step forward, Hinman said, because it provides a more quantitative scale for evaluating the disease. That means the blood test can be used to follow the progression of the disease or to identify people who are candidates for prevention efforts or treatments for CSVD.

• #1 What is microvascular angina? – BHF

  https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/microvascular-angina

  Our research aims to determine whether routine use of new blood vessel tests might help detect sub-groups of patients with angina due to small vessel disease. […] We are actively studying the underlying causes of small vessel disease in the hearts of individual patients with a view to making personalised treatment decisions that are linked to the underlying problem. […] To this end, researchers in Glasgow, and other groups in the UK and abroad are actively working to develop new medicines to specifically help patients with microvascular angina and coronary artery spasm. […] We also aim to develop new tests using a blood and/or urine sample to help diagnose the cause of chest pain in individual patients in the clinic.

• #1

  https://journals.lww.com/co-neurology/fulltext/2021/04000/cerebral_small_vessel_disease_and_vascular.15.aspx

  Importantly, according to VICCCS guidelines, individuals with neuroimaging signs of SVD may qualify for SIVaD, post-stroke dementia or mixed-dementia, depending on temporal associations and comorbidities. […] MRI is considered the gold-standard imaging method for the clinical diagnosis of VCI. […] Established SVD markers include WMH, lacunes, PVS, recent small subcortical infarcts, CMB, cSS, ICH and atrophy. […] Although conventional MRI markers are appealing for being widely available and easily evaluated, advanced MRI techniques offer stronger cognitive associations in general, likely as a result of their sensitivity to microstructural abnormalities and disruption of network connections. […] Detection of underlying microvascular disease relies strongly on neuroimaging, for which MRI is considered the gold-standard.

• #1 Research finds causal evidence tying cerebral small-vessel disease to Alzheimer’s, dementia – Biggs Institute

  https://biggsinstitute.org/2024/06/21/causal-evidence-tying-cerebral-small-vessel-disease-to-alzheimers/

  Research finds causal evidence tying cerebral small-vessel disease to Alzheimer’s, dementia. […] Research led by in part by The University of Texas Health Science Center at San Antonio (UT Health San Antonio) finds that the most common cerebral small-vessel disease feature seen in brain magnetic resonance imaging is a primary vascular factor associated with dementia risk. […] Results of the major international study emphasize the significance of that feature, known as white matter hyperintensity (WMH) burden, in preventive strategies for dementia. […] “Our findings provide converging evidence that WMH is a major vascular factor associated with dementia risk,” said Muralidharan Sargurupremraj, PhD, an assistant professor at the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases at UT Health San Antonio. […] “As vascular disease is a treatable contributor to dementia risk, our findings have broad significance for prevention strategies of Alzheimer’s and dementia as a whole,” Sargurupremraj concluded.

• #1 Spotlight Series | Microvascular Dysfunction: Invasive and Noninvasive Diagnosis of Small Vessel Disease

  https://www.acc.org/Latest-in-Cardiology/Articles/2022/08/01/01/42/Spotlight-Series-Microvascular-Dysfunction-Invasive-and-Noninvasive-Diagnosis-of-Small-Vessel-Disease

  Ischemia with no obstructive coronary arteries (INOCA) refers to myocardial ischemia with stable or unstable anginal symptoms in the setting of normal or nonobstructive coronary arteries.1 Coronary microvascular dysfunction (CMD) and epicardial coronary artery spasm are pathophysiologic mechanisms of INOCA and are diagnosed in up to four in five patients undergoing invasive evaluation for suspected INOCA.2-6 […] Patients with INOCA are often misdiagnosed as having symptoms of noncardiac origin, as traditional stress tests have low sensitivity for diagnosing CMD7 and diagnosis of vasospasm often requires acetylcholine provocation.8 As CMD and epicardial spasm are associated with adverse long-term prognosis in patients without obstructive coronary artery disease (CAD),9-15 the diagnosis of these INOCA endotypes should be considered in patients with anginal symptoms. Furthermore, stratified medical therapy based on diagnosis of microvascular and/or vasospastic angina has demonstrated improved angina and quality of life in patients with INOCA.1

• #1 Spotlight Series | Microvascular Dysfunction: Invasive and Noninvasive Diagnosis of Small Vessel Disease

  https://www.acc.org/Latest-in-Cardiology/Articles/2022/08/01/01/42/Spotlight-Series-Microvascular-Dysfunction-Invasive-and-Noninvasive-Diagnosis-of-Small-Vessel-Disease

  The Coronary Vasomotor Disorders International Study (COVADIS) study group was established in 2012 to develop international standards for the diagnostic criteria of microvascular and vasospastic angina (Table),17,18 now used in national and European guidelines.19,20 The 2021 ACC/AHA chest pain guideline adopted these definitions and proposed a diagnostic evaluation pathway for patients with stable chest pain and suspected INOCA (Figure), including noninvasive and invasive testing strategies.19 Test selection should be guided by local availability and expertise. […] Clinical noninvasive diagnosis of CMD relies on identification of impaired coronary flow reserve (CFR) in the absence of flow-limiting CAD. Impaired CFR, calculated as the ratio of hyperemic to rest coronary blood flow (or myocardial blood flow), reflects flow abnormalities within the epicardial coronary arteries and microvasculature.21,22 Maximal hyperemia is induced with dipyridamole, adenosine or regadenoson.

• #1 Microvascular Coronary Artery Disease: Review Article | USC Journal

  https://www.uscjournal.com/articles/microvascular-coronary-artery-disease-review-article?language_content_entity=en

  Recently it has become more apparent that microvascular dysfunction is responsible for morbidity and mortality in many different cardiovascular diseases. […] Coronary microvascular disease can be diagnosed by means of invasive coronary reactivity testing and noninvasively by echocardiography, computerized tomography, magnetic resonance, and positron emission tomography. […] Given the increasingly recognized importance of microvascular disease, we present this review focusing on the mechanisms leading to CMVD, its diagnostic evaluation, as well as possible treatment options, and propose a practical diagnostic algorithm for CMVD. […] Multiple diagnostic modalities have been proposed to diagnose patients with microvascular dysfunction. Both invasive (thrombolysis in myocardial infarction [TIMI] frame rate, intracoronary Doppler flow wire [IDFW] recording with coronary reactivity testing) and noninvasive (PET, CT, cardiac magnetic resonance imaging) tests can be used.

• #1 Microvascular Coronary Artery Disease: Review Article | USC Journal

  https://www.uscjournal.com/articles/microvascular-coronary-artery-disease-review-article?language_content_entity=en

  The microvascular function can be evaluated indirectly by determining the CFR, which is measured by using vasoactive agents such as adenosine, dipyridamole (endothelium-independent vasodilator), or ACh (endothelium-dependent). […] IDFW is considered the gold standard in the evaluation of coronary microcirculation. IDFW directly measures the CBF velocity, direction, and pressure in an epicardial artery. Additionally, IDFW can evaluate the response to intracoronary injection of vasodilators and vasoconstrictors medications. […] Currently, the evidence for effective therapy in the treatment of CMVD is limited as there are no large randomized trials available. […] Therefore, most clinicians will treat CMVD with traditional antianginal therapies that have not necessarily been shown to improve patient outcomes.

• #1 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology

  http://www.ajnr.org/content/43/5/650

  The classic MR imaging markers of SVD include recent small subcortical infarctions, lacunes of presumed vascular origin, WMH of presumed vascular origin, PVS, and CMB. […] The STRIVE guidelines define lacunes of presumed vascular origin as round or ovoid, subcortical, fluid-filled cavities (with signal similar to that of CSF in all sequences), measuring between 3 and 15mm in diameter, consistent with a previous, small subcortical infarct or hemorrhage located in deep gray and white matter and in a territory of perforating arteriole. […] WMH of presumed vascular origin are characterized by hyperintense lesions on T2 FLAIR and decreased attenuation on CT in the periventricular/deep cerebral white matter, subcortical gray matter, basal ganglia, and brainstem. […] The severity of WMH is strongly associated with cerebrovascular disease, vascular risk factors, gait disturbance, cognitive symptoms, and poststroke functional outcomes.

• #1 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology

  http://www.ajnr.org/content/43/5/650

  The total SVD score is a simple and pragmatic way of assessing overall brain health and has been shown to be a prognostic indicator of cognitive decline and recurrent stroke. […] The imaging rating points of total SVD burden are outlined in Table 2. […] The recognition of endothelial and neurogliovascular unit dysfunction as the main underlying mechanisms of SVD is fundamental to develop the role of advanced neuroimaging techniques.

• #1

  https://journals.lww.com/co-neurology/fulltext/2021/04000/cerebral_small_vessel_disease_and_vascular.15.aspx

  We present recent developments in the field of small vessel disease (SVD)-related vascular cognitive impairment, including pathological mechanisms, updated diagnostic criteria, cognitive profile, neuroimaging markers and risk factors. […] The updated consensus criteria aim to standardize vascular cognitive impairment (VCI) diagnosis, relying strongly on cognitive profile and MRI findings. […] Advanced imaging techniques provide tools for early diagnosis and may play an important role as surrogate markers for cognitive endpoints in clinical trials. […] The clinical diagnosis of VCI relies strongly on cognitive profile and neuroimaging findings. […] According to the most recent diagnostic guidelines, from the Vascular Impairment of Cognition Classification Consensus Study (VICCCS), VCI’s definition aligns with the terminology of DSM-V and encompasses a broad clinical spectrum that ranges from mild to major VCI, and incorporates mixed-disease cases.

• #1 Consensus statement for diagnosis of subcortical small vessel disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4758552/

  However, diagnosis of vascular dementia due to SVD was more controversial because of the frequent occurrence of white-matter changes in normal elderly, the high incidence of overlap with other neurodegenerative disorders, and the lack of consensus on the use of clinical, cerebrospinal fluid (CSF), neuroimaging, and neuropathologic findings in the diagnosis. […] Small vessel disease is a broad term that includes lesions in subcortical gray and white matter. […] Lacunes are often present along with extensive white-matter changes, which are often the case in hypertensive SVD. […] Diagnosis of BD is complicated by the overlap with AD and white-matter changes of aging. […] The CSF eliminates nonvascular causes, such as inflammation secondary to infection, vasculitis, and multiple sclerosis.

• #1 Small Vessel Disease I Ohio State Medical Center

  https://wexnermedical.osu.edu/heart-vascular/cardiology/small-vessel-disease

  Small vessel disease occurs when the heart’s small arteries narrow. […] Diagnosis is typically made if you have ongoing symptoms and significant disease in the main arteries has been excluded. Tests to diagnose small vessel disease are similar to those for other types of heart disease: […] Studies have shown that women with ongoing chest pain (even with normal main heart arteries) have a higher incidence of cardiac events than those without chest pain. These women are often undiagnosed and untreated for small vessel disease.

• #1 Microvascular Dysfunction | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/microvascular-dysfunction.html

  Stanfords cardiologists have extensive experience treating all forms of non-obstructive coronary artery dysfunction and other forms of non-obstructive coronary artery disease. […] We have ongoing enrollment in a registry of patients who have nonobstructive coronary artery disease that helps us understand microvascular dysfunction and other hidden causes of chest pain. […] Studies indicate that microvascular dysfunction may be one of the earliest signs of heart disease, and it may lead to atherosclerosis (plaque or blockages in arteries), heart failure, heart attack, or stroke. […] Our cardiologists are skilled at diagnosing and treating microvascular dysfunction, a heart disease, to minimize chest pain and complications.

• #1 Small Blood Vessel Disease: Causes, Symptoms, Diagnosis & Treatment

  https://www.yashodahospitals.com/health-faqs/small-blood-vessel-disease/

  Small blood vessel disease is treatable but can be difficult to detect. A proper diagnosis is required to treat it effectively. […] To diagnose blood vessel problems, a doctor will evaluate your family history, medical history, and symptoms. Furthermore, to look for damage or blockages, they can perform diagnostic imaging procedures such as cardiac MRI, cardiac PET scan, and cardiac CT angiography scan. Additionally, an endothelial dysfunction test may be required to check the blood flow. […] Once the small blood vessel disease is diagnosed, the doctor can begin the treatment with an initial option. It includes managing symptoms and risk factors, relieving pain, and restricting the blood vessels to become narrow. […] In most cases, doctors can manage and reverse the damage caused by small blood vessel disease. It mostly depends on how fast it gets diagnosed.

• #1 Neuroimaging in Cerebral Small Vessel Disease

  https://www.jneurology.com/articles/neuroimaging-in-cerebral-small-vessel-disease.html

  Morphologic imaging indicates the extent and severity of SVD, but the observed changes are not directly related to functional or cognitive impairment and prognosis. […] Functional effects of SVD can only be detected by combining morphological imaging with more complex technologies. […] The diagnosis of vascular cognitive impairment (VCI) is difficult because there is no consensus on clinical criteria. […] PET provides additional information, which increases the diagnostic certainty. […] In VCI FDG PET can clearly differentiate scattered areas of focal cortical and subcortical hypometabolism that differ from the typical metabolic pattern seen in AD with marked hypometabolism affecting the association areas. […] The unique potentials of PET in localizing and quantifying metabolic changes in gray matter structures responsible for functional/cognitive disturbances and caused by SVD mainly affecting the white matter makes this technique the preferred tool for studying patients with VCI.

• #1 Spotlight Series | Microvascular Dysfunction: Invasive and Noninvasive Diagnosis of Small Vessel Disease

  https://www.acc.org/Latest-in-Cardiology/Articles/2022/08/01/01/42/Spotlight-Series-Microvascular-Dysfunction-Invasive-and-Noninvasive-Diagnosis-of-Small-Vessel-Disease

  With consideration of small vessel ischemia and angina now included within ACC/AHA evidence-based guidelines, improving quality of care to reduce adverse cardiac event risk and enhance quality of life for patients is critical. […] The recent ACC/AHA chest pain guideline recommends considering invasive and noninvasive tools for the diagnosis of INOCA endotypes and to enhance risk stratification (class 2a).19 Widespread adoption of these tools requires standardized protocols and reporting tools, which are increasingly available. Future directions include clinical trials using these diagnostic strategies to investigate therapeutic advances and to determine optimal therapy for each INOCA endotype and impact on long-term cardiovascular outcomes.

• #1 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology

  http://www.ajnr.org/content/43/5/650

  Small vessel disease, a disorder of cerebral microvessels, is an expanding epidemic and a common cause of stroke and dementia. […] The STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria have standardized the nomenclature. […] Conventional and advanced small vessel disease imaging markers allow a comprehensive assessment of global brain health. […] There have been competing systems in the past regarding the neuroimaging standards for classification of SVD. […] However, due to the substantial variation in how studies have defined SVD on conventional MR imaging, a most recent international effort to establish clinical and research standards to facilitate a more consistent approach in describing SVD neuroimaging was proposed by the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE).

• #2 Small vessel disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-vessel-disease/diagnosis-treatment/drc-20352123

  To diagnose small vessel disease, your health care provider will usually do a physical exam and ask questions about your medical history and family history of heart disease. He or she will likely listen to your heart with a stethoscope. […] The tests used to diagnose small vessel disease are similar to those used to diagnosis other types of heart disease and include: […] Stress test with imaging. A stress test measures how the heart and blood vessels respond to activity. […] Coronary angiogram. This test helps determine if the main arteries to the heart are blocked. […] CT coronary angiogram. This other type of angiogram uses a powerful X-ray machine to produce a series of images of the heart and its blood vessels. […] Positron emission tomography (PET). This test uses a radioactive tracer and medication to measure blood flow to the heart muscle.

• #2 Coronary Microvascular Disease (Small Vessel Disease): Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21052-microvascular-coronary-disease

  Microvascular coronary disease affects tiny vessels that deliver blood to heart tissue. […] Microvascular coronary disease causes lasting chest pain and can raise your heart attack risk. […] Small vessel disease is more likely to affect women than men. This is especially true in people with low estrogen levels, which occurs around menopause. […] Diagnosing microvascular heart disease is challenging because microvessels are too small to assess using standard heart tests. […] Cardiac catheterization with coronary flow reserve (CFR) is the gold standard for diagnosing microvascular coronary disease. […] Medications and lifestyle changes help many people get symptom relief and avoid complications.

• #2 Small Vessel Disease

  https://www.rwjbh.org/treatment-care/heart-and-vascular-care/diseases-conditions/small-vessel-disease/

  Diagnosing small vessel disease can be difficult. Your doctor will have to evaluate your medical history, family history, and symptoms. After doing so, your doctor will perform one or more of the following diagnostic tests: […] Electrocardiogram (EKG/ECG) […] Blood tests […] Echocardiogram (ECHO) […] Cardiac catheterization […] Angiogram […] Magnetic Resonance Imaging (MRI) […] Computed Tomography (CT scan) […] Stress tests.

• #2 Small Vessel Disease | Diagnosis & Treatment | Freedmans Health

  https://freedmanshealth.org/diseases-conditions/diagnosis-treatment/small-vessel-disease/

  Diagnosing microvascular heart disease is challenging because microvessels are too small to assess using standard heart tests. […] Seeing a cardiologist who specializes in small vessel disease can help you receive an accurate diagnosis and timely care. […] Cardiac catheterization with coronary flow reserve (CFR) is the gold standard for diagnosing microvascular coronary disease. […] Additional tests to measure coronary blood flow may include: Nuclear cardiac stress test (PET scan). […] Cardiac MRI with perfusion.

• #2 Small vessel disease | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/small-vessel-disease

  Coronary angiogram. This test helps determine if the main arteries to the heart are blocked. A long, thin flexible tube (catheter) is inserted into a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter to arteries in the heart. The dye makes the arteries easier to see on X-ray images and video. […] Additional tests may be done during an angiogram to measure blood flow through the heart. […] CT coronary angiogram. This other type of angiogram uses a powerful X-ray machine to produce a series of images of the heart and its blood vessels. You’ll lie on a long table that slides through a short, tunnel-like machine (CT scanner). Dye injected through an IV in the arm or hand makes blood vessels easier to see on the CT images. […] Positron emission tomography (PET). This test uses a radioactive tracer and medication to measure blood flow to the heart muscle. After the tracer is injected, you usually lie in a doughnut-shaped machine to have images taken of the heart.

• #2 Consensus statement for diagnosis of subcortical small vessel disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4758552/

  Vascular cognitive impairment (VCI) is the diagnostic term used to describe a heterogeneous group of sporadic and hereditary diseases of the large and small blood vessels. […] Identification of this subgroup can be facilitated by multimodal disease markers obtained from clinical, cerebrospinal fluid, neuropsychological, and imaging studies. […] The challenge is to identify patients with similar underlying pathologic processes at an early stage through the use of disease markers derived from clinical, imaging, and biochemical studies to establish a relatively homogeneous population to test treatments developed in animal models. […] Currently, there is general agreement about the diagnosis of VCI in patients with large vessel strokes due to either thrombosis or embolism, which can be readily seen on neuroimaging.

• #2 Microvascular Ischemic Disease: Definition and Symptoms

  https://www.healthline.com/health/microvascular-ischemic-disease

  Small vessel ischemic disease is very common in older adults. […] The main test used to diagnose this condition is magnetic resonance imaging (MRI). […] Microvascular ischemic disease can appear on an MRI in a few different ways: small strokes (lacunar infarcts), white matter lesions that show up as bright spots on the scan (white matter hyperintensities), bleeding from small blood vessels in the brain (cerebral microbleeds). […] Ischemic small-vessel disease can be very serious, leading to stroke, dementia, and death if it isnt treated.

• #2 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology

  http://www.ajnr.org/content/early/2021/10/07/ajnr.A7302

  Perivascular spaces are extensions of the extracerebral fluid space that are covered by the pia mater, which surrounds cerebral vessels from the brain surface into and through the brain parenchyma. […] CMB are small round or ovoid lesions (10mm in diameter) of marked hypointensity with associated blooming on T2 gradient-echo (T2*) or other sequences that are sensitive to susceptibility effects, especially SWI. […] Total SVD score is a simple and pragmatic way of assessing overall brain health and has been shown to be a prognostic indicator of cognitive decline and recurrent stroke. […] Advanced imaging techniques such as high-field MR imaging, DTI, blood oxygen leveldependent (BOLD) MR imaging, and perfusion imaging show considerable promise. […] Vessel wall imaging has recently been developed to address this limitation, enabling better detection of nonstenotic lesions and better characterization of stenotic lesions.

• #2 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology

  http://www.ajnr.org/content/43/5/650

  Small vessel disease, a disorder of cerebral microvessels, is an expanding epidemic and a common cause of stroke and dementia. […] The STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria have standardized the nomenclature. […] Conventional and advanced small vessel disease imaging markers allow a comprehensive assessment of global brain health. […] There have been competing systems in the past regarding the neuroimaging standards for classification of SVD. […] However, due to the substantial variation in how studies have defined SVD on conventional MR imaging, a most recent international effort to establish clinical and research standards to facilitate a more consistent approach in describing SVD neuroimaging was proposed by the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE).

• #2 Small vessel disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-vessel-disease/symptoms-causes/syc-20352117

  Small vessel disease is treatable but may be difficult to detect. The condition is typically diagnosed after a health care provider finds little or no narrowing in the main arteries of the heart despite the presence of symptoms that suggest heart disease. […] It might be hard to tell if some symptoms are due to small vessel disease, especially if you don’t have chest pain. See your health care provider to determine the cause of your symptoms. […] In coronary small vessel disease, the small arteries don’t relax (dilate) as usual. As a result, the heart doesn’t get enough oxygen-rich blood.

• #2 Understanding Chronic Small Vessel Ischemic Disease

  https://craftbodyscan.com/blog/chronic-small-vessel-ischemic-disease/

  Chronic small vessel ischemic disease may sound like a complex medical term, but at its heart, its about understanding how the health of tiny blood vessels in your brain can impact your overall well-being. […] Because these symptoms can overlap with other neurological conditions, advanced imaging like an MRI or CT scan is often necessary to confirm a diagnosis. […] Diagnosis typically involves a combination of clinical evaluations and advanced imaging. Heres what your doctor might use to pinpoint the condition: […] MRI Scans: Considered the gold standard, MRIs can detect white matter lesions and small vessel damage in detail. […] These tools together provide a comprehensive picture, helping your doctor tailor a treatment plan that meets your needs.

• #2 Simple Blood Test Assesses Risk of Cerebral Small Vessel Disease | Technology Networks

  https://www.technologynetworks.com/diagnostics/news/simple-blood-test-assesses-risk-of-cerebral-small-vessel-disease-330254

  A UCLA-led study has found that levels of six proteins in the blood can be used to gauge a person’s risk for cerebral small vessel disease, or CSVD, a brain disease that affects an estimated 11 million older adults in the U.S. […] The hope is that this will spawn a novel diagnostic test that clinicians can start to use as a quantitative measure of brain health in people who are at risk of developing cerebral small vessel disease, said Dr. Jason Hinman, a UCLA assistant professor of neurology and lead author of the paper. […] Typically, doctors diagnose CSVD with an MRI scan after a person has experienced dementia or suffered a stroke. […] The blood test is a step forward, Hinman said, because it provides a more quantitative scale for evaluating the disease. That means the blood test can be used to follow the progression of the disease or to identify people who are candidates for prevention efforts or treatments for CSVD.

• #2 Cerebral small vessel disease: symptoms, diagnosis, and treatment

  https://www.topdoctors.co.uk/medical-articles/cerebral-small-vessel-disease-causes-symptoms-diagnosis-and-treatment

  Cerebral small vessel disease (CSVD) is a condition where the tiny blood vessels in the brain become narrowed, blocked, or damaged, restricting blood flow to brain tissue. This can lead to tiny strokes (lacunar infarcts), white matter damage, and a higher risk of vascular dementia. […] CSVD is typically detected through brain imaging techniques such as MRI scans: these provide detailed images of the brain, showing white matter damage and small strokes. […] Cognitive assessments: doctors may perform tests to assess cognitive function if memory or thinking skills are affected. […] While the damage caused by CSVD cannot be completely reversed, steps can be taken to slow its progression and reduce the risk of complications.

• #2 Spotlight Series | Microvascular Dysfunction: Invasive and Noninvasive Diagnosis of Small Vessel Disease

  https://www.acc.org/Latest-in-Cardiology/Articles/2022/08/01/01/42/Spotlight-Series-Microvascular-Dysfunction-Invasive-and-Noninvasive-Diagnosis-of-Small-Vessel-Disease

  The Coronary Vasomotor Disorders International Study (COVADIS) study group was established in 2012 to develop international standards for the diagnostic criteria of microvascular and vasospastic angina (Table),17,18 now used in national and European guidelines.19,20 The 2021 ACC/AHA chest pain guideline adopted these definitions and proposed a diagnostic evaluation pathway for patients with stable chest pain and suspected INOCA (Figure), including noninvasive and invasive testing strategies.19 Test selection should be guided by local availability and expertise. […] Clinical noninvasive diagnosis of CMD relies on identification of impaired coronary flow reserve (CFR) in the absence of flow-limiting CAD. Impaired CFR, calculated as the ratio of hyperemic to rest coronary blood flow (or myocardial blood flow), reflects flow abnormalities within the epicardial coronary arteries and microvasculature.21,22 Maximal hyperemia is induced with dipyridamole, adenosine or regadenoson.

• #2 Microvascular Coronary Artery Disease: Review Article | USC Journal

  https://www.uscjournal.com/articles/microvascular-coronary-artery-disease-review-article?language_content_entity=en

  The microvascular function can be evaluated indirectly by determining the CFR, which is measured by using vasoactive agents such as adenosine, dipyridamole (endothelium-independent vasodilator), or ACh (endothelium-dependent). […] IDFW is considered the gold standard in the evaluation of coronary microcirculation. IDFW directly measures the CBF velocity, direction, and pressure in an epicardial artery. Additionally, IDFW can evaluate the response to intracoronary injection of vasodilators and vasoconstrictors medications. […] Currently, the evidence for effective therapy in the treatment of CMVD is limited as there are no large randomized trials available. […] Therefore, most clinicians will treat CMVD with traditional antianginal therapies that have not necessarily been shown to improve patient outcomes.

• #2 Small Vessel Disease, a Marker of Brain Health: What the Radiologist Needs to Know | American Journal of Neuroradiology

  http://www.ajnr.org/content/early/2021/10/07/ajnr.A7302

  SUMMARY: Small vessel disease, a disorder of cerebral microvessels, is an expanding epidemic and a common cause of stroke and dementia. […] The STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria have standardized the nomenclature. […] Conventional and advanced small vessel disease imaging markers allow a comprehensive assessment of global brain health. […] The spectrum of SVD includes white matter hyperintensities (WMH) of presumed vascular origin, recent small subcortical infarcts, lacunes, microbleeds, superficial siderosis, prominent perivascular spaces, microinfarcts, and brain atrophy. […] The classic MR imaging markers of SVD include recent small subcortical infarctions, lacunes of presumed vascular origin, WMH of presumed vascular origin, PVS, and CMB.

• #2 Cerebral small vessel disease | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cerebral-small-vessel-disease?lang=us

  Cerebral small vessel disease, also known as cerebral microangiopathy, is an umbrella term for lesions in the brain attributed to pathology of small arteries, arterioles, capillaries, venules, or small veins. It is the most common cause of vascular dementia/cognitive impairment and is a major cause of ischemic and hemorrhagic strokes. […] Many aetiopathogenic types of small vessel disease are described. The most common is arteriolosclerosis, or age and vascular risk factor related small vessel disease, which based on a progressive clinical syndrome of cognitive impairment and compatible imaging features is diagnosed as Binswanger disease. […] Chronic small vessel disease is often an incidental asymptomatic finding on imaging. However, it has been shown to cause vascular dementia and it is more common in patients with dementia (vascular dementia, Alzheimer disease, Lewy body dementia) compared to the general population. […] The differential causes of small vessel disease are enumerated above in the Etiology section.

• #2 Consensus statement for diagnosis of subcortical small vessel disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4758552/

  However, diagnosis of vascular dementia due to SVD was more controversial because of the frequent occurrence of white-matter changes in normal elderly, the high incidence of overlap with other neurodegenerative disorders, and the lack of consensus on the use of clinical, cerebrospinal fluid (CSF), neuroimaging, and neuropathologic findings in the diagnosis. […] Small vessel disease is a broad term that includes lesions in subcortical gray and white matter. […] Lacunes are often present along with extensive white-matter changes, which are often the case in hypertensive SVD. […] Diagnosis of BD is complicated by the overlap with AD and white-matter changes of aging. […] The CSF eliminates nonvascular causes, such as inflammation secondary to infection, vasculitis, and multiple sclerosis.

• #2 Small Vessel Disease: Understanding Its Impact on Heart Health – Longmore Clinic

  https://longmoreclinic.org/small-vessel-disease-understanding-its-impact-on-heart-health/

  Small vessel disease (SVD), also known as microvascular disease or coronary microvascular disease, is a condition that affects the small arteries in the heart. Its characterized by the narrowing or damage to these small blood vessels, which impairs blood flow and oxygen delivery to the heart muscle. This can cause symptoms similar to those of coronary artery disease (CAD), such as chest pain (angina). […] The diagnosis and treatment of small vessel disease can be challenging, as the condition may not be detected by standard tests used to assess heart health. […] Diagnosis of small vessel disease can be challenging, as it may not be detected by standard tests for heart disease, such as coronary angiography. Your doctor may use a combination of tests, including stress tests, imaging studies, and blood tests, to diagnose the condition.

• #2 What is microvascular angina? – BHF

  https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/microvascular-angina

  Our research aims to determine whether routine use of new blood vessel tests might help detect sub-groups of patients with angina due to small vessel disease. […] We are actively studying the underlying causes of small vessel disease in the hearts of individual patients with a view to making personalised treatment decisions that are linked to the underlying problem. […] To this end, researchers in Glasgow, and other groups in the UK and abroad are actively working to develop new medicines to specifically help patients with microvascular angina and coronary artery spasm. […] We also aim to develop new tests using a blood and/or urine sample to help diagnose the cause of chest pain in individual patients in the clinic.

• #2 Neuroimaging in Cerebral Small Vessel Disease

  https://www.jneurology.com/articles/neuroimaging-in-cerebral-small-vessel-disease.html

  However, due to the scarcity of complete PET installations including cyclotron and radiochemistry, PET is mainly restricted to applications in research. […] The diagnosis of SVD is difficult because there is no consensus on clinical criteria. […] MRI remains the key neuroimaging modality in chronic vascular cognitive impairment (VCI) because it has higher sensitivity and specificity for detecting pathological changes. […] That means that molecular imaging by PET may play an important role in the differentiation of vascular and degenerative cognitive impairment.

• #2

  https://journals.lww.com/co-neurology/fulltext/2021/04000/cerebral_small_vessel_disease_and_vascular.15.aspx

  We present recent developments in the field of small vessel disease (SVD)-related vascular cognitive impairment, including pathological mechanisms, updated diagnostic criteria, cognitive profile, neuroimaging markers and risk factors. […] The updated consensus criteria aim to standardize vascular cognitive impairment (VCI) diagnosis, relying strongly on cognitive profile and MRI findings. […] Advanced imaging techniques provide tools for early diagnosis and may play an important role as surrogate markers for cognitive endpoints in clinical trials. […] The clinical diagnosis of VCI relies strongly on cognitive profile and neuroimaging findings. […] According to the most recent diagnostic guidelines, from the Vascular Impairment of Cognition Classification Consensus Study (VICCCS), VCI’s definition aligns with the terminology of DSM-V and encompasses a broad clinical spectrum that ranges from mild to major VCI, and incorporates mixed-disease cases.

• #2 Small Blood Vessel Disease: Causes, Symptoms, Diagnosis & Treatment

  https://www.yashodahospitals.com/health-faqs/small-blood-vessel-disease/

  Small blood vessel disease is treatable but can be difficult to detect. A proper diagnosis is required to treat it effectively. […] To diagnose blood vessel problems, a doctor will evaluate your family history, medical history, and symptoms. Furthermore, to look for damage or blockages, they can perform diagnostic imaging procedures such as cardiac MRI, cardiac PET scan, and cardiac CT angiography scan. Additionally, an endothelial dysfunction test may be required to check the blood flow. […] Once the small blood vessel disease is diagnosed, the doctor can begin the treatment with an initial option. It includes managing symptoms and risk factors, relieving pain, and restricting the blood vessels to become narrow. […] In most cases, doctors can manage and reverse the damage caused by small blood vessel disease. It mostly depends on how fast it gets diagnosed.

• #3 Small vessel disease | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/small-vessel-disease

  Coronary angiogram. This test helps determine if the main arteries to the heart are blocked. A long, thin flexible tube (catheter) is inserted into a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter to arteries in the heart. The dye makes the arteries easier to see on X-ray images and video. […] Additional tests may be done during an angiogram to measure blood flow through the heart. […] CT coronary angiogram. This other type of angiogram uses a powerful X-ray machine to produce a series of images of the heart and its blood vessels. You’ll lie on a long table that slides through a short, tunnel-like machine (CT scanner). Dye injected through an IV in the arm or hand makes blood vessels easier to see on the CT images. […] Positron emission tomography (PET). This test uses a radioactive tracer and medication to measure blood flow to the heart muscle. After the tracer is injected, you usually lie in a doughnut-shaped machine to have images taken of the heart.

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