DocTalk Podcast: Coronary Microvascular Disease (CMD): Small Vessels, Big Impact

When chest pain, shortness of breath, and fatigue send you to the ER, a normal stress test or “clear arteries” on an angiogram should feel reassuring, but for many people, the symptoms don’t stop. In this episode of MedStar Health DocTalk, host Debra Schindler sits down with Dr. Brian Case, interventional cardiologist at MedStar Southern Maryland Medical Center, to explain coronary microvascular disease (CMD), a condition affecting the heart’s smallest blood vessels that is often missed or misunderstood. Dr. Case shares how common “normal coronaries” are during cardiac catheterization, why CMD disproportionately affects women, and how symptoms can mimic obstructive heart disease (or even be dismissed as reflux, anxiety, or “all in your head”). You’ll learn the difference between microvascular dysfunction and microvascular spasm, how specialized coronary functional testing in the cath lab can help make a formal diagnosis (often with only a few extra minutes), and how treatment is tailored from beta blockers or calcium channel blockers to other medication options and cardiac rehab. They also discuss emerging research, including the potential future role of GLP-1 medications and investigational devices. If you’ve been told your heart is “fine” but you still don’t feel well, this conversation offers validation, and next steps to discuss with your doctor.