Small vessel disease signs and symptoms include:

• Chest pain, squeezing or discomfort (angina), which may worsen during daily activities and times of stress
• Discomfort in your left arm, jaw, neck, back or abdomen associated with chest pain
• Shortness of breath
• Tiredness and lack of energy

If you've been treated for coronary artery disease with angioplasty and stents and your signs and symptoms haven't gone away, you might also have small vessel disease.

Experts suspect that the causes of small vessel disease are the same as the causes for disease of the larger vessels of the heart, such as high blood pressure, high cholesterol, obesity and diabetes.

The large vessels in your heart can become narrowed or blocked through a condition in which fatty deposits build up in the arteries (atherosclerosis). In small vessel disease, damage to the small vessels affects their ability to expand (endothelial dysfunction). As a result, your heart doesn't get enough oxygen-rich blood.

Small vessel disease is more common in women. Risk factors include:

• Tobacco use
• Unhealthy cholesterol levels
• High blood pressure
• Obesity (body mass index of 30 or higher)
• Unhealthy diet
• Inactive lifestyle
• Diabetes
• Insulin resistance
• Estrogen deficiency, in women
• Polycystic ovarian syndrome
• Increasing age, older than 45 in men and older than 55 in women
• Chronic inflammation

It's not clear why the same risk factors, such as obesity or an inactive lifestyle, cause some people to develop small vessel disease instead of large vessel coronary artery disease.

Because small vessel disease can make it harder for the heart to pump blood to the rest of the body, the condition, if untreated, can cause serious problems, such as:

• Coronary artery spasm
• Heart attack
• Congestive heart failure