First in Region to Offer Diagnostic Study for Unexplained Heart-Related Chest Pain

CHESAPEAKE, VA – Chesapeake Regional Healthcare has become the first non-academic health system in Virginia and North Carolina to offer coronary microvascular dysfunction (CMD) studies, providing answers for patients with unexplained chest pain who previously faced repeated testing and treatment based on guesswork.

The breakthrough diagnostic procedure addresses a significant gap in cardiac care. Between 20-30% of patients who undergo cardiac catheterization (a minimally invasive procedure that uses a catheter placed through blood vessels in the arm or groin to the heart to diagnose blockages or valve issues) with angina symptoms (chest pain or pressure) show no significant blockages in their coronary arteries. These patients, most of whom are women, have symptoms that are often dismissed. They typically endure an average of three to five cardiac catheterizations before receiving a proper diagnosis.

A Local Solution

Dr. Asheesh Buch, board-certified in interventional cardiology, cardiovascular disease, and internal medicine, recently began performing this procedure at Chesapeake Regional Medical Center. This specialized testing is new to Hampton Roads. Residents previously would have needed to travel to academic centers such as the University of Virginia or Duke for diagnosis. Northeast North Carolina hospitals do not offer the study.

CMD occurs when the heart's smallest blood vessels don't function properly, causing pain without large-scale coronary artery disease that standard tests detect. The condition has been recognized since the 1960s, but recent advances in technology and standardized drug protocols have made testing more accessible.

The Power of a Formal Diagnosis

Coronary function testing provides definitive answers through invasive and non-invasive imaging and tests that measure coronary flow reserve and resistance while assessing for endothelial dysfunction. In this condition, the inner lining of blood vessels stops working properly, leading to blood vessels that can't dilate (open) effectively. By formally identifying the condition, physicians can:

• Stop the cycle: Prevent unnecessary and invasive repeat testing by providing a concrete diagnosis.
• Personalize treatment: Recent randomized clinical trials, including the CoRMICA trial and the ILIAS-ANOCA study published in August 2024 in the European Heart Journal, show that tailoring medical therapy based on coronary function testing results in significantly better angina relief compared to empirical treatment approaches.
• Advance future care: Correctly identifying patients with CMD ensures they can access new therapies as they become available.

Treatment involves lifestyle changes, strict control of cardiovascular risk factors, and medications including statins, ACE inhibitors, beta-blockers, and calcium channel blockers to manage symptoms and improve blood flow. Research shows that accurate diagnosis and treatment based on microvascular testing lead to significant improvements in angina severity and better overall patient outcomes.

Begin the Path to Better Health

Patients struggling with persistent chest pain with no clear explanation are encouraged to start a conversation with their doctor or visit the Chesapeake Regional Healthcare website to learn more about this CMD study.

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