Can you have heart disease without blocked arteries? - Ep 75 - I AM YOU

I AM YOU is hosted by Dr. Nitza I. Alvarez, MD, FACC — board-certified cardiologist, Women’s Heart Specialist, and bestselling author. Each episode shares real stories and expert insights to help women protect the heart that carries them through every stage of life — and step into their power as the CEO of their own health.

In this Ask the Heart Doctor-style episode, Dr. Alvarez answers a critical question many women never hear explained clearly: can you have heart disease without blocked arteries? The answer is yes.

Dr. Alvarez breaks down why women, especially around perimenopause and menopause, can experience chest pressure, shortness of breath, palpitations, fatigue, or feeling that “something isn’t right” — even after being told their stress test, echocardiogram, or arteries look normal.

This episode reframes heart disease beyond the traditional blockage model. Dr. Alvarez explains how the heart is not only supplied by large arteries, but also by a network of small blood vessels that deliver oxygen to the heart muscle. When those small vessels do not relax or function properly, women can experience real cardiac symptoms even without major artery blockages. This is known as microvascular dysfunction.

With clarity and urgency, she breaks down:

• Why “clean arteries” do not always mean the heart is healthy
• What microvascular dysfunction is and why it matters in women
• How endothelial dysfunction affects blood flow, inflammation, and vessel flexibility
• Why estrogen plays a major role in vascular health
• How menopause-related hormonal changes can create early cardiovascular warning signs
• Why symptoms like chest pressure, shortness of breath, palpitations, fatigue, indigestion, upper back pain, or neck discomfort deserve proper evaluation
• Why women should ask whether doctors are evaluating function — not just blockages
• The importance of early markers including blood pressure patterns, fasting glucose, hemoglobin A1c, fasting insulin, advanced lipid testing, ApoB, lipoprotein(a), vascular health, body composition, visceral fat, and hormone patterns.

This episode is a direct reminder that women are too often under-recognized, under-diagnosed, and under-treated when it comes to heart disease. Normal tests do not always mean nothing is happening. Sometimes the earliest phase of cardiovascular disease begins as dysfunction, not obstruction.

If you feel something is wrong, don’t dismiss it. Don’t stop at “your tests are normal.” Ask better questions. Push for a deeper evaluation. Becoming the CEO of your own health starts with taking your symptoms seriously — because you can have heart disease without blocked arteries.

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