Fibromuscular dysplasia (FMD) » The Texas Heart Institute Center for Cardiovascular Care (2024)

A condition called fibromuscular dysplasia (FMD) is impacting women disproportionately – in fact, women represent 90% of FMD cases.

Coronary Artery Disease (CAD) is usually caused by fatty deposits (plaque) in the artery walls. These deposits are encouraged by high blood pressure, high cholesterol levels, tobacco smoking, and diabetes. Cholesterol-lowering medicines are often prescribed for people with CAD. However, sometimes arteries narrow or dissect without plaque buildup, possibly due to underlying FMD.

Why does this matter? Because the treatments we prescribe for CAD and FMD may differ. A treatment strategy for FMD may include different medications, such as medicine for blood pressure and clots, or even require vascular procedures, such as angioplasty or surgery.

What is FMD?

FMD is a non-inflammatory, non-atherosclerotic disorder. Meaning it is not caused by inflammation or plaque buildup. FMD causes narrowing or blockage of specific arteries in your body and can also lead to bulging of an artery caused by weakening of the artery wall (“aneurysm”) or a tear in the artery (“dissection”).

When FMD causes arteries to narrow, the blood flow through those arteries is reduced, and the loss of blood flow to the organs can affect their function. The arteries commonly affected by FMD are the ones from the heart to the kidneys (“renal arteries”) and the carotid and vertebral arteries, which provide blood flow to the brain. About two-thirds of patients with FMD have multiple arteries involved.

Photo credit: Dr. Santhi Ganesh/Ganesh Laboratory

What Causes FMD?

The cause of FMD is still unknown, and progress has been slow in understanding the epidemiology, pathogenesis, and outcomes since its first description in 1938. It is still unclear whether genetics plays a role in the development of FMD. It is now a subject of research investigation at The Texas Heart Institute (THI).

We are beginning to recognize common features like abnormal cell development in the artery wall. Some factors like genetic predisposition, hormonal influence, mechanical factors (stretching of smooth muscle cells and trauma to the blood vessel wall), and ischemia of the blood vessel wall could predispose people to the disease.

What are the symptoms?

Our clinic manages for patients with fibromuscular dysplasia and all related artery disorders. In patients with FMD, symptoms can vary from none at all to any of the following:

Kidney artery (Renal artery)
High blood pressure
Tissue damage in your kidneys (revealed by blood test results: elevated creatinine or a drop in glomerular filtration rate [GFR])
Chronic kidney failure (rare)

Brain arteries (Carotid and vertebral arteries)
Dizziness
Headache, neck pain
Blurred vision or temporary loss of vision
Pulsating ringing in your ears (tinnitus)
Facial weakness or numbness
Signs of stroke or transient ischemic attack

Heart arteries (Coronary arteries)
Chest pain
Heart attack (rare)

Abdominal arteries (Mesenteric, celiac, hepatic arteries)
Abdominal pain after eating
Unintended weight loss

Arteries leading to your extremities (Peripheral arteries)
Discomfort when moving your arms, legs, hands or feet
Cold limbs
Weakness
Changes in color or appearance of skin
Numbness

How is FMD Diagnosed?

The most common tests used to diagnose FMD noninvasively are CT scans with contrast and ultrasound with Doppler. These exams determine if the artery is narrowed and show the typical pattern of a “string of beads.”

What are the risk factors for FMD?

Some factors that can increase a person’s risk of developing FMD are:

Gender: Women have a greater risk of FMD – 90% of patients with FMD are women.

Age: In the past, FMD was identified as a disease of young women, but lately this has changed. According to the United States FMD Registry, the average age at diagnosis is 52 years, with a range of 5 to 86 years.

Smoking: Smoking increases a person’s risk of developing FMD. For people already diagnosed with the disease, smoking is a risk factor for more serious FMD.

Are there any complications?

High blood pressure: This is the most common complication. The narrowing of the arteries causes higher pressure on your artery walls, which can lead to further artery damage, heart disease or heart failure.

Dissected artery: One possible complication of FMD is a tear in the wall of your heart arteries (coronary arteries), causing a leak. This is known as arterial dissection or spontaneous coronary artery dissection (SCAD). The signs and symptoms of SCAD are shortness of breath, nausea, sweating and chest pain. Also, SCAD can cause heart attacks.

Aneurysms: FMD can weaken the walls of your arteries, creating a bulge called an aneurysm. If an aneurysm ruptures, it can be a life-threatening emergency.

Stroke: If you have a dissected artery leading to your brain or if an aneurysm in an artery to your brain ruptures, you can have a stroke. High blood pressure can also increase your risk of stroke.

Make an Appointment

Contact the FMD Clinic or request an appointment through the Contact Us form below.

Learn More

KPRC News Haley Hernandez talks with Drs. Stephanie Coulter and Zvonimir Krajcer about FMD & SCAD

Fibromuscular Dysplasia (FMD): The Rare Disease That Isn’t

Inside the Studio with Dr. Stephanie Coulter

FMD & SCAD Video Library

What kind of treatment is there for FMD?

Research to Improve Outcomes

The Texas Heart Institute is a site for theNorth American Registry for Fibromuscular Dysplasia (FMD Registry),a global research effort designed to collect clinical data and provide resources for FMD patients and healthcare providers.The Texas Heart Institute’s participation in the FMD Registry underscores its long-standing commitment to advancing research and improving care for those affected by FMD. By participating in the registry, The Texas Heart Institute contributes clinical information that can help inform treatment decisions and improve outcomes for FMD patients.

“We are proud to join the FMD Registry and contribute to this important research effort. By sharing our data and experiences, we hope to make a real difference in the lives of those affected by FMD, which primarily affects women in the prime of their life.”

Dr. Stephanie Coulter

Contact the Registry to Request Contact by our FMD Research Team at fmd@texasheart.org