Coronary microcirculation is all about the tiny arteries and arterioles that play a vital role in controlling blood flow to the heart muscle. When these microvessels function properly, they ensure that the heart gets enough blood and oxygen. However, if they don’t work as they should, it can lead to issues like microvascular angina, ischemia, and a higher risk of cardiovascular problems, even if the larger arteries are in good shape.To assess the health of the coronary microcirculation, doctors use both invasive and non-invasive methods. These include measuring coronary flow reserve, using intravascular imaging, and performing perfusion imaging. Grasping the state of microvascular health is essential for diagnosing small vessel disease, tailoring treatment plans, and ultimately enhancing patient outcomes. With targeted approaches—like medication and lifestyle changes—we can help restore microvascular function and safeguard overall heart health.