(See also Overview of Coronary Artery Disease Overview of Coronary Artery Disease Coronary artery disease (CAD) involves impairment of blood flow through the coronary arteries, most commonly by atheromas. Clinical presentations include silent ischemia, angina pectoris, acute... read more .)
Patients with microvascular angina have
Normal coronary arteriograms (eg, no atherosclerosis, embolism, or inducible arterial spasm)
Some of these patients have ischemia detected during stress testing; others do not. In some patients, the cause of ischemia seems to be reflex intramyocardial coronary constriction and reduced coronary flow reserve. Other patients have microvascular dysfunction within the myocardium: The abnormal vessels do not dilate in response to exercise or other cardiovascular stressors; sensitivity to cardiac pain may also be increased.
This disorder should not be confused with variant angina Variant Angina Variant angina is angina pectoris secondary to epicardial coronary artery spasm. Symptoms include angina at rest and rarely with exertion. Diagnosis is by electrocardiography (ECG) and provocative... read more due to epicardial coronary spasm.
Prognosis is better than for patients with demonstrable coronary artery disease Overview of Coronary Artery Disease Coronary artery disease (CAD) involves impairment of blood flow through the coronary arteries, most commonly by atheromas. Clinical presentations include silent ischemia, angina pectoris, acute... read more , although symptoms of ischemia may recur for years.
The mainstay of treatment is controlling risk factors with lipid-lowering therapy and glycemic control. In many patients, traditional anti-ischemic treatment, including beta-blockers and calcium channel blockers, helps to relieve symptoms (1 General reference Microvascular angina (previously known as syndrome X) is cardiac microvascular dysfunction or constriction causing angina in patients with normal epicardial coronary arteries on angiography... read more ).
1. Crea F, Camici PG, Bairey Merz CN: Coronary microvascular dysfunction: an update. Eur Heart J 35:1101–1111, 2014. doi: 10.1093/eurheartj/eht513
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