Merck Manual

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Microvascular Angina

(Angina With no Obstructive Coronary Artery Disease [ANOCA])

By

Ranya N. Sweis

, MD, MS, Northwestern University Feinberg School of Medicine;


Arif Jivan

, MD, PhD, Northwestern University Feinberg School of Medicine

Medically Reviewed Jun 2022 | Modified Sep 2022
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Microvascular angina (previously known as syndrome X) is cardiac microvascular dysfunction or constriction causing angina in patients with normal epicardial coronary arteries on angiography.

Patients with microvascular angina have

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.

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 ).

General reference

Drugs Mentioned In This Article

Drug Name Select Trade
Deponit, GONITRO , Minitran, Nitrek, Nitro Bid, Nitrodisc, Nitro-Dur, Nitrogard , Nitrol, Nitrolingual, NitroMist , Nitronal, Nitroquick, Nitrostat, Nitrotab, Nitro-Time, RECTIV, Transdermal-NTG, Tridil
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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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