American Journal of Cardiovascular Drugs

, Volume 14, Issue 1, pp 31–40 | Cite as

Management of Microvascular Angina Pectoris

  • Gaetano A. Lanza
  • Rossella Parrinello
  • Stefano Figliozzi
Therapy in Practice


Microvascular angina (MVA) is defined as angina pectoris caused by abnormalities of small coronary arteries. In its most typical presentation, MVA is characterized by angina attacks mainly caused by effort, evidence of myocardial ischemia on non-invasive stress tests, but normal coronary arteries at angiography. Patients with stable MVA have excellent long-term prognoses, but often present with persistent and/or worsening of angina symptoms. Treatment of MVA is initially based on standard anti-ischemic drugs (beta-blockers, calcium antagonists, and nitrates), but control of symptoms is often insufficient. In these cases, several additional drugs, with different potential anti-ischemic effects, have been proposed, including ranolazine, ivabradine, angiotensin-converting enzyme (ACE) inhibitors, xanthine derivatives, nicorandil, statins, alpha-blockers and, in perimenopausal women, estrogens. In patients with ‘refractory MVA’, some further alternative therapies (e.g., spinal cord stimulation, pain-inhibiting substances such as imipramine, rehabilitation programs) have shown favorable results.


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Gaetano A. Lanza
    • 1
  • Rossella Parrinello
    • 1
  • Stefano Figliozzi
    • 1
  1. 1.Department of Cardiovascular Sciences Istituto di CardiologiaUniversità Cattolica del Sacro CuoreRomeItaly

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