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Microvascular Angina as a Cause of Ischemia: An Update

  • Edina Cenko
  • Peter Louis Amaduzzi
  • Raffaele Bugiardini
Chapter

Abstract

Since initial reports over four decades ago, the diagnosis and the management of “microvascular angina” continue to be a troublesome dilemma for physicians. Microvascular angina is suspected in those patients presenting with angina or angina-like chest pain whose coronary angiograms show no evidence of obstructive coronary artery disease. Many of these patients often complain of chest pain and disability for years, and the morbidity is considerable. Earlier reports have questioned the presence of ischemia in such patients. Recent investigations have sought to demonstrate an association of chest pain with the occurrence of adverse events including cardiac death and nonfatal myocardial infarction. The role of coronary microvascular function remains controversial with regards to pathophysiology, diagnosis and management.

Keywords

Women Coronary vasospasm Microvascular angina Coronary microvascular dysfunction Endothelial dysfunction Coronary angiography Non-obstructive coronary artery disease 

Abbreviations

ACC

American College of Cardiology

ACE

Angiotensin-converting enzyme

ACS

Acute coronary syndromes

AHA

American Heart Association

CAD

Coronary artery disease

CASS

Coronary Artery Surgery Study

CCB

Calcium channel blockers

CCTA

Coronary computed tomography angiography

CFR

Coronary flow reserve

CMD

Coronary microvascular dysfunction

CMRI

Cardiac magnetic resonance imaging

CVD

Coronary vascular dysfunction

ECG

Electrocardiogram

EECP

Enhanced external counterpulsation

EMMACE-2

Evaluation of Methods and Management of Acute Coronary Events

ESC

European Society of Cardiology

FFR

Fractional flow reserve

GRACE

Global Registry of Acute Coronary Events

HDL

High-density lipoprotein

HOPE

Heart Outcome Prevention Evaluation

IMR

Index of microvascular resistance

IVUS

Intravascular ultrasound

LDL

Low-density lipoprotein

MVA

Microvascular angina

PET

Positron emission tomography

RCT

Randomized clinical trials

SAQ

Seattle Angina Questionnaire

SPECT

single photon emission computed tomography

TIMI

Thrombolysis in Myocardial Infarction

TTDE

Transthoracic doppler echocardiography

VINTAGE-MI

Vascular Interaction With Age in Myocardial Infarction

WISE

Women’s Ischemia Syndrome Evaluation

Notes

Conflict of Interest Statement

We declare that we have no conflict of interest.

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Edina Cenko
    • 1
  • Peter Louis Amaduzzi
    • 1
  • Raffaele Bugiardini
    • 1
  1. 1.Department of Experimental, Diagnostic and Specialty MedicineUniversity of BolognaBolognaItaly

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