scholarly journals Мicrovascular angina - terapeutic challenge. analisis of medical treatment options and a clinical case

2020 ◽  
Vol 26 (4) ◽  
pp. 68-72
Author(s):  
Svetlin Tsonev
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Clinical Case ◽  
Obstructive Coronary Artery Disease ◽  
Treatment Options ◽  
Microvascular Dysfunction ◽  
Original Data ◽  
Microvascular Angina ◽  
History Of ◽  
Artery Disease

Etiology, diagnostics and treatment of patients with angina like symptoms and angiographically coronary arteries with no changes remain uncertain. Microvascular dysfunction is main cause for the symptoms in these patients. Chest pain is usually severe and longer than in patients with obstructive coronary artery disease and this results in reduced functional capacity and often hospitalizations. Classic scheme of antiischemic treatment is insufficient in patients with microvascular dysfunctions, but metabolic class medicines reduce anginal episodes and their duration. We represent original data from our study and clinical case of a woman with long history of severe stenocardia and verified microvascular angina.

The coronary microcirculation and coronary microvascular dysfunction

2021 ◽  
pp. 18-21
Author(s):  
Romana Herscovici ◽  
C. Noel Bairey Merz
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Signs And Symptoms ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Cardiac Syndrome ◽  
Artery Disease

The role of revascularization in the treatment of obstructive coronary artery disease is well established, and its impact on improving survival has been proven. Nevertheless, patients with signs and symptoms considered of cardiac origin but with no obstructive coronary artery disease on coronary angiography are increasingly seen. Initially described as a ‘paradox’ or cardiac syndrome X and subsequently defined as microvascular angina, angina-like chest pain and evidence of ischaemia with non-obstructive coronary artery disease, is the consequence of altered coronary microvascular response to various stimuli despite non-obstructed epicardial vessels.

scholarly journals Clinical outcomes in patients with primary stable microvascular angina: is the jury still out?

2019 ◽  
Vol 5 (4) ◽  
pp. 283-291 ◽  
Author(s):  
Gaetano Antonio Lanza ◽  
Filippo Crea ◽  
Juan Carlos Kaski
Keyword(s):  
Chest Pain ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Published Data ◽  
Microvascular Angina ◽  
Coronary Events ◽  
Artery Disease

Abstract Several studies have demonstrated that angina chest pain in presence of normal or near normal coronary arteries (NCAs) is mainly related to coronary microvascular dysfunction (CMD). However, controversial findings exist about clinical outcome of these patients. In this article, we critically review characteristics and results of the main clinical studies reporting clinical outcome of stable patients with angina chest pain and non-obstructive coronary artery disease (NO-CAD). Published data indicate that clinical outcomes of these patients are heterogeneous, but those with strict criteria for primary stable microvascular angina (MVA, i.e. typical angina with NCAs mainly related to efforts) do not appear to have an increased mortality or risk of major coronary events. A major determinant of outcome in patients with MVA and NO-CAD seems instead related to non-critical atherosclerotic disease, the presence of which should suggest a more aggressive management of cardiovascular risk factors and preventive management. Future studies should assess whether CMD may have a relevant prognostic role in the latter clinical context and/or in other clinical settings of NO-CAD different from primary stable MVA.

scholarly journals Berries and Their Polyphenols as a Potential Therapy for Coronary Microvascular Dysfunction: A Mini-Review

2021 ◽  
Vol 22 (7) ◽  
pp. 3373
Author(s):  
Rami S. Najjar ◽  
Arielle M. Schwartz ◽  
Brett J. Wong ◽  
Puja K. Mehta ◽  
Rafaela G. Feresin
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Treatment Options ◽  
Microvascular Dysfunction ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Coronary Microvascular Dysfunction ◽  
Common Diagnosis ◽  
Artery Disease

Ischemia with no obstructive coronary artery disease (INOCA) is a common diagnosis with a higher prevalence in women compared to men. Despite the absence of obstructive coronary artery disease and no structural heart disease, INOCA is associated with major adverse cardiovascular outcomes as well a significant contributor to angina and related disability. A major feature of INOCA is coronary microvascular dysfunction (CMD), which can be detected by non-invasive imaging and invasive coronary physiology assessments in humans. CMD is associated with epicardial endothelial-dependent and -independent dysfunction, diffuse atherosclerosis, and left-ventricular hypertrophy, all of which lead to insufficient blood flow to the myocardium. Inflammatory and oxidative stress signaling, upregulation of the renin-angiotensin-aldosterone system and adrenergic receptor signaling are major drivers of CMD. Treatment of CMD centers around addressing cardiovascular risk factors; however, there are limited treatment options for those who do not respond to traditional anti-anginal therapies. In this review, we highlight the ability of berry-derived polyphenols to modulate those pathways. The evidence supports the need for future clinical trials to investigate the effectiveness of berries and their polyphenols in the treatment of CMD in INOCA patients.

scholarly journals Prevalence of microvascular angina among patients with stable symptoms in the absence of obstructive coronary artery disease: a systematic review

2021 ◽  
Author(s):  
Elif Aribas ◽  
Jeanine E Roeters van Lennep ◽  
Suzette E Elias-Smale ◽  
Jan J Piek ◽  
Maurits Roos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Comprehensive Evaluation ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Non Invasive ◽  
Artery Disease ◽  
Reported Data

Abstract Our purpose was to perform a systematic review to assess the prevalence of microvascular angina (MVA) among patients with stable symptoms in the absence of obstructive coronary artery disease (CAD). We performed a systematic review of the literature to group the prevalence of MVA, based on diagnostic pathways and modalities. We defined MVA using three definitions: (i) suspected MVA using non-invasive ischaemia tests; proportion of patients with non-obstructive CAD among patients with symptoms and a positive non-invasive ischaemia test result, (ii) suspected MVA using specific modalities for MVA; proportion of patients with evidence of impaired microvascular function among patients with symptoms and non-obstructive CAD, and (iii) definitive MVA; proportion of patients with positive ischaemia test results among patients with an objectified impaired microvascular dysfunction. We further examined the ratio of women-to-men for the different groups. Of the 4547 abstracts, 20 studies reported data on MVA prevalence. The median prevalence was 43% for suspected MVA using non-invasive ischaemia test, 28% for suspected MVA using specific modalities for MVA, and 30% for definitive MVA. Overall, more women were included in the studies reporting sex-specific data. The women-to-men ratio for included participants was 1.29. However, the average women-to-men ratio for the MVA cases was 2.50. In patients with stable symptoms of ischaemia in the absence of CAD, the prevalences of suspected and definitive MVA are substantial. The results of this study should warrant cardiologists to support, promote and facilitate the comprehensive evaluation of the coronary microcirculation for all patients with symptoms and non-obstructive CAD.

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