PATHOPHYSIOLOGY, CLINICAL FEATURES AND TREATMENT OF MICROVASCULAR ANGINA: A REVIEW

Microvascular angina is a non-obstructive coronary syndrome which presents itself as anginal chest pain with different features compared to other causes of angina pectoris. Although, it occurs through a similar mechanism with the better-understood variant (prinzmetal) angina, unlike the former, microvascular angina affects the subendocardial thin, therefore less compliant vessels. It is essential for every medical practitioner to recognize a patient with microvascular angina, as the disease has some characteristic presentations, does not respond well to the classical treatments for angina pectoris, and eventually may result in serious complications later.

Keywords:

Microvascular angina coronary syndrome, angina pectoris,

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1. Gandhi MM, Lampe FC, Wood DA. Incidence, clinical char- acteristics, and short-term prognosis of angina pectoris. Heart 1995;73(2):193-8.
2. Hermann LK, Weingart SD, Yoon YM, et al. Comparison of fre- quency of inducible myocardial ischemia in patients presenting to emergency department with typical versus atypical or nonanginal chest pain. Am J Cardiol 2010;105(11):1561-4.
3. Baggiano A, Guglielmo M, Muscogiuri G et al. (Epicardial and microvascular) angina or atypical chest pain: differential diag- noses with cardiovascular magnetic resonance. Eur Hear J Suppl 2020;22:116-30.
4. Park JJ, Park SJ, Choi DJ. Microvascular angina: Angina that pre- dominantly affects women. Korean J Intern Med 2015;30(2):140-7.
5. Bøtker HE, Sonne HS, Sørensen KE. Frequency of systemic mi- crovascular dysfunction in syndrome x and in variant angina. Am J Cardiol 1996;78(2):182-6.
6. Dessalvi CC, Deidda M, Giorgi M et al. Vascular damage – coro- nary artery disease. J Cardiovasc Echogr 2020;30:11-6.
7. Algranati D, Kassab GS, Lanir Y. Why is the subendocardium more vulnerable to ischemia? A new paradigm. Am J Physiol - Hear Circ Physiol 2011;300(3):1090-100.
8. Kayikcioglu M, Payzin S, Yavuzgil O et al. Benefits of statin treat- ment in cardiac syndrome-X1. Eur Heart J 2003;24(22):1999-2005.
9. Ford TJ, Corcoran D, Berry C. Stable coronary syndromes: Pathophysiology, diagnostic advances and therapeutic need. Heart 2018;104(4):284-92.
10. Lanza GA, De Vita A, Kaski JC. “Primary” microvascular angi- na: clinical characteristics, pathogenesis and management. Interv Cardiol Rev 2018;13(3):108-11.
11. Alroy S, Preis M, Barzilai M et al. Endothelial cell dysfunction in women with cardiac syndrome X and MTHFR C677T mutation. Isr Med Assoc J 2007;9(4):321-5.
12. Seery JP. Therapeutic approach to microvascular angina (syn- drome x). J Am Coll Cardiol 1995;25(6):1472.
13. O’Rourke MF, Nichols WW. Microvascular angina or “vis a ter- go.” J Am Coll Cardiol 2010;55(6):611.
14. Gould KL, Johnson NP. Coronary physiology beyond coronary flow reserve in microvascular angina: jacc state-of-the-art review. J Am Coll Cardiol 2018;72(21):2642-62.
15. Kaski JC, Russo G. Cardiac syndrome X: an overview. Hosp Pract 2000;35(2):75-94.
16. Khera R, Secemsky E, Wang Y et al. Revascularization prac- tices and outcomes in patients with multivessel coronary ar- tery disease who presented with acute myocardial infarction and cardiogenic shock in the us, 2009-2018. JAMA Intern Med 2020;180(10):1317-27.
17. Berry C, Sidik N, Pereira AC et al. Small-vessel disease in the heart and brain: current knowledge, unmet therapeutic need, and future directions. J Am Heart Assoc 2019;8(3):e011104.
18. Rahman H, Demir OM, Khan F et al. Physiological stratification of patients with angina due to coronary microvascular dysfunction. J Am Coll Cardiol 2020;75(20):2538-49.
19. Pelletier-Galarneau M, Dilsizian V. Microvascular angina diag- nosed by absolute PET myocardial blood flow quantification. Curr Cardiol Rep 2020;22(2):9.
20. Manfrini O, Amaduzzi P, Bergami M et al. Effects of statin treat- ment on patients with angina and normal or nearly normal angio- grams. Eur Cardiol 2020;15:e15.