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Related Experiment Videos

Exercise testing in patients with microvascular angina.

S E Epstein1, R O Cannon, R O Bonow

  • 1Cardiology Branch, National, Heart, Lung, and Blood Institute, Bethesda, Md. 20892.

Circulation
|May 1, 1991
PubMed
Summary
This summary is machine-generated.

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Microvascular angina, characterized by chest pain and exercise-induced ischemia in patients with normal coronary arteries, stems from abnormal microvascular responses. This distinct syndrome highlights a key cause of false positives in cardiac ischemia testing.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Physiology

Background:

  • Exercise testing often yields false positive results for myocardial ischemia in patients with normal epicardial coronary arteries.
  • Chest pain and ischemic changes in these patients are typically attributed to noncardiac origins.
  • The underlying mechanisms of angina-like symptoms in patients with normal coronary arteries require further investigation.

Purpose of the Study:

  • To investigate the mechanisms of angina-like pain in patients with angiographically normal coronary arteries.
  • To evaluate coronary blood flow and left ventricular function in patients with suspected microvascular dysfunction.
  • To identify a distinct clinical syndrome associated with abnormal coronary microvasculature responses.

Main Methods:

Related Experiment Videos

  • Studied patients with normal epicardial coronary arteries presenting with angina-like pain or exercise-induced ischemic changes.
  • Measured great cardiac vein flow under baseline, pacing, and ergonovine administration.
  • Utilized radionuclide angiography to assess left ventricular function before and during exercise.

    • Main Results:

    • A significant proportion of subjects exhibited inadequate coronary vasodilator reserve.
    • Exercise-induced left ventricular dysfunction, suggestive of myocardial ischemia, was observed.
    • Only 10% of patients with documented microvascular angina showed ischemic ST changes during exercise testing.

    Conclusions:

    • A distinct clinical syndrome, termed microvascular angina, is caused by abnormal prearteriolar coronary microvasculature resistance.
    • Microvascular angina explains angina-like symptoms and ischemic changes in patients with normal coronary arteries.
    • Exercise testing has limited sensitivity for detecting microvascular angina, particularly in men.