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Microvascular angina: an update on diagnosis and treatment

Jane S Titterington1, Olivia Y Hung, Nanette K Wenger

  • 1Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA, USA.

Future Cardiology
|March 12, 2015
PubMed

Insights

Many patients experience chest pain due to microvascular angina, not just blockages in large coronary arteries. This condition, originating in the heart’s small vessels, is often overlooked but is now diagnosable and treatable.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • Chest pain is frequently misdiagnosed as noncardiac when coronary angiography shows no obstructive stenoses.
  • Myocardial ischemia can stem from conditions beyond obstructive coronary artery disease, particularly involving the heart's microcirculation.
  • Recent advancements provide a framework for understanding and diagnosing microvascular dysfunction.

Purpose of the Study:

  • To highlight the diagnostic challenges and therapeutic strategies for microvascular angina.
  • To emphasize the role of the microcirculation in causing myocardial ischemia.
  • To guide clinicians in identifying ischemic heart disease in patients with 'normal' coronary arteries.

Main Methods:

  • Review of current diagnostic tools for microvascular dysfunction.
  • Analysis of the pathophysiology of microvascular angina.
  • Discussion of treatment protocols for microvascular angina.

Main Results:

  • Microvascular angina is a significant cause of ischemic heart disease in patients without obstructive coronary artery disease.
  • Diagnostic tools now allow for the identification of microvascular dysfunction.
  • Treatment strategies targeting the microcirculation can effectively manage symptoms.

Conclusions:

  • Microvascular angina is an underdiagnosed cause of chest pain and myocardial ischemia.
  • Accurate diagnosis and targeted treatment of microvascular dysfunction are crucial for patient outcomes.
  • Understanding the microcirculation's role reclassifies many cases of presumed noncardiac chest pain.

Keywords:
coronary flow reserveendothelial dysfunctionischemic heart diseasemicrovascular anginamicrovascular coronary dysfunctionnonobstructive coronary artery disease

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