Coronary microvascular dysfunction equivalent to left main coronary artery disease

Area of Science:

• Cardiology
• Vascular Medicine

Background:

• Coronary microvascular dysfunction (CMD), or cardiac syndrome X, presents as angina with myocardial ischemia despite normal coronary angiography.
• Approximately 50% of patients with suspected ischemia show no obstructive coronary artery disease.

Observation:

• A patient experienced hypotension and ST segment depressions during a treadmill exercise test, suggesting significant coronary artery disease.
• Initial suspicion focused on left main or multivessel coronary artery disease.

Findings:

• Coronary angiography revealed normal coronary arteries, ruling out obstructive disease.
• Coronary flow reserve (CFR) measurement demonstrated severe microvascular dysfunction.

Implications:

• This case underscores the importance of assessing coronary microvascular function in patients with anginal symptoms and normal coronary arteries.
• Utilizing CFR measurements is crucial for diagnosing CMD when traditional angiography is inconclusive.
• Recognizing CMD is vital for appropriate patient management and treatment strategies.