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[Angina pectoris and coronary insufficiency with a normal coronary angiogram: pathophysiological principles,
1Medizinische Klinik, Universität Düsseldorf.
Insights
Coronary insufficiency with normal arteriograms often involves microcirculation issues. Diagnosis and treatment focus on underlying vascular, rheological, and metabolic disorders for persistent angina.
Area of Science:
- Cardiology
- Vascular Biology
- Internal Medicine
Context:
- Coronary insufficiency with normal coronary arteriogram affects 10-20% of patients with exercise-induced symptoms.
- Microcirculatory disturbances are frequently implicated in this condition.
Purpose:
- To investigate the causes and diagnostic approaches for coronary insufficiency despite normal coronary arteriograms.
- To highlight the role of coronary microcirculation in this clinical syndrome.
Summary:
- This condition involves microvascular dysfunction stemming from vascular diseases, rheological disorders, or impaired oxygen transport.
- Diagnosis utilizes standard tests (ECG, stress ECG) and advanced functional assessments (coronary blood flow, vascular reserve, viscosity).
Impact:
- Effective management involves addressing underlying systemic diseases affecting vascular, rheological, and metabolic functions.
- Persistent angina with normal arteriograms necessitates further diagnostic exploration of coronary microcirculation for functional and therapeutic assessment.
Abstract:
The clinical syndrome "coronary insufficience at normal coronary arteriogram" is found in approximately 10-20% of patients with exercise-induced coronary insufficience. In most of these cases disturbances of coronary microcirculation are present. They can appear in vascular diseases (arterial hypertension, systemic immunopathies, immune complex vasculitis, etc.), in rheological diseases (paraproteinemia, hyperlipoproteinemia, polyglobulia, etc.), and in disturbances of transport and diffusion of oxygen (carbon monoxide intoxication, methemoglobinemia, hyperlipoproteinemia). The clinical diagnosis is based on usual diagnostic programs (electrocardiogram, exercise electrocardiogram, responsiveness to nitroglycerin, etc.), as well as on newer, functionally orientated diagnostic procedures (determinations of coronary blood flow and of coronary vascular reserve, production of lactate, serological findings, histology and immune histology of peripheral arteries, measurements of viscosities in both plasma and blood, etc.). Many clinically relevant disturbances in coronary microcirculation can thus be detected and treated on a rational basis by the management of the internal main disease, that is, by the treatment of the vascular, rheological, and metabolic disorders. Persistent angina pectoris in the presence of normal coronary arteriogram represents no termination of coronary diagnostics, but moreover implies the clinical task for using diagnostic possibilities to enable functional and therapeutical assessment of coronary microcirculation.