Diffuse non-obstructive coronary artery disease: two clinical faces of the same disease-a case report
Matjaž Klemenc1, Gregor Budihna1, Igor Kranjec2
1Department of Intensive Care Unit, General Hospital of Nova Gorica, Padlih borcev 13A, Šempeter pri Gorici 5290, Slovenia.
Insights
Coronary artery disease (CAD) often has a long preclinical phase. This case highlights how non-obstructive CAD can present with varied symptoms, requiring advanced diagnostics for proper management.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) frequently exhibits a prolonged preclinical stage, characterized by diffuse non-obstructive disease, stenoses, or thrombosis before clinical manifestation.
- Understanding the diverse clinical presentations of non-obstructive CAD is crucial for timely diagnosis and intervention.
Observation:
- A middle-aged male presented with a spectrum of chest pain symptoms, including atypical pain, severe retrosternal pain, and effort angina.
- Diagnostic workup involved non-invasive testing, coronary angiography, intravascular imaging, and flow reserve assessments to characterize the coronary artery disease.
Findings:
- Diffuse non-obstructive coronary artery disease can manifest with varied clinical symptoms, necessitating comprehensive evaluation.
- Exercise stress testing can be a valuable initial tool for assessing effort angina.
- Flow reserve testing differentiates diffuse from focal disease patterns, guiding therapeutic strategies.
- Intravascular imaging provides critical insights into plaque morphology and risk features.
Implications:
- Accurate diagnosis of diffuse non-obstructive CAD relies on a combination of clinical assessment and advanced imaging techniques.
- Personalized treatment strategies, including risk factor modification, pharmacotherapy optimization, and percutaneous coronary intervention, are essential for managing patients with non-obstructive CAD.
- These diagnostic and therapeutic approaches align with current best clinical practices for managing coronary artery disease.
Background:
Coronary artery disease has a long preclinical phase before manifesting itself clinically due to diffuse non-obstructive disease, stenoses, or thrombosis.
Case Summary:
We present a case of a middle-aged male complaining of atypical chest pain, then severe retrosternal pain, and, eventually, effort angina. We performed non-invasive testing, coronary angiography, intravascular imaging, and flow reserve tests, each as appropriate. Cardiovascular risk control, optimization of drug therapy, and percutaneous coronary intervention were considered trying to comply with the best clinical practice.
Discussion:
Diffuse non-obstructive coronary artery disease may present clinically in different ways. Exercise stress test might be sufficient to assess effort angina before a potential angiography. Flow reserve tests across the diseased vessel can distinguish between diffuse and focal pattern of the disease and assist in the adequate selection of therapy. Finally, intravascular imaging is invaluable for the assessment of the plaque risk features.
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