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Angina with normal coronary arteries: diagnosis, pathophysiology and treatment

S L Chierchia1, G Fragasso

  • 1Department of Cardiology, Istituto Scientifico H San Raffaele, Milano, Italy.

European Heart Journal
|December 1, 1996
PubMed

Insights

Many patients with cardiac ischemia have normal coronary arteries due to microcirculation issues, metabolic disorders, and neurological factors. Beta-blockers are effective for symptom control in this condition.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Neurocardiology

Background:

  • Coronary arteriography reveals normal coronary arteries in approximately 20% of patients with cardiac ischemia.
  • The underlying mechanisms are multifactorial, involving coronary microcirculation, cardiac metabolism, insulin resistance, and pain perception.

Purpose of the Study:

  • To explore the potential mechanisms contributing to cardiac ischemia in patients with angiographically normal coronary arteries.
  • To identify effective therapeutic strategies for managing symptoms in this patient population.

Main Methods:

  • Review of existing literature on patients with normal coronary arteries and cardiac ischemia.
  • Analysis of the role of sympathetic nervous system activity, coronary microcirculation, and metabolic factors.

Main Results:

  • Increased sympathetic outflow may reduce coronary flow reserve and alter metabolic utilization.
  • Insulin resistance is observed in some patients, potentially linked to sympathetic activity.
  • Beta-blockers show efficacy in symptom management.

Conclusions:

  • Cardiac ischemia with normal coronary arteries likely results from a complex interplay of microvascular, metabolic, and neurological factors.
  • Therapeutic approaches should consider these underlying mechanisms, with beta-blockers being a primary option and certain calcium antagonists potentially useful for microvascular angina.

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