Angina with normal coronary arteries: diagnosis, pathophysiology and treatment

European Heart Journal
S L Chierchia, G Fragasso

Abstract

Approximately 20% of patients undergoing diagnostic coronary arteriography for acute or chronic cardiac ischaemia have angiographically normal coronary arteries. The mechanism behind this phenomenon is likely to be the result of a combination of functional or anatomical abnormalities in the coronary microcirculation, a metabolic disorder which affects the handling of energy substrates by the heart, insulin resistance and a neurological component affecting pain perception. Indeed, it has been demonstrated that these patients often exhibit an increase in sympathetic outflow to the cardiovascular system, which might account for the reduction in coronary flow reserve, changes in metabolic utilization and development of insulin resistance that are seen in some of these patients. Therapeutically, beta-blockers appear to be most effective in controlling the symptoms associated with this condition, although those calcium antagonists which do not affect the neurohormonal system may be of some utility in patients with primary microvascular angina, in which microvascular spasm is operating or in whom excessive constriction of the distal component of the coronary circulation limits the vasodilatory reserve.

Citations

Jul 24, 2002·Circulation Journal : Official Journal of the Japanese Circulation Society·Hiroshi SuzukiTakashi Katagiri
Mar 5, 2013·Revista Portuguesa De Cardiologia : Orgão Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology·Nádia MoreiraLuís Providência
May 20, 2003·Alimentary Pharmacology & Therapeutics·G D EslickN J Talley
Jan 18, 2006·International Journal of Cardiology·Isabel Coma-CanellaMiguel Artaiz
Apr 7, 2018·The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology·Yasser Yazied AbdelmonemMohammed Mahmoud Abdel Ghany

❮ Previous
Next ❯

Related Concepts

Related Feeds

Antianginal Drugs: Mechanisms of Action

Antianginal drugs, including nitrates, beta-blockers, and calcium channel blockers, are used in the treatment of angina pectoris. Here is the latest research on their use and their mechanism of action.

Cardiology Journals

Discover the latest cardiology research in this collection of the top cardiology journals.