ABSTRACT
Impaired vasodilation and/or inappropriate vasoconstriction of the coronary microcirculation (i.e. microvascular spasm) can lead to myocardial ischemia and angina (microvascular angina) in patients with normal coronary angiograms. Invasive and non-invasive investigations have documented the occurrence of myocardial ischemia in the absence of epicardial coronary disease in some patients. Myocardial scintigraphy, cardiac MRI perfusion, positron emission tomography, and transthoracic Doppler echocardiography have all been used with characterize blood fl ow responses in patients with microvascular angina. Microvascular angina is often associated with endothelial dysfunction in the coronary microcirculation caused by traditional cardiovascular risk factors, estrogen defi - ciency (in women) and chronic infl ammation and oxidative stress. Treatment of this condition should aim at improving symptoms (e.g. by the administration of calcium channel blockers or nitrates) and ameliorating endothelial function with the use of ACE-inhibitors and statins. This chapter focuses on the management of microvascular angina in patients without obstructive epicardial coronary artery disease (CAD) or myocardial diseases (Fig. 29.1). Dysfunction of the coronary microvessels (diameter <200 μm, Fig. 29.2) can cause microvascular angina (1). Microvascular dysfunction can occur in patients with stable angina and also in those with acute coronary syndrome.
