Microvascular Angina

Chapter: Microvascular Angina
McMaster Section Editor(s): P.J. Devereaux
Section Editor(s) in Interna Szczeklika: Andrzej Budaj, Wiktoria Leśniak
McMaster Author(s): Tej Sheth
Author(s) in Interna Szczeklika: Tomasz Pasierski, Waldemar Banasiak, Wiktoria Leśniak, Maria Referowska
Additional Information

Definition and Clinical Features Top

Microvascular angina refers to angina pectoris with accompanying ST-segment depression on the electrocardiography (ECG) stress test (resting ECG is usually normal) and normal coronary angiography (without epicardial coronary artery spasm on ergonovine or acetylcholine challenge). Microvascular angina was formerly termed cardiac syndrome X.

Symptoms: Chest pain is often atypical; it may be very severe and usually develops on exertion but may also occur at rest. The pain usually lasts >10 minutes (up to >30 minutes after the end of exertion); it responds poorly to nitroglycerin. Symptoms of anxiety disorders may occur. Acute coronary syndrome may occur despite the absence of significant epicardial artery occlusion on angiography.

Diagnosis Top

Diagnosis is based on the exclusion of significant (or dominant) coronary artery disease and other diseases that may cause chest pain (see Chest Pain).

Treatment Top

Acetylsalicylic acid (ASA) and statins are recommended in all patients; treatment of chest pain using beta-blockers (first-line agents), nitrates, or calcium channel blockers: see Table 3.11-13, see Table 3.11-14. In patients not responding to these agents, used either alone or in combination, administer imipramine 50 mg once daily. Some studies have reported beneficial effects of angiotensin-converting enzyme inhibitors (ACEIs), sildenafil, ranolazine, L-arginine, and metformin. Behavioral interventions and physical exercise also may be beneficial.

Prognosis Top

Prognosis is good with respect to survival and maintaining good left ventricular systolic function, but chronic symptoms affect the quality of life.

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