Vessel Plus 2021;5:[Accepted].10.20517/2574-1209.2021.68@The Author(s) 2021
Clinico-pathophysiological considerations in coronary microvascular disorders
Correspondence Address: Prof. John F. Beltrame, The University of Adelaide, Discipline of Medicine, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, Adelaide, SA 5011, Australia. E-mail: email@example.com
Received: 30 Apr 2021 | Revised: 14 Jul 2021 | Accepted: 2 Aug 2021 | First online: 6 Aug 2021
AbstractAround half of the patients undergoing an elective coronary angiogram to investigate typical stable angina symptoms are found to have non-obstructive coronary arteries (defined as < 50% stenosis). These patients are younger with a female predilection. While underlying mechanisms responsible in these presentations are heterogeneous, structural, and functional abnormalities of the coronary microvasculature are highly prevalent. Thus, coronary microvascular dysfunction (CMD) is increasingly recognised an important consideration in patients with non-obstructive coronary arteries. This review will focus on primary coronary microvascular disorders and summarise the four common clinical presentation pictures which can be considered as endotypes – Microvascular Ischaemia (formerly ‘Syndrome X’), Microvascular Angina, Microvascular Spasm and Coronary Slow Flow. Furthermore, the pathophysiological mechanisms associated with CMD are also heterogenous. CMD may arise from an increased microvascular resistance, impaired microvascular dilation and/or inducible microvascular spasm, ultimately causing myocardial ischaemia and angina. Alternatively, the chest pain may arise from hypersensitivity of myocardial pain receptors, rather than myocardial ischaemia. These two major abnormalities should be considered when assessing an individual clinical picture and ultimately, the question arises whether to target the heart or the pain perception to treat the anginal symptoms.
KeywordsCoronary microvascular dysfunction, normal coronary angiography, coronary slow flow phenomenon, syndrome X, microvascular angina, microvascular spasm, non-obstructive coronary arteries
Cite This Article
La S, Tavella R, Pasupathy S, Beltrame JF. Clinico-pathophysiological considerations in coronary microvascular disorders. Vessel Plus 2021;5:[Accept]. DOI: http://dx.doi.org/10.20517/2574-1209.2021.68