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Vessel Plus 2021;5:[Accepted].10.20517/2574-1209.2021.68@The Author(s) 2021
Accepted Manuscript
Open AccessReview

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: john.beltrame@adelaide.edu.au


© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.


Around 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.

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

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