Angina pectoris with a normal coronary angiogram.
Angina in the setting of a normal angiogram (NOCAD) occurs in 20-30% of patients undergoing coronary angiography. The etiologies of NOCAD can be anatomically classified into three groups: epicardial disease, coronary microvascular dysfunction, and noncoronary disease. Epicardial disease resulting in NOCAD includes endothelial dysfunction, coronary artery spasm, and coronary artery bridging. Microvascular dysfunction may be secondary to hypertension, cardiomyopathy, infiltrative disease, valvular disease, or idiopathic. Noncoronary artery disease states involving other organs systems such as the pulmonary, gastrointestinal, or musculoskeletal systems can also result in NOCAD. This review focuses on the coronary etiologies of NOCAD. The pathophysiology of disease is discussed as well as a systematic diagnostic strategy. Potential therapeutic options and prognosis are also reviewed.
Yang
Eric H
EH
Division of Cardiovascular Diseases, Center of Coronary Physiology and Imaging, Mayo College of Medicine, Rochester, Minnesota 55905, USA.
Lerman
Amir
A
D002986:Clinical Trials as Topic; D006801:Humans; D017566:Microvascular Angina / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors