title: Microvascular coronary dysfunction in women: pathophysiology, diagnosis, and management.
abstract: Women exhibit a greater symptom burden, more functional disability, and a higher prevalence of no obstructive coronary artery disease compared to men when evaluated for signs and symptoms of myocardial ischemia. Microvascular coronary dysfunction (MCD), defined as limited coronary flow reserve and/or coronary endothelial dysfunction, is the predominant etiologic mechanism of ischemia in women with the triad of persistent chest pain, no obstructive coronary artery disease, and ischemia evidenced by stress testing. Evidence shows that approximately 50% of these patients have physiological evidence of MCD. MCD is associated with a 2.5% annual major adverse event rate that includes death, nonfatal myocardial infarction, nonfatal stroke, and congestive heart failure. Although tests such as adenosine stress cardiac magnetic resonance imaging may be a useful noninvasive method to predict subendocardial ischemia, the gold standard test to diagnose MCD is an invasive coronary reactivity testing. Early identification of MCD by coronary reactivity testing may be beneficial in prognostication and stratifying these patients for optimal medical therapy. Currently, understanding of MCD pathophysiology can be used to guide diagnosis and therapy. Continued research in MCD is needed to further advance our understanding.
authors: Kamlesh
authors: K
authors: Kothawade
authors: C Noel
authors: CN
authors: Bairey Merz
mesh_terms: D001783:Blood Flow Velocity; D003326:Coronary Circulation / Q000502:physiology; D003331:Coronary Vessels / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008833:Microcirculation; D017566:Microvascular Angina / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy; D005996:Nitroglycerin / Q000494:pharmacology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D014664:Vasodilation; D014665:Vasodilator Agents / Q000494:pharmacology; D016387:Women's Health
chemical_list: D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D005996:Nitroglycerin