title: [Coronary microvascular dysfunction. An update].
abstract: Several studies in the last years have shown that a dysfunction of coronary microcirculation may be responsible for abnormalities in coronary blood flow and some clinical pictures. Coronary microvascular dysfunction, in absence of other coronary artery abnormalities,  can cause anginal symptoms, resulting in a condition named microvascular angina (MVA). MVA can occur in a chronic form, predominantly related to effort (stable MVA), more frequently referred as cardiac syndrome X, or in an acute form, most frequently ensuing at rest, which simulates an acute coronary syndrome (unstable MVA).  The main abnormalities characterizing these two forms of MVA consist of an impaired vasodilation and an increased vasoconstriction of small resistive coronary arteries, respectively. The mechanisms responsible for stable MVA are still unclear, but seem to include, together with the known traditional cardiovascular risk factors, an abnormally increased cardiac adrenergic activity. The prognosis of stable MVA is good, but some patients have progressive worsening of symptoms. Clinical outcome of patients with unstable MVA is substantially unknown, as there are no specific studies about this population. Treatment of stable MVA includes traditional anti-ischemic drugs as first step; in case of persisting symptoms several other drugs have been proposed, including xanthine derivatives, ACE-inhibitors, statins and, in women, estrogens. Severe forms of  intense constriction (or spasm) of small coronary arteries may cause transmural myocardial ischemia, as the microvascular form of variant angina and the tako-tsubo syndrome.
authors.affiliation: Universita Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Lamendola
authors.forename: Antonino
authors.initials: A
authors.lastname: Di Franco
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Tarzia
authors.forename: Maria
authors.initials: M
authors.lastname: Milo
authors.forename: Marianna
authors.initials: M
authors.lastname: Laurito
authors.forename: Gaetano A
authors.initials: GA
authors.lastname: Lanza
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D000789:Angina, Unstable / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003326:Coronary Circulation; D004359:Drug Therapy, Combination; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D017566:Microvascular Angina / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D017202:Myocardial Ischemia / Q000503:physiopathology; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000503:physiopathology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D014970:Xanthines / Q000627:therapeutic use
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004967:Estrogens; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014665:Vasodilator Agents; D014970:Xanthines