title: Management of microvascular angina pectoris.
abstract: Microvascular angina (MVA) is defined as angina pectoris caused by abnormalities of small coronary arteries. In its most typical presentation, MVA is characterized by angina attacks mainly caused by effort, evidence of myocardial ischemia on non-invasive stress tests, but normal coronary arteries at angiography. Patients with stable MVA have excellent long-term prognoses, but often present with persistent and/or worsening of angina symptoms. Treatment of MVA is initially based on standard anti-ischemic drugs (beta-blockers, calcium antagonists, and nitrates), but control of symptoms is often insufficient. In these cases, several additional drugs, with different potential anti-ischemic effects, have been proposed, including ranolazine, ivabradine, angiotensin-converting enzyme (ACE) inhibitors, xanthine derivatives, nicorandil, statins, alpha-blockers and, in perimenopausal women, estrogens. In patients with 'refractory MVA', some further alternative therapies (e.g., spinal cord stimulation, pain-inhibiting substances such as imipramine, rehabilitation programs) have shown favorable results.
authors.affiliation: Department of Cardiovascular Sciences Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy, galanza@alice.it.
authors.forename: Gaetano A
authors.initials: GA
authors.lastname: Lanza
authors.forename: Rossella
authors.initials: R
authors.lastname: Parrinello
authors.forename: Stefano
authors.initials: S
authors.lastname: Figliozzi
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017023:Coronary Angiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D017566:Microvascular Angina / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D047648:Perimenopause; D011379:Prognosis
chemical_list: D002317:Cardiovascular Agents