title: Angina pectoris and myocardial ischemia in the absence of obstructive coronary artery disease: practical considerations for diagnostic tests.
abstract: Angina and myocardial ischemia without obstructive coronary artery disease are common clinical findings, often neglected for the assumption of a good prognosis. Most often, such patients are neither further investigated nor offered specific treatment beyond reassurance. However, the absence of significant coronary stenoses on angiography does not necessarily imply a "healthy" coronary tree. In such cases, myocardial ischemia may result from different types of functional disease involving the epicardial coronary arteries, the coronary microcirculation, or both; an accurate assessment of these components should be systematically performed after exclusion of organic epicardial disease because a correct diagnosis has relevant prognostic and therapeutic implications. Here we discuss the basic principles of diagnostic tests in this setting and propose a diagnostic sequence of reasonable practical implementation that may help identify patients at risk of future cardiac events.
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Radico
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cicchitti
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zimarino
authors.affiliation: Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy. Electronic address: rdecater@unich.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caterina
mesh_terms: D000465:Algorithms; D017023:Coronary Angiography; D019091:Critical Pathways; D006334:Heart Function Tests; D006801:Humans; D017566:Microvascular Angina / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
keywords: angina; cardiac syndrome X; coronary microcirculation; coronary spasm; endothelial dysfunction; myocardial ischemia; normal coronary arteries