Microvascular angina: angina that predominantly affects women.
In women receiving evaluation for suspected ischemic symptoms, a "normal" diagnosis is five times more common than it is in men. These women are often labeled as having cardiac syndrome X, also known as microvascular angina (MVA). MVA is defined as angina pectoris caused by abnormalities of the small coronary arteries, and is characterized by effort chest pain and evidence of myocardial ischemia with a non-invasive stress test, although the coronary arteries can appear normal or near normal by angiography. MVA patients are often neglected due to the assumption of a good prognosis. However, MVA has important prognostic implications and a proper diagnosis is necessary in order to relieve the patients' symptoms and improve clinical outcomes. The coronary microvasculature cannot be directly imaged using coronary angiography, due to the small diameter of the vessels; therefore, the coronary microvascular must be assessed functionally. Treatment of MVA initially includes standard anti-ischemic drugs (β-blockers, calcium antagonists, and nitrates), although control of symptoms is often insufficient. In this review, we discuss the pathophysiology, diagnosis, and treatment of MVA.
Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Jin Joo
JJ
Park
Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Sung-Ji
SJ
Park
Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. ; Seoul National University College of Medicine, Seoul, Korea.
Dong-Ju
DJ
Choi
D002317:Cardiovascular Agents / Q000627:therapeutic use; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008833:Microcirculation; D017566:Microvascular Angina / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents
Microvascular angina; Review