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Small vessel disease

Small vessel disease is a condition in which the walls of the small arteries in the heart are damaged. The condition causes signs and symptoms of heart disease, such as chest pain (angina).

Small vessel disease is sometimes called coronary microvascular disease or small vessel heart disease. It’s often diagnosed after a doctor finds little or no narrowing in the main arteries of your heart, despite your having symptoms that suggest heart disease.

Small vessel disease is more common in women and in people who have diabetes or high blood pressure. The condition is treatable but can be difficult to detect.

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Research

Treatment of coronary microvascular dysfunction

Contemporary data indicate that patients with signs and symptoms of ischaemia and non-obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD) with elevated risk for adverse outcomes. Coronary endothelial (constriction with acetylcholine) and/or microvascular (limited coronary flow reserve with adenosine) dysfunction are well-documented, and extensive non-obstructive atherosclerosis is often present.

Despite these data, patients with INOCA currently remain under-treated, in part, because existing management guidelines do not address this large, mostly female population due to the absence of evidence-based data.

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News

New Webinars Series on INOCA

A new webinars series regarding myocardial ischaemia without obstructive coronary disease is now available on the IHSA website. This series of webinars was brought to you by PCRonline and is dedicated to the management of patients with ischemia and non-obstructive coronary artery disease.

The series includes 7 webinars where healthcare professionals discuss together many complex issues to educate others on INOCA.

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Research

Testing for Coronary Microvascular Dysfunction

The small blood vessels in the heart, called the coronary microvasculature, carry most of the blood flow to the heart muscle, delivering oxygen. These blood vessels can become unhealthy when there is damage to their inner lining. There can also be plaque buildup in the larger coronary arteries that does not narrow them but can contribute to abnormal blood flow.

Over time, this leads to abnormal widening or narrowing of the small vessels in response to exercise or stress, which can cause problems with the blood supply to the heart, causing chest pain, shortness of breath, heart attack, and heart failure.

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Research

Reappraisal of Ischemic Heart Disease

In recent years, it has become apparent that coronary microvascular dysfunction plays a pivotal pathogenic role in angina pectoris. Functional and structural mechanisms can affect the physiological function of the coronary microvasculature and lead to myocardial ischemia in people without coronary atheromatous disease and also in individuals with obstructive coronary artery disease.

Abnormal dilatory responses of the coronary microvessels, coronary microvascular spasm, and extravascular compressive forces have been identified as pathogenic mechanisms in both chronic and acute forms of ischemic heart disease.

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Research

Myocardial ischemia: From disease to syndrome

Although current guidelines on the management of stable coronary artery disease acknowledge that multiple mechanisms may precipitate myocardial ischemia, recommended diagnostic, prognostic and therapeutic algorithms are still focused on obstructive epicardial atherosclerotic lesions, and little progress has been made in identifying management strategies for non-atherosclerotic causes of myocardial ischemia.

The purpose of this consensus paper is three-fold: 1) to marshal scientific evidence that obstructive atherosclerosis can co-exist with other mechanisms of ischemic heart disease (IHD); 2) to explore how the awareness of multiple precipitating mechanisms could impact on pre-test probability, provocative test results and treatment strategies; and 3) to stimulate a more comprehensive approach to chronic myocardial ischemic syndromes, consistent with the new understanding of this condition.

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Research

Fourth universal definition of myocardial infarction (2018)

In the late 19th century, post-mortem examinations demonstrated a possible relationship between thrombotic occlusion of a coronary artery and myocardial infarction (MI). However, it was not until the beginning of the 20th century that the first clinical descriptions appeared describing a connection between the formation of a thrombus in a coronary artery and its associated clinical features.

Despite these landmark observations, considerable time elapsed before general clinical acceptance of this entity was achieved, in part due to one autopsy study that showed no thrombi in the coronary arteries of 31% of deceased patients with an MI.

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Research

Coronary microvascular disease: current concepts of pathophysiology, diagnosis and management

Coronary microvascular disease (CMD) is present in 30% of patients with angina and is associated with increased morbidity and mortality. We now have an improved understanding of the pathophysiology of CMD and the invasive and noninvasive tests that can be used to make the diagnosis.

Recent studies have shown that management of CMD guided by physiological testing yields better results than empirical treatment. Despite major advances in diagnosing and stratifying this condition, therapeutic strategies remain limited and poorly defined.

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Research

Clinical characteristics and prognosis of patients with microvascular angina: an...

To provide multi-national, multi-ethnic data on the clinical characteristics and prognosis of patients with microvascular angina (MVA). The Coronary Vasomotor Disorders International Study Group proposed the diagnostic criteria for MVA. We prospectively evaluated the clinical characteristics of patients according to these criteria and their prognosis.

The primary endpoint was the composite of major cardiovascular events (MACE), verified by institutional investigators, which included cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization due to heart failure or unstable angina.

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Research

The Lancet women and cardiovascular disease Commission: reducing the global...

Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum.

Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated.

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Around The World

Real Patient Stories

Arthur’s story

My name is Arthur. I am a Scot but have lived in London for nearly forty years.

In 2014, I had my first heart attack. In the following six years, I went to A&E at least twice a year. Every time, I was sent home and was told it was reflux.

My own doctor in about 2015/16 put me on half an angina pill. When I was in hospital, I was told by the cardiology doctors that I did not need it as I never had angina at all.

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Barbara’s story

I am a 62-year-old retired physician. My story began at age 47.

I was a very busy practicing OB/Gyn physician who was otherwise healthy.

I was on call at the hospital, and it was turning out to be one of the busiest days I had ever experienced as a physician. I was in a medical group that took call for 24 hours straight, most of the time working the entire 24 hours.

Halfway through that 24-hour call, I was in the operating room doing a C/Section on a patient. Halfway through the surgery I began to feel crushing chest pain.

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Charlotte’s story

While at work in September 2014, I lost vision of my left eye and had terrible feeling of “heat” all over the left side of my body.

The ER ophthalmologist directed me to cardiology for a vascular problem.

A week later, I could not walk 100 meters (325 feet) without crushing chest pain and shortness of breath.

I was no longer functional. Making my bed was all I could do in a whole day. I was no longer an active 54-year-old.

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