Recognition of suspected ischaemia with no obstructive coronary artery disease – termed INOCA – has increased over the past decades, with a key contributor being microvascular angina. Patients with microvascular angina are at higher risk for major adverse cardiac events including MI, stroke, heart failure with preserved ejection fraction and death but to date there are no clear evidence-based guidelines for diagnosis and treatment.
Recently, the Coronary Vasomotion Disorders International Study Group proposed standardised criteria for diagnosis of microvascular angina using invasive and non-invasive approaches. The management strategy remains empirical, largely due to the lack of high-level evidence-based guidelines and clinical trials. In this review, the authors will illustrate the updated approach to the diagnosis of microvascular angina and address evidence-based pharmacological and non-pharmacological treatments for patients with the condition.