Tag: ischemic heart disease

Research

Evaluating Ischemic Heart Disease in Women: Focus on Angina With...

Ischemic heart disease (IHD) is common in women, and cardiovascular disease is a leading cause of morbidity and mortality. While obstructive coronary artery disease is the most common form of IHD, millions of women suffer from angina with nonobstructive coronary arteries (ANOCA), an umbrella term encompassing multiple nonatherosclerotic disorders of the coronary tree.

The underlying pathology leading to ischemia in these syndromes may be challenging to diagnose, leaving many women without a diagnosis despite persistent symptoms that impact quality of life and adversely affect long-term cardiovascular prognosis. In the last decade, there have been significant advances in the recognition and diagnostic evaluation of ANOCA.

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Research

Pathophysiology of Coronary Microvascular Dysfunction

Ischemic heart disease (IHD) is commonly recognized as the consequence of coronary atherosclerosis and obstructive coronary artery disease (CAD). However, a significant number of patients may present angina or myocardial infarction even in the absence of any significant coronary artery stenosis and impairment of the coronary microcirculation has been increasingly implicated as a relevant cause of IHD.

The term “coronary microvascular dysfunction” (CMD) encompasses several pathogenic mechanisms resulting in functional and/or structural changes in the coronary microcirculation and determining angina and myocardial ischemia in patients with angina without obstructive CAD (“primary” microvascular angina), as well as in several other conditions, including obstructive CAD, cardiomyopathies, Takotsubo syndrome and heart failure, especially the phenotype with preserved ejection fraction.

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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

Assessment of Vascular Dysfunction in Patients Without Obstructive Coronary Artery...

Ischemic heart disease secondary to coronary vascular dysfunction causes angina and impairs quality of life and prognosis. About one-half of patients with symptoms and signs of ischemia turn out not to have obstructive coronary artery disease, and coronary vascular dysfunction may be relevant.

Adjunctive tests of coronary vasomotion include guidewire-based techniques with adenosine and reactivity testing, typically by intracoronary infusion of acetylcholine. The CorMicA (Coronary Microvascular Angina) trial provided evidence that routine management guided by an interventional diagnostic procedure and stratified therapy improves angina and quality of life in patients with angina but no obstructive coronary artery disease.

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Research

The Who, What, Why, When, How and Where of Vasospastic...

Ischemic heart disease involves both “structural” and/or “functional” disorders of the coronary circulation. Structural atherosclerotic coronary artery disease (CAD) is well recognized, with established diagnostic and treatment strategies. In contrast, “functional CAD” has received limited attention and is seldom actively pursued in the investigation of ischemic heart disease.

Vasospastic angina encompasses “functional CAD” attributable to coronary artery spasm and this “state of the art” consensus statement reviews contemporary aspects of this disorder.

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Real Patient Stories

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Sinéad’s story

My first episode caught me completely off guard on a Sunday morning in 2014. I was an active, healthy 35-year-old mother of 3. It felt like what I imagined having a heart attack would feel like. After a minute or two it stopped as suddenly as it had started and I got out of bed to start my day, I had experienced palpitations before and brushed it off as a once off.

I had about 8 more episodes before lunch time and made a deal with myself that if it continued, I would call an ambulance. I was a busy mum and didn’t want to be ‘dramatic’! It resolved by 2 p.m.

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Natsuko’s story

At 4am, I woke up in the dark with crushing chest pain, nausea, shortness of breath, and pain radiating to my left arm and jaw. I was terrified. You would think that such symptoms would lead to a quick diagnosis. But as a young woman in my 20s who looked “healthy,” my journey to finally being diagnosed with Microvascular Angina was anything but easy.

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Mary’s story

First came the headaches – worse than migraines – then the shortness of breath and having to lay down after crossing the room.

Five months after my symptoms began, I was diagnosed with a 99% blockage in my LAD and 99% blockage in an artery branch off that.

I was stented and, in doing so, they jailed an artery. I was given Metoprolol and I got worse.

I underwent another Angiogram, and all was fine, so they changed my medication and I began to use my Nitro more.

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CORONARY VASOSPASMMICROVASCULAR ANGINA

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