Tag: microvascular angina

Research

Societal, occupational, and economic considerations for women with (M)INOCA: a...

Cardiovascular disease is one of the leading causes of mortality in women, despite underrepresentation in the medical literature. Women have higher rates of ischemia and no obstructive coronary artery disease (INOCA) and myocardial infarction with no obstructive coronary artery disease (MINOCA) compared to men. The aim of this review is to describe the occupational, economic, and psychosocial factors which disproportionately impact women with (M)INOCA.

Read More »
Research

Functional Coronary Angiography for the Diagnosis of Coronary Vasomotor Disorders

Microvascular and/or vasospastic angina are two common forms of coronary vasomotor disorders that may occur in patients with ischaemia and non-obstructed coronary arteries (INOCA) or myocardial infarction with non-obstructive coronary arteries (MINOCA).

Functional coronary angiography involves invasive guidewire-based assessment of the coronary circulation using pharmacological vasoactive agents to assess small and large vasomotor dysfunction. Typically, responses to adenosine (microvascular vasodilator) and acetylcholine (large and small vessel vasospastic agent) are sequentially assessed.

Read More »
Research

Current Evidence-Based Treatment of Angina With Nonobstructive Coronary Arteries (ANOCA)

Although the techniques for coronary function testing (CFT) were largely developed more than 30 years ago, consensus on the specific diagnostic criteria and endotypes is still lacking. Furthermore, the management of patients with angina with nonobstructive coronary arteries (ANOCA) is challenging for most cardiologists. These patients are often a burden to the health care system due to recurrent presentations to the emergency room, repeated coronary angiography, and lack of improvement in their anginal symptoms even after being properly diagnosed with CFT.

Read More »
Research

Protocol Variation in Functional Coronary Angiography Among Patients With Suspected...

Introduction

Angina with non-obstructive coronary arteries (ANOCA) remains a common clinical finding among patients undergoing invasive coronary angiography for the investigation of suspected ischaemic syndromes. ANOCA may result from coronary microvascular disease or vasospasm (microvascular or epicardial spasm), which may be diagnosed using comprehensive physiology testing such as invasive functional coronary angiography (FCA).

Current guidelines (European Society […]

Read More »
Research

The invasive investigation of INOCA in the coronary catheterization lab

Over half of all patients with angina have no angiographically demonstratable obstructive coronary disease, with a significant proportion of these patients having undiagnosed microvascular dysfunction and/or vasospastic angina. In chronic coronary syndrome, ischemia with non-obstructive coronary artery disease (INOCA) often remains undiagnosed, or uninvestigated. INOCAmay occur due to vasospastic angina and microvascular dysfunction and require invasive assessment in the coronary catheterization lab. To evaluate INOCA coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) are used to assess microvascular dysfunction before acetylcholine provocation testing for coronary spasm. This review provides an overview of the invasive investigation of INOCA in the coronary catheterization lab for patients with angina to be optimally managed.

Read More »
Research

ChaMP-CMD: A Phenotype-Blinded, Randomized Controlled, Cross-Over Trial

Angina with nonobstructive coronary arteries is a common condition for which no effective treatment has been established. We hypothesized that the measurement of coronary flow reserve (CFR) allows identification of patients with angina with nonobstructive coronary arteries who would benefit from anti-ischemic therapy.

Patients with angina with nonobstructive coronary arteries underwent blinded invasive CFR measurement and were randomly assigned to receive 4 weeks of amlodipine or ranolazine. After a 1-week washout, they crossed over to the other drug for 4 weeks; final assessment was after the cessation of study medication for another 4 weeks.

Read More »
Research

Invasive Endotyping in Patients With Angina and No Obstructive Coronary...

We investigated the usefulness of invasive coronary function testing to diagnose the cause of angina in patients with no obstructive coronary arteries.

Outpatients referred for coronary computed tomography angiography in 3 hospitals in the United Kingdom were prospectively screened. After coronary computed tomography angiography, patients with unobstructed coronary arteries, and who consented, underwent invasive endotyping.

Read More »
Research

Prognostic association of plasma NT-proBNP levels in patients with microvascular...

The aim of this study was to assess the prognostic association of plasma levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) with clinical outcomes of patients with microvascular angina (MVA).

In this international prospective cohort study of MVA by the Coronary Vasomotor Disorders International Study (COVADIS) group, we examined the association between plasma NT-proBNP levels and the incidence of major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization due to heart failure or unstable angina.

Read More »
Research

Microvascular Angina: Diagnosis and Management

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.

Read More »
Research

Insights to advance our management of myocardial ischemia: From obstructive...

The Coronary Vasomotor Disorders International Study Group (COVADIS) invited leading experts to address strategies to enhance our clinical understanding of INOCA with an emphasis on the management of coronary vasomotor disorders.

Under-recognition of coronary vasomotor disorders, distinguishing different presentations of angina due to vasospasm and/or abnormal microvascular vasodilatation, developing invasive/non-invasive testing and treatment protocols, integrating diagnostic protocols into cardiologists’ workflow and trials to inform guideline development were identified as key knowledge gaps and will be briefly addressed in this Viewpoint article.

Read More »
Research

The Role of Mental Stress in Ischaemia with No Obstructive...

Ischaemic heart disease has been estimated to affect 126.5 million people globally. Approximately 70% of patients with angina and suspected myocardial ischaemia show no signs of obstructed coronary arteries after coronary angiography, but may still demonstrate ischaemia. Ischaemia with no obstructive coronary artery disease (INOCA) is increasingly acknowledged as a serious condition because of its association with poor quality of life and elevated risk for cardiovascular events.

The negative effects of psychological stress on INOCA are gaining more attention. Psychological stress is associated with adverse cardiovascular outcomes such as mental stress-induced myocardial ischaemia. Psychological stress includes anxiety, depression, anger and personality disturbances.

Read More »
News

Patient perspectives: how a quest for better recognition and care...

Around 40% of all patients undergoing angiography are found to have normal coronary arteries or non-obstructive coronary artery disease (NOCAD). This often results in ongoing issues in accessing effective care and treatment. Four women confronted with inconsistent medical advice decided to take matters into their own hands by forming a patient group to bridge the knowledge gap.

The International Heart Spasms Alliance (IHSA) was officially set up in 2021 by Terri Shumaker, a single mother of two in the United States, Cindy McCall, an Australian nurse, Sarah Brown, a retired British midwife, and American Annette Pompa. It aims to advocate for people with heart conditions that are frequently undiagnosed/misdiagnosed and misunderstood by both patients and clinicians.

Read More »
Around The World

Real Patient Stories

MaryAnn’s story

When I was 39, with zero risk factors for heart disease, I had all the classic symptoms associated with a heart attack. My doctors put me on three blood thinners to dissolve a clot in a minor artery seen in an angiogram. The next day, while the original clot had dissolved, I had a clot in a larger artery. Baffled, the cardiologists put in a stent. As they backed the scope out of the artery, it spasmed in another location.

At that time, I had a 4-year-old, an 8-year-old, and a 12-year-old. My husband traveled extensively for work. I asked myself two questions: 1) How do I feel about dying at age 39? 2) If I don’t die, how do I live?

Read More »

Sandra’s story

My story began in January 2010, while sitting at a traffic light returning to the office. I was working as a home health physical therapist. I began having chest pain out of nowhere. I got to my office and my boss, an RN, asked me if I was OK. I told her about the chest pain. By then it was starting to progress down my left arm. She took my blood pressure, normally 98/68. It was 140/90. She called my husband and told him to meet me at the ER. I drove myself there. They ran the normal tests and diagnosed me with costochondritis. Pain meds made the symptoms go away. The pain came back six times in the next 6 months. I asked for a cardiologist referral, but was denied, due to my age (39), lack of family history, and being in shape.

Read More »

Dima’s story

March 3rd, 2021 was the day that changed everything. At 55, I had a busy counselling practice and a few other projects on the go. The pandemic was causing anxiety for many of my clients and in my private life. I had a lot of stress of my own: there were safety issues in the building where I lived, and I was looking for a new apt. Despite this, I thought I was handling it well. I was fairly healthy, I walked daily, ate well, meditated and didn’t smoke or drink.

I started to experience heavy fatigue towards the end of 2020 but told myself it was normal considering all that was going on in the world.

Read More »

Get Informed

Learn all about the symptoms, causes and triggers of these heart conditions.

Educate. Inform. Enlighten.