Tag: vasospastic angina

Research

Coronary Microvascular Dysfunction and Vasospastic Angina—Pathophysiology, Diagnosis and Management Strategies

Coronary artery disease is one of the leading public health problems in the world in terms of mortality and economic burden from the disease. Traditionally, the focus of research and clinical pathways leading to the diagnosis and treatment of coronary artery disease was on the more common variant of the disease resulting from atherosclerosis in the epicardial coronary arteries. However, coronary microvasculature, representing the vast majority of the total heart circulation, has the greatest influence on overall coronary resistance and, therefore, blood flow. Coronary microvascular dysfunction (CMD), characterized by structural or functional abnormalities in the microvasculature, significantly impacts myocardial perfusion. Endothelial dysfunction results in inadequate coronary dilation during exercise or spontaneous spasm in the microvasculature or epicardial arteries.

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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.

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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.

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Research

Diagnostic Yield and Clinical Utility of Coronary Angiography Versus Coronary...

Approximately 50% of women referred for invasive coronary angiography have angina and nonobstructive coronary arteries, which includes coronary microvascular dysfunction, vasospastic angina, and other vasomotor disorders. We sought to determine the real‐world diagnostic yield of invasive coronary angiography and coronary function testing in women with angina and nonobstructive coronary arteries.

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Research

Diagnosis and treatment of patients with ANOCA Consensus document of...

A substantial number of patients undergoing coronary angiography for angina or ischemia in noninvasive tests have coronary arteries without lesions or with nonsignificant stenosis. Many of these patients have nonobstructive myocardial ischemia (INOCA/ANOCA), which is an entity with prognostic importance that significantly affects patients’ quality of life.

The absence of a proper diagnosis leads to inappropriate medical treatment, repeat diagnostic tests, and greater use of social and health resources. An adequate diagnostic strategy is required for individualized treatment that improves symptoms and quality of life.

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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 […]

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Research

Vasospastic angina: a review on diagnostic approach and management

Vasospastic angina (VSA) refers to chest pain experienced as a consequence of myocardial ischaemia caused by epicardial coronary spasm, a sudden narrowing of the vessels responsible for an inadequate supply of blood and oxygen. Coronary artery spasm is a heterogeneous phenomenon that can occur in patients with non-obstructive coronary arteries and obstructive coronary artery disease, with transient spasm causing chest pain and persistent spasm potentially leading to acute myocardial infarction (MI).

VSA was originally described as Prinzmetal angina or variant angina, classically presenting at rest, unlike most cases of angina (though in some patients, vasospasm may be triggered by exertion, emotional, mental or physical stress), and associated with transient electrocardiographic changes (transient ST-segment elevation, depression and/or T-wave changes).

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Research

Living with myocardial ischaemia and no obstructive coronary arteries: a...

Coronary artery disease is traditionally characterised by obstructive atherosclerosis. However, up to two in five people experience symptoms of myocardial ischaemia without obstructive coronary artery disease. This condition can be caused by a range of underlying pathologies including coronary endothelial dysfunction, microvascular remodelling, microvascular and epicardial spasm and vasomotor abnormalities.

A range of medical terms is used to describe distinct aspects of these conditions, including microvascular angina, coronary microvascular dysfunction, vasospastic angina, coronary vasospasms, coronary artery spasms, prinzmetal/variant angina and angina/ischaemia with no obstructive coronary arteries (ANOCA/INOCA). Women are disproportionately affected, particularly over the age of 40 years.

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Research

A Short History of Vasospastic Angina

The syndrome of chest pain and/or myocardial ischemia with normal or nonobstructive coronary arteries at angiography is common and is of practical importance to the general medical audience. Many studies have tried to address this topic over the last 4 decades. Only 1 thing is clear: for patients with ongoing signs and symptoms of ischemia in acute coronary syndromes, the prognosis is not so favorable, as believed earlier in the 1990s. Yet, physicians remain confused by other patients who refer a history of effort angina or angina-like chest pain whose coronary angiograms show no evidence of obstructive coronary artery disease (CAD) and who have no structural heart disease.

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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.

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Research

JCS/CVIT/JCC 2023 guideline focused update on diagnosis and treatment of...

In 2008, the Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) were developed by the Japanese Circulation Society, and the revised version was published in 2013. Since then, new findings from various fields such as coronary microvascular dysfunction (CMD), biomarkers, imaging, physiological functions, and genes have accumulated.

Furthermore, together with the spread of emergency coronary angiography (CAG) for acute coronary syndrome (ACS) and the development of diagnostic techniques using high-sensitive troponin, the new concepts of myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischemia with non-obstructive coronary artery disease (INOCA) have been proposed.

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Research

Management of vasospastic angina

Vasospastic angina is a well-established cause of chest pain that is caused by coronary artery spasm. It can be clinically diagnosed during a spontaneous episode by documenting nitrate-responsive rest angina with associated transient ischaemic ECG changes but more often requires provocative coronary spasm testing with acetylcholine during coronary angiography.

Vasospastic angina may result in recurrent episodes of angina (including nocturnal angina), which can progress on to major adverse cardiac events. Calcium channel blockers are first-line therapy for this condition, given their anti-anginal and cardioprotective benefits.

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Around The World

Real Patient Stories

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.

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Lynn’s story

I had my first spasm when I was just a young child and continued for almost 50 years with no diagnosis. I always assumed everybody had flushing feelings throughout their body, and hot flashes accompanied by chest pain.

It wasn’t until I was walking my dogs with my sister, one day, and we were going up a steep incline and I couldn’t keep up. I asked her if she felt chest pains when she walked up hills. She looked at me like I was crazy and told me: No!

I then realized something might be wrong with me.

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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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