Document Detail

[Angina pectoris without coronary stenosis--current concepts].
MedLine Citation:
PMID:  20830663     Owner:  NLM     Status:  MEDLINE    
This review aims at demonstrating current concepts for the occurrence of angina pectoris (AP) and myocardial ischemia in patients without significant epicardial stenoses based on typical clinical examples. For applying these concepts, it is of utmost importance to clinically distinguish patients with resting AP only from those with exercise-induced symptoms or both. Resting AP may not only be caused by plaque rupture and subsequent coronary thrombosis, but may also be due (especially when repeated attacks occur in the early morning hours) to coronary vasospasm (in the microvasculature as well as in epicardial coronary segments). Similarly, exercise-induced AP and/or a pathological exercise test result may not only be caused by severe coronary stenoses, but may also be due to a reduced coronary perfusion reserve secondary to microvascular dysfunction. Hence, a pathological non-invasive stress-test result should not be necessarily described as "false positive" in case of the absence of any significant stenosis. In principle, proatherogenic cardiovascular risk factors are not only associated with atherosclerotic coronary artery disease (CAD), but also with the occurrence of a coronary vasomotility disorder. Both disease entities are characterised by the occurrence of myocardial ischemia. So far, the exact pathomechanism of respective subforms of coronary vasomotility disorders has not yet been not elucidated in detail. Endothelial dysfunction, abnormalities of the smooth muscle cells in the media as well as genetic predisposition or specific immunological abnormalities are discussed as underlying reasons. Intracoronary provocative testing (such as the acetylcholine-test) may help to diagnose as well as to differentiate the different subforms of coronary vasomotility disorders.
A Yilmaz; U Sechtem
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Publication Detail:
Type:  Case Reports; English Abstract; Journal Article; Review     Date:  2010-09-09
Journal Detail:
Title:  Deutsche medizinische Wochenschrift (1946)     Volume:  135     ISSN:  1439-4413     ISO Abbreviation:  Dtsch. Med. Wochenschr.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-22     Completed Date:  2010-10-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0006723     Medline TA:  Dtsch Med Wochenschr     Country:  Germany    
Other Details:
Languages:  ger     Pagination:  1925-30     Citation Subset:  IM    
Copyright Information:
© Georg Thieme Verlag KG Stuttgart · New York.
Abteilung für Kardiologie, Robert-Bosch-Krankenhaus Stuttgart.
Vernacular Title:
Angina pectoris ohne Koronarstenosen - aktuelle Konzepte.
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MeSH Terms
Acetylcholine / diagnostic use
Angina Pectoris / diagnosis
Coronary Angiography
Coronary Stenosis* / diagnosis
Coronary Thrombosis / diagnosis
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging
Exercise Test*
Magnetic Resonance Angiography
Microvascular Angina / diagnosis*,  etiology*
Middle Aged
Myocarditis / diagnosis
Parvoviridae Infections / diagnosis
Parvovirus B19, Human
Sensitivity and Specificity
Vasodilator Agents / diagnostic use
Reg. No./Substance:
0/Vasodilator Agents; 51-84-3/Acetylcholine

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