Document Detail

Coronary microvascular dysfunction in the clinical setting: from mystery to reality.
MedLine Citation:
PMID:  22915165     Owner:  NLM     Status:  MEDLINE    
Far more extensive than the epicardial coronary vasculature that can be visualized angiographically is the coronary microcirculation, which foregoes routine imaging. Probably due to the lack of techniques able to provide tangible evidence of its crucial role, the clinical importance of coronary microvascular dysfunction is not fully appreciated. However, evidence gathered over the last several decades indicates that both functional and structural abnormalities of the coronary microvasculature can lead to myocardial ischaemia, often comparable with that caused by obstructive coronary artery disease. Indeed, a marked increase in coronary microvascular resistance can impair coronary blood flow and trigger angina pectoris, ischaemic ECG shifts, and myocardial perfusion defects, and lead to left ventricular dysfunction in patients who otherwise have patent epicardial coronary arteries. This condition--often referred to as 'chest pain with normal coronary arteries' or 'cardiac syndrome X'--encompasses several pathogenic mechanisms involving the coronary microcirculation. Of importance, coronary microvascular dysfunction can occur in conjunction with several other cardiac disease processes. In this article, we review the pathogenic mechanisms leading to coronary microvascular dysfunction and its diagnostic assessment, as well as the different clinical presentations and prognostic implications of microvascular angina. As such, this review aims to remove at least some of the mystery surrounding the notion of coronary microvascular dysfunction and to show why it represents a true clinical entity.
Joerg Herrmann; Juan Carlos Kaski; Amir Lerman
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review     Date:  2012-08-22
Journal Detail:
Title:  European heart journal     Volume:  33     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-15     Completed Date:  2013-04-29     Revised Date:  2013-11-05    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  2771-2782b     Citation Subset:  IM    
Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, NY, USA.
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MeSH Terms
Acute Coronary Syndrome / diagnosis,  etiology,  physiopathology
Cardiac Imaging Techniques / methods
Cardiomyopathies / diagnosis,  etiology,  physiopathology
Chronic Disease
Heart Failure / diagnosis,  etiology,  physiopathology
Hemodynamics / physiology
Microcirculation / physiology
Microvascular Angina / diagnosis,  etiology*,  physiopathology
Myocardial Infarction / diagnosis,  etiology,  physiopathology
Percutaneous Coronary Intervention
Grant Support

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