Document Detail

Microvascular angina and the continuing dilemma of chest pain with normal coronary angiograms.
MedLine Citation:
PMID:  19712795     Owner:  NLM     Status:  MEDLINE    
Since initial reports over 4 decades ago, cases of patients with angina-like chest pain whose coronary angiograms show no evidence of obstructive coronary artery disease and who have no structural heart disease continue to be a common occurrence for cardiologists. Many features of this patient population have remained constant with successive reports over time: a female predominance, onset of symptoms commonly between 40 and 50 years of age, pain that is severe and disabling, and inconsistent responses to conventional anti-ischemic therapy. Because patients may have had abnormal noninvasive testing that led to performance of coronary angiography, investigators have sought to show an association of this syndrome with myocardial ischemia. Abnormalities in coronary flow and metabolic responses to stress have been reported by several groups, findings consistent with a microvascular etiology for ischemia and symptoms, but others have questioned the presence of ischemia, even in patients selected for abnormal noninvasive testing. Despite considerable efforts by many groups over 4 decades, the syndrome remains controversial with regard to pathophysiology, diagnosis, and management.
Richard O Cannon
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, N.I.H., Intramural; Review    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  54     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-28     Completed Date:  2009-09-23     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  877-85     Citation Subset:  AIM; IM    
Translational Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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MeSH Terms
Chest Pain / radiography*
Coronary Angiography*
Coronary Artery Disease / metabolism
Coronary Circulation
Coronary Vessels / metabolism
Endothelium, Vascular / physiopathology
Microvascular Angina / metabolism,  physiopathology*,  radiography,  therapy
Middle Aged
Myocardial Ischemia
Nitric Oxide / antagonists & inhibitors,  metabolism
Risk Factors
Ventricular Function, Left
omega-N-Methylarginine / pharmacology
Grant Support
Reg. No./Substance:
10102-43-9/Nitric Oxide; 17035-90-4/omega-N-Methylarginine
Comment In:
J Am Coll Cardiol. 2010 Jul 13;56(3):239-40; author reply 240   [PMID:  20620747 ]
J Am Coll Cardiol. 2010 Feb 9;55(6):611   [PMID:  20152571 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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