Document Detail


Microvascular coronary dysfunction in women: pathophysiology, diagnosis, and management.
MedLine Citation:
PMID:  21723447     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Women exhibit a greater symptom burden, more functional disability, and a higher prevalence of no obstructive coronary artery disease compared to men when evaluated for signs and symptoms of myocardial ischemia. Microvascular coronary dysfunction (MCD), defined as limited coronary flow reserve and/or coronary endothelial dysfunction, is the predominant etiologic mechanism of ischemia in women with the triad of persistent chest pain, no obstructive coronary artery disease, and ischemia evidenced by stress testing. Evidence shows that approximately 50% of these patients have physiological evidence of MCD. MCD is associated with a 2.5% annual major adverse event rate that includes death, nonfatal myocardial infarction, nonfatal stroke, and congestive heart failure. Although tests such as adenosine stress cardiac magnetic resonance imaging may be a useful noninvasive method to predict subendocardial ischemia, the gold standard test to diagnose MCD is an invasive coronary reactivity testing. Early identification of MCD by coronary reactivity testing may be beneficial in prognostication and stratifying these patients for optimal medical therapy. Currently, understanding of MCD pathophysiology can be used to guide diagnosis and therapy. Continued research in MCD is needed to further advance our understanding.
Authors:
Kamlesh Kothawade; C Noel Bairey Merz
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Current problems in cardiology     Volume:  36     ISSN:  1535-6280     ISO Abbreviation:  Curr Probl Cardiol     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-07-04     Completed Date:  2011-10-25     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  7701802     Medline TA:  Curr Probl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  291-318     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Blood Flow Velocity
Coronary Circulation / physiology
Coronary Vessels / physiopathology
Endothelium, Vascular / pathology,  physiopathology*
Female
Humans
Microcirculation
Microvascular Angina / diagnosis*,  pathology,  physiopathology*,  therapy
Nitroglycerin / pharmacology
Platelet Aggregation Inhibitors / therapeutic use
Prognosis
Vasodilation
Vasodilator Agents / pharmacology
Women's Health
Grant Support
ID/Acronym/Agency:
MO1-RR00425/RR/NCRR NIH HHS; N01-HV-68161/HV/NHLBI NIH HHS; N01-HV-68162/HV/NHLBI NIH HHS; N01-HV-68163/HV/NHLBI NIH HHS; N01-HV-68164/HV/NHLBI NIH HHS; R01 HL090957-01A1/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Vasodilator Agents; 55-63-0/Nitroglycerin
Comments/Corrections

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


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