Microvascular Angina diagnosis and management: a review
Ischaemia in the absence of obstructive coronary artery disease (also known as INOCA) has increasingly been recognised through the detection of microvascular angina. Microvascular angina presents a risk factor for cardiac issues such as stroke or even death, with 4 in 5 patients with microvascular angina are thought to have coronary microvascular dysfunction. Yet, there exists little in the form of guidelines for its diagnosis and treatments. Despite this lack of clinical trials and solid, evidence-based guidelines, the Coronary Vasomotion Disorders International Study Group have recently suggested a new criteria of microvascular angina diagnosis and management. This involves both invasive & non-invasive testing, as well as pharmacological & non-pharmacological treatment options.
This review by Aldiwani H et al. aimed to define the diagnosis criteria and management guidelines of microvascular angina.
The group proposed a diagnosis criteria involving identifying symptoms of ischaemia without coronary artery disease, as well as evidence of myocardial ischaemia or vasomotor dysfunction. Symptoms of ischaemia include retrosternal chest pain/discomfort, which may develop either after exercise or at rest, and can also involve jaw or back pain; this presents sufficient evidence to test for microvascular angina.
Testing methods were suggested to be non-invasive (cardiac PET/CT, CMR, transthoracic doppler and cardiac MRI) or invasive (coronary function test).
Management is suggested to include non-invasive testing and treatment with examples such as β-blockers, angiotensin-converting enzyme inhibitors or statins (although further trials are required to assess their improvement of angina). Lifestyle changes may also include weight loss.