ANGINA PECTORIS AND MYOCARDIAL ISCHEMIA IN THE ABSENCE OF OBSTRUCTIVE CORONARY ARTERY DISEASE: CLINICAL CASE

  • M. M Karavanova V.N. Karazin Kharkiv National University, Kharkiv, Ukraine https://orcid.org/0000-0002-6411-4512
  • N. O Lisova V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
  • M. I. Shevchuk V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
Keywords: Cardiac syndrome X, angina, ischemia, microvascular disfunctional

Abstract

Our clinical case shows patient with worsening clinical signs of angina without obstructive lesions of coronary artery which requires further control. Recommendations for lifestyle modification as well as further treatment tactics are described.

This case is іnterestіng іn the development of decompensatіon (oedema of the lower extremities, reduced tolerance to stress) in a patient with cardiac syndrome X.

Management of patents with angina and evidence of myocardial schema on stress testing without obstructive coronary artery disease by angiography (previously referred to as cardiac syndrome X, or CSX) is a challenge.

Key points for the clіnіcіan include recognition of schema and deployment of guideline-endorsed therapy for angina and reduction of cardiac risk factors.

Systemic hypertension is often associated with mіcrovascular angіna. Several pathogenic mechanisms have been іdentіfіed which represent suitable targets for treatment. Mіcrovascular dysfunction needs to be іnvestіgated (and treated if present) іn patents with systemic hypertension, angina and angіographically normal coronary arteries.

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Author Biographies

M. M Karavanova, V.N. Karazin Kharkiv National University, Kharkiv, Ukraine

Svobody sq., 6, Kharkiv, 61022, Ukraine

N. O Lisova, V.N. Karazin Kharkiv National University, Kharkiv, Ukraine

Svobody sq., 6, Kharkiv, 61022, Ukraine

M. I. Shevchuk, V.N. Karazin Kharkiv National University, Kharkiv, Ukraine

Svobody sq., 6, Kharkiv, 61022, Ukraine

References

Agrawal S., Mehta P. K., Merz C. N. B. Cardiac syndrome X: update // Heart failure clinics. – 2016. – Т. 12. – No. 1. – p. 141–156.

Kret M. Cardiac syndrome X--epidemiology, diagnostics, ethiopatoghenesis, prognosis, treatment and latest guidelines // Przeglad lekarski. – 2016. – Т. 73. – No. 1. – p. 40–45.

Cadeddu C. et al. Altered transmural contractility in postmenopausal women affected by cardiac syndrome X //Journal of the American Society of Echocardiography. – 2014. – Т. 27. – No. 2. – p. 208–214.

Lansky A. J., Pietras C. Coronary Microvascular Dysfunction: Does Sex Matter? – 2015.

Chou A. Y., Saw J. Basis for sex-specific expression of Takotsubo cardiomyopathy, cardiac syndrome X, and spontaneous coronary artery dissection // Canadian Journal of Cardiology. – 2014. – Т. 30. – No. 7. – p. 738–746.

Nelson M. D. et al. Coronary microvascular dysfunction and heart failure with preserved ejection fraction as female-pattern cardiovascular disease: the chicken or the egg? // European heart journal. – 2018.

Pepine C. J., Merz C. N. B., Johnson B. D. Reply: Association Between Migraine Headache and Cardiac Syndrome X // Journal of the American College of Cardiology. – 2016. – Т. 67. – No. 17. – P. 2088.

Zuchi C., Tritto I., Ambrosio G. Microvascular angina: Are all women created equal? // International Journal of Cardiology. – 2018.

Mahfouz R. A. et al. Association of morning blood pressure surge with carotid intima-media thickness and cardiac dysfunction in patients with cardiac syndrome-X // Blood pressure. – 2018. – P. 1–7.

Marinescu M. A. et al. Coronary microvascular dysfunction, microvascular angina, and treatment strategies // JACC: Cardiovascular Imaging. – 2015. – Т. 8. – No. 2. – P. 210–220.

Bairey Merz C. N. et al. Ischemia and No Obstructive Coronary Artery Disease (INOCA) Developing Evidence-Based Therapies and Research Agenda for the Next Decade // Circulation. – 2017. – Т. 135. – No. 11. – P. 1075–1092.

Khaliq A. et al. Relationships between components of metabolic syndrome and coronary intravascular ultrasound atherosclerosis measures in women without obstructive coronary artery disease: the NHLBISponsored Women‘s Ischemia Syndrome Evaluation Study // Cardiovascular endocrinology. – 2015. – Т. 4. – No. 2. – P. 45.

O'neill S., O'driscoll L. Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies // Obesity reviews. – 2015. – Т. 16. – No. 1. – P. 1–12.

Prieto D., Contreras C., Sánchez A. Endothelial dysfunction, obesity and insulin resistance // Current vascular pharmacology. – 2014. – Т. 12. – No. 3. – P. 412–426.

Patel T. P. et al. Insulin resistance: an additional risk factor in the pathogenesis of cardiovascular disease in type 2 diabetes // Heart failure reviews. – 2016. – Т. 21. – No. 1. – P. 11–23.

Laakso M., Kuusisto J. Insulin resistance and hyperglycaemia in cardiovascular disease development // Nature Reviews Endocrinology. – 2014. – Т. 10. – No. 5. – P. 293.

Thomson L. E. J. et al. Cardiac magnetic resonance myocardial perfusion reserve index is reduced in women with coronary microvascular dysfunction: a National Heart, Lung, and Blood Institute-sponsored study from the Women‘s Ischemia Syndrome Evaluation // Circulation: Cardiovascular Imaging. – 2015. – Т. 8. – No. 4. – P. e002481.

Zhang X. et al. Effects of combination of statin and calcium channel blocker in patients with cardiac syndrome X // Coronary artery disease. – 2014. – Т. 25. – No. 1. – P. 40–44.

Zaya M., Mehta P. K., Merz C. N. B. Provocative testing for coronary reactivity and spasm // Journal of the American College of Cardiology. – 2014. – Т. 63. – No. 2. – P. 103–109.

Cocco G., Jerie P. Angina pectoris in patients without flow-limiting coronary artery disease (cardiac syndrome X). A forest of a variety of trees // Cardiology journal. – 2015. – Т. 22. – No. 6. – P. 605–612.

Szot W. et al. Cardiac rehabilitation: a good measure to improve quality of life in peri-and postmenopausal women with microvascular angina // Annals of Agricultural and Environmental Medicine. – 2015. – Т. 22. – No. 2.

Crea F., Lanza G. A. Treatment of microvascular angina: the need for precision medicine. – 2016.

Park J. J., Park S. J., Choi D. J. Microvascular angina: angina that predominantly affects women // The Korean journal of internal medicine. – 2015. – Т. 30. – No. 2. – P. 140.

Published
2019-01-08
How to Cite
Karavanova, M., Lisova, N., & Shevchuk, M. (2019). ANGINA PECTORIS AND MYOCARDIAL ISCHEMIA IN THE ABSENCE OF OBSTRUCTIVE CORONARY ARTERY DISEASE: CLINICAL CASE. The Journal of V. N. Karazin Kharkiv National University, Series "Medicine", (36), 58-62. Retrieved from https://periodicals.karazin.ua/medicine/article/view/12186
Section
Clinical case