Myocardial ischemia and bizarre symptoms occur without obstructive lesions in major arteries as seen with standard coronary radiography due to peripheral artery obstructions. Is there a standard protocol to investigate and treat such patients?
In these patients, who are difficult to treat and to coach, there is a mixture of patients with coronary spasms and patients with microvascular disease. In a remaining subset the cause of angina is undetermined and ischaemia cannot be provoked with enough certainty.
I refer to the recent ESC guidelines, who nicely cover this subject.
Best regards,
Thierry
Article 2013 ESC guidelines on the management of stable coronary art...
As Dr. Gillebert has already stated, this syndrome consists of a heterogenous group of people ...those having coronary spasms, those with microvascular disease and those with undetermined causes. For those with coronary spasms, calcium channel blockers alongwith antiplatelets and statins play a major role. For those with microvascular disease nicorandil, ranolazine and even trimetazidine may be tried, if not controlled with the conventional anti-anginal management. It must be borne in mind that though they have normal coronaries, yet they run quite a high risk of future cardiovascular events.
My question was not on treatment but on diagnosis - is there a standard protocal for diagnosis?
For diagnosis of coronary artery spasm, the standard method is provocation test in angiographic lab. The method is not 100% standardized, some studies use acetylcholine and other use ergonovine maleate. Also the max. concentration is variable.
For example:
http://www.ncbi.nlm.nih.gov/pubmed/24573349
In my professional experience, I identified cases of Angina without obstruction mecanical.
Two cases of Angina with enzymes high and electrocardiogram changes, but without obstruction. Our conclusion was, coronarian spasm because adrenergic hyperativity.
Others cases with Angina with electrocardiogram changes but without enzymes changes was because coronaria ducking. When small segment of a coronary under segment of myocardium.
But I saw many cases of Angina with coronary arteries thin and tortuous, without obstruction.