Diagnostic approach for coronary microvascular dysfunction in patients with chest pain and no obstructive coronary artery disease.

A large number of studies has demonstrated that abnormalities of coronary microcirculation may be re-sponsible for both acute and chronic cardiac ischemic syndromes. In clinical practice the microvascular origin of myocardial ischemia and angina is usually considered in patients who are found to have nor-mal or near-normal coronary arteries at angiography. In this article, we review the diagnostic approach to patients with suspected coronary microvascular dysfunction as a cause of ischemic syndromes and also suggest a classification of chronic and acute microvascular coronary ischemic syndrome, including myocardial infarction with normal coronary arteries.(c) 2021 Elsevier Inc. All rights reserved.

Automated summary

Numerous studies have shown that abnormalities in coronary microcirculation may be the cause of acute and chronic cardiac ischemic syndromes. The microvascular origin of myocardial ischemia and angina is considered in clinical practice when patients have normal or near-normal coronary arteries during angiography. This article reviews the diagnostic approach for patients suspected of having coronary microvascular dysfunction as the cause of ischemic syndromes and proposes a classification for chronic and acute microvascular coronary ischemic syndrome, including myocardial infarction with normal coronary arteries.