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European Heart Journal 1996 17(Supplement G):14-19; doi:10.1093/eurheartj/17.suppl_G.14
Copyright © 1996 by the European Society of Cardiology.
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© 1996 1996 The European Society of Cardiology

Angina with normal coronary arteries: Diagnosis, pathophysiology and treatment

S. L. Chierchia and G. Fragasso

Department of Cardiology, Istituto Scientifico H San Raffaele Milano, Italy

Correspondence: Professor Sergio L. Chierchia, Divisione di Cardiologia, Istituto Scientifico H San Raffaele, Via Olgettina 60, 20132 Milano, Italy.

Approximately 20% of patients undergoing diagnostic coronary arteriography for acute or chronic cardiac ischaemia have angiographically normal coronary arteries. The mechanism behind this phenomenon is likely to be the result of a combination of functional or anatomical abnormalities in the coronary microcirculation, a metabolic disorder which affects the handling of energy substrates by the heart, insulin resistance and a neurological component affecting pain perception. Indeed, it has been demonstrated that these patients often exhibit an increase in sympathetic outflow to the cardiovascular system, which might account for the reduction in coronary flow reserve, changes in metabolic utilization and development of insulin resistance that are seen in some of these patients. Therapeutically, β-blockers appear to be most effective in controlling the symptoms associated with this condition, although those calcium antagonists which do not affect the neurohormonal system may be of some utility in patients with primary microvascular angina, in which microvascular spasm is operating or in whom excessive constriction of the distal component of the coronary circulation limits the vasodilatory reserve. (Eur Heart J 1996; 17 (Suppl G): 14–19

Key Words: β-blockers • calcium antagonists • syndrome X • microvascular angina • sympathetic nervous system


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