Mechanisms of exertional angina in patients with normal coronary arteries

摘要

Background Forty per cent of patients undergoing angiography to investigate exertional chest pain have normal coronary arteries. While described for nearly half a century, this condition has remained a mechanistic enigma.1–2 Diminished coronary blood flow augmentation to a pharmacological vasodilator, or coronary microvascular dysfunction (MVD), portends a greater risk of major adverse cardiovascular events.3–4 However, patients report symptoms during physical exercise, and the response to pharmacological ‘stress’ and physical exercise differ in the healthy heart.5 Moreover, it is unclear whether MVD is confined to the coronary circulation or a generalised disorder in myocardial and systemic blood flow during stress.