Evolving strategies for the treatment of microvascular angina in women

Abstract

Microvascular angina, also known as cardiac syndrome X, is characterized by anginal chest pain, at least one cardiovascular risk factor, an abnormal stress test and normal coronary arteries on angiography. It is significantly more common in women than in men. A definitive diagnosis of microvascular angina can be made by invasive or noninvasive methods; a presumptive diagnosis can also be made based on fulfillment of diagnostic criteria. Effective treatment of microvascular angina requires aggressive risk factor modification; exercise is one of the most effective treatment modalities. Several other treatment strategies have been shown to relieve anginal symptoms as well as improve vascular function; these include b-blockers, angiotensin-converting enzyme inhibitors, ranolazine, l-arginine, statin drugs and potentially estrogen replacement therapy. Nitrates may be effective for symptom relief. Further studies are required to determine whether specific treatments are associated with improved survival as well as decreased symptoms.

Keywords::

• cardiac syndrome X
• coronary flow reserve
• endothelial dysfunction
• microvascular angina
• Women’s Ischemic Syndrome Evaluation

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.