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Endothelial Dysfunction in Microvascular Angina

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Chest Pain with Normal Coronary Arteries

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Abstract

A large proportion of patients with chest discomfort, thought to be angina pectoris, have “normal” or non-obstructive epicardial coronary arteries at angiography. However, absence of angiographic evidence of stenosis is not a sufficient criterion to fully determine the health status of the coronary vasculature as related to exclusion of ischemic heart disease (IHD). Endothelial and vascular smooth muscle dysfunction, at both the microvascular and macrovascular level, may negatively influence myocyte oxygenation and cannot be directly visualized by coronary angiography. Alternative techniques that measure coronary blood flow changes in response to stressors or resistance changes are required to more fully evaluate coronary microvascular function. Of the pathophysiological mechanisms proposed to explain functional impairment of the microvasculature as well as IHD, endothelial dysfunction is one central etiologic substrate. While dysfunctional endothelium clearly impacts coronary vasomotor properties and blood flow responses, endothelium-independent vascular smooth muscle dysfunction also has a role in the development of IHD and related symptoms like angina and is a predictor of adverse outcomes.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Florida, 1600 S.W. Archer Road, 100277, Gainesville, FL, 32610-0277, USA

    Domenico G. Della Rocca MD & Carl J. Pepine MD

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  1. Domenico G. Della Rocca MD
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  2. Carl J. Pepine MD
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Correspondence to Carl J. Pepine MD .

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Editors and Affiliations

  1. Medical School, Coronary Artery Disease, Research Group, St George's Hospital, Cranmer Terrace, London, SW17 0RE, United Kingdom

    Juan Carlos Kaski

  2. University of Sydney, Discipline of Surgery, The Whiteley-Martin Research Centre, Parker Street, Sydney, 2747, New South Wales, Australia

    Guy D. Eslick

  3. , Women's Heart Center, Cedars-Sinai Heart Institute, S. San Vicente Blvd 444, Los Angeles, 90048, USA

    C. Noel Bairey Merz

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Rocca, D.G.D., Pepine, C.J. (2013). Endothelial Dysfunction in Microvascular Angina. In: Kaski, J., Eslick, G., Bairey Merz, C. (eds) Chest Pain with Normal Coronary Arteries. Springer, London. https://doi.org/10.1007/978-1-4471-4838-8_8

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  • DOI: https://doi.org/10.1007/978-1-4471-4838-8_8

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