Abstract
Patients with microvascular angina are characterized by angina pectoris with proof
of myocardial ischemia in the absence of any relevant epicardial stenosis and without
myocardial disease (type 1 coronary microvascular dysfunction according to Crea and
Camici). Structural and functional alterations of the coronary microvessels (diameter
< 500 µm) are the reason for this phenomenon. Frequently such alterations are associated
with cardiovascular risk factors. Patients with angina pectoris without epicardial
stenoses represent for 10 – 50 % of all patients undergoing coronary angiography depending
on the clinical presentation. Diagnostic approaches include non-invasive (e. g. combination
of coronary CT-angiography and positron emission tomography/echo Doppler-based coronary
flow reserve measurements) as well as invasive procedures (coronary flow reserve measurements
in response to adenosine, intracoronary acetylcholine testing). Pharmacological treatment
of these patients is often challenging and should be based on the characterization
of the underlying mechanisms. Moreover, strict risk factor control and individually
titrated combinations of antianginal substances (e. g. beta blockers, calcium channel
blockers, nitrates, ranolazine, ivabradine etc.) are recommended.
Die Evaluation von Patienten mit Angina pectoris zählt zu den Kernaufgaben der Inneren
Medizin/Kardiologie. Bei typischen Symptomen und Zeichen für eine myokardiale Ischämie
erfolgt in der Regel eine Koronarangiografie. Diese zeigt jedoch relativ häufig keine
relevanten Koronarstenosen. Oft wird dann, vor allem bei Frauen, die fatale Diagnose
„nicht-kardialer Brustschmerz“ gestellt, obwohl eine mikrovaskuläre Angina pectoris
vorliegt.
Schlüsselwörter
Mikrovaskuläre Angina pectoris - koronare mikrovaskuläre Dysfunktion - Diagnostik
- Therapie
Key words
microvascular angina - coronary microvascular dysfunction - diagnosis - therapy
