Please use this identifier to cite or link to this item: https://hdl.handle.net/1/1569
Title: Stable coronary syndromes: pathophysiology, diagnostic advances and therapeutic need
Authors: Ford, Tom ;Corcoran, D.;Berry, C.
Affliation: Central Coast Local Health District
Gosford Hospital
Issue Date: Feb-2018
Source: 104(4):284-292
Journal title: Heart
Department: Cardiology
Abstract: The diagnostic management of patients with angina pectoris typically centres on the detection of obstructive epicardial CAD, which aligns with evidence-based treatment options that include medical therapy and myocardial revascularisation. This clinical paradigm fails to account for the considerable proportion (approximately one-third) of patients with angina in whom obstructive CAD is excluded. This common scenario presents a diagnostic conundrum whereby angina occurs but there is no obstructive CAD (ischaemia and no obstructive coronary artery disease-INOCA). We review new insights into the pathophysiology of angina whereby myocardial ischaemia results from a deficient supply of oxygenated blood to the myocardium, due to various combinations of focal or diffuse epicardial disease (macrovascular), microvascular dysfunction or both. Macrovascular disease may be due to the presence of obstructive CAD secondary to atherosclerosis, or may be dynamic due to a functional disorder (eg, coronary artery spasm, myocardial bridging). Pathophysiology of coronary microvascular disease may involve anatomical abnormalities resulting in increased coronary resistance, or functional abnormalities resulting in abnormal vasomotor tone. We consider novel clinical diagnostic techniques enabling new insights into the causes of angina and appraise the need for improved therapeutic options for patients with INOCA. We conclude that the taxonomy of stable CAD could improve to better reflect the heterogeneous pathophysiology of the coronary circulation. We propose the term 'stable coronary syndromes' (SCS), which aligns with the well-established terminology for 'acute coronary syndromes'. SCS subtends a clinically relevant classification that more fully encompasses the different diseases of the epicardial and microvascular coronary circulation.
URI: https://elibrary.cclhd.health.nsw.gov.au/cclhdjspui/handle/1/1569
DOI: 10.1136/heartjnl-2017-311446
Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/29030424
ISSN: 1355-6037
Publicaton type: Journal Article
Keywords: Cardiology
Cardiovascular Disease
Heart Disease
Study or Trial: Reviews/Systematic Reviews
Appears in Collections:Cardiology

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