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Hansen B, Holtzman JN, Juszczynski C, Khan N, Kaur G, Varma B, Gulati M. Ischemia with No Obstructive Arteries (INOCA): A review of the prevalence, diagnosis and management. Curr Probl Cardiol 2022; 48:101420. [DOI: 10.1016/j.cpcardiol.2022.101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 11/03/2022]
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Fu B, Wei X, Lin Y, Chen J, Yu D. Pathophysiologic Basis and Diagnostic Approaches for Ischemia With Non-obstructive Coronary Arteries: A Literature Review. Front Cardiovasc Med 2022; 9:731059. [PMID: 35369287 PMCID: PMC8968033 DOI: 10.3389/fcvm.2022.731059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/31/2022] [Indexed: 02/05/2023] Open
Abstract
Ischemia with non-obstructive coronary arteries (INOCA) has gained increasing attention due to its high prevalence, atypical clinical presentations, difficult diagnostic procedures, and poor prognosis. There are two endotypes of INOCA-one is coronary microvascular dysfunction and the other is vasospastic angina. Diagnosis of INOCA lies in evaluating coronary flow reserve, microcirculatory resistance, and vasoreactivity, which is usually obtained via invasive coronary interventional techniques. Non-invasive diagnostic approaches such as echocardiography, single-photon emission computed tomography, cardiac positron emission tomography, and cardiac magnetic resonance imaging are also valuable for assessing coronary blood flow. Some new techniques (e.g., continuous thermodilution and angiography-derived quantitative flow reserve) have been investigated to assist the diagnosis of INOCA. In this review, we aimed to discuss the pathophysiologic basis and contemporary and novel diagnostic approaches for INOCA, to construct a better understanding of INOCA evaluation.
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Affiliation(s)
- Bingqi Fu
- Shantou University Medical College, Shantou, China
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuebiao Wei
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Division of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingwen Lin
- Shantou University Medical College, Shantou, China
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Danqing Yu
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Nguyen TH, Ong GJ, Girolamo OC, De Menezes Caceres' V, Muminovic A, Chirkov YY, Horowitz JD. Angina due to coronary artery spasm (variant angina): diagnosis and intervention strategies. Expert Rev Cardiovasc Ther 2021; 19:917-927. [PMID: 34633245 DOI: 10.1080/14779072.2021.1991314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Since Prinzmetal first described a 'variant' form of angina pectoris, with predominantly resting episodes of pain and cyclic severity variations, it has gradually become apparent that this clinical presentation is caused by episodes of coronary artery spasm (CAS) involving focal or diffuse changes in large and/or small coronary arteries in the presence or absence of 'fixed' coronary artery stenoses. However, most clinicians have only limited understanding of this group of disorders. AREAS COVERED We examine the clinical presentation of CAS, associated pathologies outside the coronary vasculature, impediments to making the diagnosis, provocative diagnostic tests, available and emerging treatments, and the current understanding of pathogenesis. EXPERT OPINION CAS is often debilitating and substantially under-diagnosed and occur mainly in women. Many patients presenting with CAS crises have non-diagnostic ECGs and normal serum troponin concentrations, but CAS can be suspected on the basis of history and association with migraine, Raynaud's phenomenon and Kounis syndrome. Definitive diagnosis requires provocative testing at coronary angiography. Treatment still centers around the use of calcium antagonists, but with greater understanding of pathogenesis, new management options are emerging.
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Affiliation(s)
- Thanh Ha Nguyen
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - Gao-Jing Ong
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - Olivia C Girolamo
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - Viviane De Menezes Caceres'
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - Armin Muminovic
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - Yuliy Y Chirkov
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
| | - John D Horowitz
- Department of Cardiology, Central Adelaide Local Health Network, University of Adelaide, Basil Hetzel Institute for Translational Research, Adelaide, Australia
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Jewulski J, Khanal S, Dahal K. Coronary vasospasm: A narrative review. World J Cardiol 2021; 13:456-463. [PMID: 34621490 PMCID: PMC8462044 DOI: 10.4330/wjc.v13.i9.456] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/26/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
Coronary artery vasospasm (CAVS) plays an important role in acute chest pain syndrome caused by transient and partial or complete occlusion of the coronary arteries. Pathophysiology of the disease remains incompletely understood, with autonomic and endothelial dysfunction thought to play an important role. Due to the dynamic nature of the disease, its exact prevalence is not entirely clear but is found to be more prevalent in East Asian and female population. Cigarette smoking remains a prominent risk factor, although CAVS does not follow traditional coronary artery disease risk factors. Many triggers continue to be identified, with recent findings identifying chemotherapeutics, allergens, and inflammatory mediators as playing some role in the exacerbation of CAVS. Provocative testing with direct visualization is currently the gold-standard for diagnosis, but non-invasive tests, including the use of biomarkers, are being increasingly studied to aid in the diagnosis. Treatment of the CAVS is an area of active research. Apart from risk factor modification, calcium channel blockers are currently the first line treatment, with nitrates playing an important adjunct role. High-risk patients with life-threatening complications should be considered for implantable cardioverter defibrillator (ICD), although timing criteria for escalated therapy require further investigation. The role of pharmaceuticals targeting oxidative stress remains incompletely understood.
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Affiliation(s)
- Jacob Jewulski
- Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, United States
| | - Sumesh Khanal
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, United States
| | - Khagendra Dahal
- Department of Cardiology, CHI Health, Creighton University School of Medicine, Omaha, NE 68118, United States
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Schuchalter Ludmir S, Bental T, Itzhaki Ben Zadok O, Eisen A, Shochat T, Heruti I, Kornowski R, Porter A. Report from a large and comprehensive single-center Women's Health Cardiology Clinic. ACTA ACUST UNITED AC 2021; 17:17455065211013767. [PMID: 33926336 PMCID: PMC8111522 DOI: 10.1177/17455065211013767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: This article describes the women population and work at a unique Women’s Health Cardiology Clinic in order to raise cardiovascular disease awareness with an emphasis on women-specific risk factors, and thus to improve women’s clinical outcomes. This expectantly will aid in opening similar centers allowing more women to get superior care. Methods: Electronic medical records of women referred to the Women’s Health Cardiology Clinic were analyzed. The statistical analysis is descriptive in nature. Women’s Health Cardiology Clinic personnel work as a multidisciplinary team, and patients receive specialized diagnostic tests and treatments. Referrals are by physicians according to traditional and women’s specific risk factors for cardiovascular disease. Results: 985 women visited the Women’s Health Cardiology Clinic, accumulating 2062 visits. Median age was 57.5 years. The majority of the women were menopausal (575 women, 58%), 62 pregnant with complications and 25 oncology patients. At least, 30% of women had diabetes/hypertension/or dyslipidemia. 72 women had a history of either cerebrovascular event or acute coronary syndrome, and 139 women had evidence of atherosclerosis. Overall, 388 women underwent endothelial function test, 40% of these women had a score indicating endothelial dysfunction. 277 women underwent a psychological intervention. Conclusion: Described here are the experiences from a multidisciplinary Women’s Health Cardiology Clinic using a gender-specific cardiovascular care approach for women geared toward improved health and wellbeing. It is of utmost importance that this report will raise women-specific cardiovascular disease risk factors awareness in order to promote women’s cardiovascular and overall health.
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Affiliation(s)
| | - Tamir Bental
- Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Osnat Itzhaki Ben Zadok
- Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Alon Eisen
- Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Tzippy Shochat
- Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Irit Heruti
- Department of Psychology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Avital Porter
- Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv, Israel
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