Chest pain without obstructive coronary artery disease: a case series report

Sidik, N., McDermott, M., McEntegart, M. B. and Berry, C. (2020) Chest pain without obstructive coronary artery disease: a case series report. European Heart Journal: Case Reports, 4(3), pp. 1-6. (doi: 10.1093/ehjcr/ytaa060) (PMID:32617474) (PMCID:PMC7319819)

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Abstract

Background: Ischaemic heart disease is a leading cause of mortality in women. Even in those without obstructive coronary artery disease (CAD), women with angina continue to have increased mortality. There are gender differences in prevalence of different pathophysiologies, including functional disorders such as microvascular and vasospastic angina. Case summary: We describe four cases of angina in women with no obstructive CAD, in whom coronary function testing was performed. These four patients were diagnosed with disorders of coronary vasomotion, including vasospastic angina and different endotypes of microvascular angina. Discussion: This case series highlights the different mechanisms of ischaemia in the absence of obstructive CAD. Patients with angina and no obstructive CAD classified by computed tomography coronary angiography may have myocardial ischaemia due to microvascular angina, vasospastic angina, or both. Conventional investigations risk under-diagnosing, and as a consequence under-treating, patients with these conditions. Coronary function testing, in the form of diagnostic guidewire-based tests and adjunctive acetylcholine provocation, has proven to be critical in the accurate diagnoses and appropriate management of these patients.

Item Type:Articles
Additional Information:This research was also supported by a BHF Centre of Research Excellence award (RE/18/6134217).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and McEntegart, Dr Margaret and Sidik, Ms Novalia
Authors: Sidik, N., McDermott, M., McEntegart, M. B., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Heart Journal: Case Reports
Publisher:Oxford University Press
ISSN:2514-2119
ISSN (Online):2514-2119
Published Online:24 April 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in European Heart Journal: Case Reports 4(3): 1-6
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
174109The conundrum of angina in patients without obstructive coronary disease: a randomised controlled pilot trial of routine testing of coronary function.Colin BerryBritish Heart Foundation (BHF)FS/17/26/32744Institute of Cardiovascular & Medical Sciences