Микроваскулярная стенокардия: патогенез, клиника, диагностика и принципы терапии

Abstract

The literature review presents current data on some mechanisms of development, clinical picture, diagnosis, and therapy tactics of microvascular angina (MA). The important role of microcirculatory pathology in the genesis of coronary heart disease is emphasized. Endothelial dysfunction and angiospasm have been shown to be the basis of MA. The article presents MA detection, including the presence of myocardial ischemia in the absence of obstructive coronary artery disease (coronary artery disease <50% or fractional flow reserve >0.80). It was noted that Holter monitoring was not informative for reliable diagnosis of myocardial ischemia, since the results of the study did not exclude or confirm the presence of coronary heart disease, including MA. Stress echocardiography and positron emission tomography were highly informative in the diagnosis of myocardial ischemia caused by microvascular pathology. The article also considers drug therapy tactics with the use of beta-adrenergic blocking agents and calcium channel blockers for patients with MA and the low efficacy of nitrates. The role of second-line drugs such as Nicorandil, Ranolazine, and Trimetazidine is discussed. The important role of statins and angiotensin-converting enzyme inhibitors, which have proven to be effective in the treatment of endothelial dysfunction, is emphasized. Disaggregants, like statins, are an important therapy component of MA.KEYWORDS: microvascular angina, endovascular dysfunction, diagnostics, therapy tactics.FOR CITATION: Shmatova E.N., Grinshtein Yu.I. Microvascular angina: pathogenesis, clinical picture, diagnosis and therapy tactics. Russian Medical Inquiry. 2020;4(7):425–430. DOI: 10.32364/2587-6821-2020-4-7-425-430.