Abstract
Angina pectoris is one of the most common symptoms of ischemic heart disease (IHD). Coronary angiography in a significant part of patients with angina pectoris and signs of myocardial ischemia does not reveal obstructive atherosclerotic changes in the coronary arteries. Independent or additional mechanisms of ischemia can be microvascular dysfunction and epicardial coronary vasospasm. The clinical form of ischemic heart disease, which is based on ischemia caused by dysfunction of the coronary vessels in the absence of obstructive changes, has recently received the definition of INOCA (Ischaemia with No Obstructive Coronary Artery Disease). The concept of INOCA comprises two types of angina pectoris – mi- crovascular and vasospastic. The underlying INOCA coronary vasomotor disorders have both different pathophysiological mechanisms and localization in the vascular system of the coronary circulation itself. Clinically the most important vasomotor disorders are epicardial and microvascular vasospasm, impaired microvascular vasodilation. The article provides a brief overview of the mechanisms of regulation of coronary blood flow under physiological conditions and vascular dysfunction in non-obstructive atherosclerotic lesions.
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