Abstract
The most common cause of myocardial ischemia and angina is coronary stenosis by atheromatous lesions in the epicardial arteries. However, a significant percentage of patients with angina and ischemia demonstrated by tests to induce it not present coronary obstructions on angiography. For this reason, the case of a 68-year-old woman is presented, who consulted for chest pain with typical oppressive characteristics, associated with autonomous symptoms, with electrocardiographic changes and elevated cardiac enzymes, given the above she received anti-ischemic, antiplatelet, and analgesic, which required coronary stratification, which was later reported within normal limits. Likewise, outpatient follow-up was carried out 3 months after the cardiovascular event, reporting within normal limits. In these cases, it is attributed to coronary spasm, endothelial dysfunction, and myocardial metabolism disorders as responsible for ischemia and its clinical manifestations. This situation constitutes a frequent and costly clinical problem, contributes to diminishing the quality of life, and presents a challenge in the diagnosis and treatment. This form of angina is not as benign as it was previously considered. We present a case in which it was not possible to demonstrated ischemia by tests performed and coronary angiography revealed no obstructive lesions.
Highlights
Atherothrombotic cardiovascular disease is the main cause of death in the world, the pathophysiological substrate of acute coronary syndromes is the rupture or fissure of an atherosclerotic plaque followed by thrombosis, vasospasm, and decreased coronary flow
The diagnosis of normality in coronary angiography is five times more frequent in women than in men [2], and it can lead to a wrong diagnosis of chest pain of non-cardiac origin, and patients remain without any treatment when clarifying studies are suspended due to International Journal of Clinical and Experimental Medical Sciences 2021; 7(4): 81-85 forgetting of alterations in the coronary microvasculature
We present a case of a patient with recurrent chest pain, and contrary to what was reported, the tests to induce ischemia were not demonstrative, and the coronary angiography did not reveal epicardial obstructive lesions
Summary
Atherothrombotic cardiovascular disease is the main cause of death in the world, the pathophysiological substrate of acute coronary syndromes is the rupture or fissure of an atherosclerotic plaque followed by thrombosis, vasospasm, and decreased coronary flow. The diagnosis of normality in coronary angiography is five times more frequent in women than in men [2], and it can lead to a wrong diagnosis of chest pain of non-cardiac origin, and patients remain without any treatment when clarifying studies are suspended due to International Journal of Clinical and Experimental Medical Sciences 2021; 7(4): 81-85 forgetting of alterations in the coronary microvasculature The prognosis of this group of patients is not as benign as was believed, they have an increase in mortality of 1.5 times more than the counterpart without any evidence of an ischemic process [3].
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