Anginal Chest Pain Research Articles

Challenging Case in Clinical Practice: An Integrative Approach to Variant Angina

Variant angina results from coronary vasospasm and is often treated with calcium channel blockers. However, when traditional medical therapies are not tolerated, integrative modalities can be considered. We describe a 57-year-old woman with variant angina, which was confirmed on left heart catheterization with intracoronary nitroglycerin, who could not tolerate diltiazem due to hypotension. Because the patient wanted an integrative approach to her care, she was started on therapies consisting of L-arginine, magnesium, yoga, biofeedback, meditation, acupuncture, optimized sleep hygiene, and moderate intensity exercise. She reported fewer episodes of variant angina at her three-month follow-up visit. This case demonstrates the potential role of integrative therapies in the management of variant angina. Further research is needed to investigate their utility in the management of variant angina and other chest pain syndromes.

Role of Speckle Tracking Echocardiography in Assessing Anginal Chest Pain on Exertion

Left bundle branch block (LBBB) poses some restriction on coronary artery disease (CAD) diagnosis with noninvasive diagnostic modalities. Objectives: Evaluating the role of 2-D speckle tracking echocardiography (STE) in the diagnosis of CAD in patients with LBBB.

Level of high sensitivity C-reactive protein in patients of acute myocardial infarction with or without diabetes mellitus

Introduction: Myocardial infarction (MI) is diagnosed by history of typical angina chest pain of prolonged duration along with ST segment elevation and ECG and or raised cardiac biomarkers. Increased levels of CRP are associated with increased risk of HTN, DM and ischemic heart disease. Increased intake of trans fatty acids lead to increased levels of CRP, endothelial dysfunction and ischemic heart disease. Vessel wall is damaged after the inflammation and CRP is a marker of inflammation, so it can predict the cardiovascular disease. Objective: The objective of this study is to determine the level of high sensitivity CRP in MI patients with or without diabetes mellitus. Materials and methods: Total 60 patients were enrolled in the study. Patients having age from 40 to 70 years, diabetic patients and non-diabetic (male) and patients with acute myocardial infarcted patients were included. Patients having heart disease other than MI, patients less than 40 years were excluded. Level of high sensitivity CRP of patients of MI was analyzed by using chemiluminescence technique. High sensitivity CRP was analyzed quantitatively. Results: In this study 60 individuals with AMI were divided into two groups based on presence(n=30) 50% and absence (n=30) 50% of diabetes mellitus. The mean age of the population was 58.32 ± 11.24 years. Levels of high sensitivity CRP were distributed in four groups, the first group includes hsCRP < 10 mg/l, group-2 includes hsCRP 11-50 mg/l, group-3 comprises levels of hsCRP from 51-100mg/l and group-4 includes hsCRP level from 101-150mg/l. Both groups of AMI patients without and with DM had significantly higher levels of hsCRP as 40% and 31% patients have CRP level lies in group 3 and group 4 respectively. Moreover, the diabetic patients had higher levels of hsCRP as 50% of diabetic patients having levels of hsCRP fall in category of group 3 whereas only 13.3% non-diabetic patients have hsCRP falls in category of group 3. And this difference is statistically significant with the p value (p=0.007). Conclusion: The raised hsCRP is seen in AMI patients with history of diabetes, smoking and hypertension as compared to those AMI patients who had no previous history of all these risk factors.

In-Silico Docking Studies of Angiotensin Converting Enzyme Using Natural Inhibitor

Lowering blood pressure (BP) using antihypertensive medicines lowers the risk of target organ failure as well as the occurrence of cardiovascular disease. The most common modifiable risk factor for death and disability is hypertension, which is associated with strokes, increased coronary and systemic atherosclerosis, heart problems, and chronic kidney diseases (CKD). The majority of deaths and disabilities globally now result from cardiovascular diseases (CVDs), mainly in low- and middle-income nations. Numerous genetic, behavioral, and environmental risk factors all contribute to hypertension, a significant component in the advancement of CVD. Given the significance of protein-ligand interactions in structure-based therapy development, we molecularly docked nifedipine to the cardiovascular target protein to determine the drug’s binding affinity. The Angiotensin Converting Enzyme (Target hypertension Protein) three-dimensional (3D) structure was docked using the Autodock tool, which was retrieved from the Protein Data Bank (PDB). Our analysis indicates that nifedipine is an effective choice for treating hypertension and reducing the symptoms of angina (chest pain).

Study of Clinical Profiles, Risk Factors and Coronary Angiographic Patterns in Female Patients Presenting with Anginal Chest Pain in a Tertiary Care Centre of Nepal

Background and Aims: Coronary artery disease is one of the important causes of deaths in females in many countries. Females with chest pain are more likely to be treated in a different way as compared to males at the time of presentation. Worldwide, there has been a considerable rise in the number of females who are undergoing coronary angiography recently.
 Methods: This study was a single-centre, prospective, observational study conducted in the department of cardiology, MCVTC, Tribhuvan University, Nepal. The study period was from 5th July 2020 to 4th July 2021.155 female patients with anginal chest pain were enrolled. Data were collected after thorough history taking, physical examination, laboratory investigations, and coronary angiography. They were further divided into three age groups:<50 years,50-65 years and >65 years. Subsequently statistical analysis was done using latest version of SPSS.
 Results: The mean age of the patients was 59.64 years (SD=11.428). There were 119 (76.77%) postmenopausal patients. The most prevalent risk factor of IHD was HTN (43.87% ). Obesity/overweight was most common (58.62%) in those with age <50 years. DM was most common (26.32%) in age group 50-65 years. HTN was the most prevalent (52.63%) in age group 50-65 years. The maximum proportion of dyslipidemic patients (34.21%) were found in age group 50-65 years. 52.25% patients presented with acute coronary syndrome. 33.55% patients had normal coronary arteries. 11.61% patients had nonobstructive coronary artery disease.
 Obstructive coronary artery disease was found in 51.61% patients. IN patients with obstructive CAD, LAD was the most commonly involved vessel followed by RCA .
 Conclusion: Findings from our study shows higher prevalence of risk factors for IHD in Nepalese females. This study also demonstrates that as females get older and become postmenopausal, the number of risk factors for CAD increases. Understanding the risk factors for CAD and angiographic patterns in females could be helpful in implementing optimal treatment strategies in females with angina.

Diagnostic value of end-tidal carbon dioxide in the differential diagnosis of unstable angina and non-cardiac chest pain

ObjectiveThis study aims to investigate the diagnostic value of End-tidal carbon dioxide (ETCO2) measured non-invasively at the bedside in order to distinguish between unstable angina pectoris (UAP) and non-cardiac chest pain among patients who present to the emergency department with chest pain without a history of cardiac pathology. Material and methodsThis clinical study is a prospective case-control study among patients presenting to the emergency department of a tertiary hospital with chest pain. After evaluating the inclusion and exclusion criteria, the patients were divided into two groups: 62 patients with UAP and 62 patients with non-cardiac chest pain. Receiver Operating Characteristic (ROC) analysis was used to determine the cut-off in diagnostic value measurements. For UAP prediction, the odds ratio of ETCO2 (including 95% confidence intervals) was calculated using univariate with binary logistic regression analysis. ResultsETCO2 had an excellent diagnostic power in detecting UAP, with 35 cut-offs determined (AUC: 0.84, 95% Cl: 0.76–0.90, p < 0.001). When ETCO2, which affects both non-cardiac chest pain and UAP, is evaluated, an ETCO2 of <35 is statistically significant and 9.74 times more common among UAP patients than patients with non-cardiac chest pain. ConclusionETCO2, a non-invasive parameter that can be measured immediately at the bedside, may be proposed as a potential biomarker for differentiating patients with UAP from those with non-cardiac chest pain.

Self-reported health and adverse outcomes among women living with symptoms of angina or unspecific chest pain but no diagnosis of obstructive coronary artery disease-findings from the DenHeart study.

The objectives were to describe differences in self-reported health at discharge between women diagnosed with angina or unspecific chest pain and investigate the association between self-reported health and adverse outcomes within 3 years. Data from a national cohort study were used, including data from the DenHeart survey combined with 3 years of register-based follow-up. The population included two groups of women with symptoms of angina but no diagnosis of obstructive coronary artery disease at discharge (women with angina and women with unspecific chest pain). Self-reported health measured with validated instruments was combined with register-based follow-up on adverse outcomes (a composite of unplanned cardiac readmissions, revascularization, or all-cause mortality). Associations between self-reported health and time to first adverse outcomes were investigated with Cox proportional hazard models, reported as hazards ratios with 95% confidence intervals. In total, 1770 women completed the questionnaire (49%). Women with angina (n = 931) reported significantly worse self-reported health on several outcomes compared to women with unspecific chest pain (n = 839). Within the 3 years follow-up, women with angina were more often readmitted (29 vs. 23%, P = 0.011) and more underwent revascularization (10 vs. 1%, P < 0.001), whereas mortality rates were similar (4 vs. 4%, P = 0.750). Self-reported health (physical and mental) was associated with adverse outcomes between both groups (on most instruments). Women with angina reported significantly worse self-reported health on most instruments compared to women with unspecific chest pain. Adverse outcomes varied between groups, with women diagnosed with angina experiencing more events. ClinicalTrials.gov (NCT01926145).

Clinical outcomes of patients with coronary microvascular dysfunction in absence of obstructive coronary atherosclerosis.

Up to 50% of patients presenting with stable, mainly exercise-induced, chest pain and 10-20% of those admitted to hospital with chest pain suggesting an acute coronary syndrome show normal or near-normal coronary arteries at angiography. Coronary microvascular dysfunction (CMD) is a major cause of symptoms in these patients. However, controversial data exist about their prognosis. In this article, we critically review characteristics and results of the main studies that assessed clinical outcome of patients with angina chest pain and nonobstructive coronary artery disease presenting with either a stable angina pattern or an acute coronary syndrome. Published data indicate that the patients included in most studies are heterogeneous and a major determinant of clinical outcome is the presence of atherosclerotic, albeit not obstructive, coronary artery disease. Long-term prognosis seems instead excellent in patients with totally normal coronary arteries and a syndrome of CMD-related stable angina (microvascular angina). On the other hand, the prognostic impact of CMD in patients presenting with an acute coronary syndrome needs to be better assessed in future studies.

A Case Report of Successful Fibrinolysis in a Multiple Coronary Ectasia ST-segment Elevation Myocardial Infarction Validated by Coronary Angiography

Coronary artery ectasia (CAE) often presents in the form of an acute coronary syndrome (ACS) caused by slow blood flow leading to thrombus formation in ectatic coronary arteries. The usual approach is thrombectomy with intracoronary thrombolysis but often does not guarantee immediate blood flow. A 45-year-old male presented with anginal chest pain and was diagnosed with ST-segment elevation myocardial infarction (STEMI), managed Immediately with tissue plasminogen activator(t-PA) followed later with coronary angiography revealing diffused Multiple coronary ectasia MCEA with no identified culprit lesions afterward. The patient was followed up periodically, with favorable outcomes on daily aspirin, direct oral anticoagulant (DOAC), and guideline-directed medical therapy (GDMT) for coronary artery disease (CAD) and reduced ejection fraction heart failure (HF-rEF). This case management strategy was dictated by available resources at the time of presentation; however, it signifies the importance and favorable outcome of thrombolysis in CEA/STEMI patients. Future large-scale studies are required toward defining the duration as well as the choice of long-term anticoagulation.

An Evaluation of the Role of Oxidative Stress in Non-Obstructive Coronary Artery Disease.

Approximately half of all women presenting to the emergency department with angina chest pain do not have obstructive coronary artery disease (CAD) on coronary angiography. This condition is termed non-obstructive coronary artery disease (NOCAD), and includes ischemia with no obstructive coronary artery disease (INOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA). Oxidative stress has been reported to be involved in the development and progression of CAD. However, a scarcity of studies has assessed a correlation between oxidative stress and NOCAD. Thus, a literature review was performed of available reports on the role of oxidative stress in NOCAD. Possible mechanisms involved in oxidative stress that may contribute to NOCAD were identified and evaluated. A key finding of this literature review was that oxidative stress caused vasoconstriction and endothelial damage, and this results in coronary microvascular dysfunction and vasospasm, which, in turn, lead to the pathogenesis of NOCAD.

Nitroglycerine-responsive ischemic irregular premature ventricular contractions post-failure of antiarrhythmic drugs in hypertensive crises and first-degree heart block

Nitroglycerin is a proven ordinarily prescribed short-acting anti-ischemic and antihypertensive medication. Historically, it is a peculiar antiarrhythmic agent. Nitroglycerin is mitigating anginal chest pain in coronary artery disease. However, coronary artery disease is a likely considerable cause of premature ventricular contractions. The irregular premature ventricular contractions exemplify a remarkable electrocardiographic cardiac issue. Concomitant presence of both the first-degree heart block and ischemic irregular premature ventricular contractions in hypertensive crises is extremely rare. First-degree heart block may be risky.

Acute Coronary Syndrome Revealing Coronary Artery Ectasia: Case Report

Coronary artery ectasia (CAE) is a dilation of the coronary artery lumen. The term "ectasia" differs from "coronary aneurysm". The first one refers to diffuse dilation of a coronary artery, while the second designate a focal coronary dilation. In most of cases, it is associated with atherosclerotic disease. CAE predispose to acute coronary events because it disturbs coronary flow and increases blood viscosity. Conventionally, CAE was treated by oral anticoagulants and it has been considered as a valid treatment option. The usual treatment of acute coronary syndrome (ACS) including dual antiplatelet therapy (DAPT) is widely employed in CAE patients presenting with ACS.We report the case of a 71year-old man who suffered from angina chest pain revealing a myocardial infraction with inferior ST-elevation. Coronary angiography demonstrated diffused coronary artery ectasia with thrombotic occlusion in the distal segment of right coronary artery. It was managed with medical treatment including DAPT and oral anticoagulation.

293 Impact of metabolic syndrome on coronary microvascular dysfunction: a single-centre experience

Abstract Aims The purpose of this study was to evaluate whether microvascular dysfunction is more present in patients with metabolic syndrome (MetS) compared to diabetics and hypertensive patients with two angiographic imaging methods, to evaluate the degree of microcirculation dysfunction, the TIMI frame count and Myocardial Blush grade. Both techniques of rapid use and relatively cheap, and allow us to have a good degree of evaluation referred to the function of the coronary microcirculation. Methods and results The study included 445 patients allocated into three groups, 157 in the MetS group, 128 in the diabetics group, and 160 patients in the hypertensive group. All patients accessed to the emergency room for anginal chest pain, all were hospitalized in the cardiac intensive care unit from 2015 to 2020. Inclusion criteria were the presences of chest pain and/or their positive stress test, and epicardial coronary arteries free from stenosis at coronary angiography. We compared the results obtained from the angiographic techniques (TIMI Frame Count and Myocardial Blush Grade) in the two subgroups: MetS vs. hypertensive, and MetS vs. diabetics. In the first subgroup, we analyzed the TFCs of the three vessels in patients with hypertension and comparing them with patients with MetS, we observed that the latter have a worse perfusion condition: the three epicardial coronary vessels have a higher TFC than the hypertensive population (TFC LAD 33.1 ± 5.6 vs. 28.4 ± 5.6, P = 0.018), (TFC RCA 27.2 ± 5.2 vs. 23.1 ± 5.2, P = 0.014) (TFC CX 27.9 ± 5.4 vs. 26.9 ± 5.4, P = 0.03). That indicates slow flow in patients with MetS coronary microcirculation. Analyzing the MBG, however, in the three coronary vessels of patients with hypertension compared to patients with metabolic syndrome, no difference was found in terms of worsening of the coronary microcirculation. Finally comparing the indices that summarize the values of the individual arteries both for the TFC and MBG, was seen as the TMBS is reduced in both groups (7.1 ± 0.49 vs. 7.1 ± 0.6, P-value = 0.04). The TTFC is instead higher in patients with MetS (83.9 ± 5.8 vs. 77.8 ± 6.7, P-value =0.024). Then we performed the same type of comparison between MetS and type 2 diabetic subgroup, in this comparison we observed how by analyzing the TFCs of the three coronary vessels, MetS patients have a slower coronary flow than patients with type 2 diabetes mellitus (TFC LAD 33.1 ± 5.6 vs. 30.6 ± 6.2, P = 0.04), (TFC RCA 27.2 ± 5.2 vs. 25 ± 5.3, P = 0.02), (TFC CX 27.9 ± 5.4 vs. 27.2 ± 5.6, P = 0.05). Comparing MBG of the three coronary vessels instead, the flow is lower in diabetic patients TTFC was higher in patients with metabolic syndrome (83.9 ± 5.8 vs. 82.7 ± 8.6, P-value = 0.02). While TMBS was lower in diabetic patients than in patients with metabolic syndrome (7.1 ± 0.49 vs. 6.7 ± 0.74, P-value = 0.01). Conclusions This study shows that patients with MetS had a major coronary microvascular dysfunction using TFC imaging technique, analysis compared to diabetics or hypertensive patients, these differences resulted to be statistically significant. A clinical evaluation of this parameters using TFC such in this study, might give further information about (CMD) in this patients in order to act to develop the best treatment to this patients and to improve their clinical condition.

Chest Pain: Common Side Effect.

For chest pain, standards of care are based on emerging evidence-based practice.&nbsp;Angina (chest pain) is the feeling of pressure, fullness, burning, squeezing, or tightness in the chest, usually provoked by exertion and relieved by rest. The discomfort can occur in the shoulders, arms, neck, jaw, or back, and radiates to one or both arms.&nbsp;Women who experience acute myocardial infarction often present with atypical chest pain and other symptoms, such as dyspnea, weakness, and fatigue.

Using the Gensini score to estimate severity of STEMI, NSTEMI, unstable angina, and anginal syndrome.

Gensini score (GS) provides valuable information on severity and prognosis of coronary artery disease (CAD).To evaluate the relationship between the severity of CAD determined by the GS and relation to ST-elevation myocardial infarction, non-ST segment elevation myocardial infarction (NSTEMI), unstable angina pectoris, chest pain (suspected angina syndrome on admission) and risk-factors for CAD and predictors of severity.Observational cross-sectional study.Consecutive patients who underwent clinically-indicated coronary angiography for ST-elevation myocardial infarction, NSTEMI, unstable angina pectoris or chest pain were enrolled.Among 600 patients, 417 (average age 67.8 ± 12.2 years) had CAD–related symptoms. Mean GS was 66.7 ± 63.8. Patients presenting with NSTEMI had the highest GS (81.3 ± 42.3; P < .001) Regression analysis of risk-factors showed the best association of GS with multivessel disease and coronary artery bypass graft. Regression analysis of medications showed that clopidogrel, had the best association with low GS.GS correlated with the severity of CAD, multivessel disease, coronary artery bypass graft, and troponin. GS was related to the cardiovascular risk-factors of diabetes, hypertension, and high-density cholesterol.

Myocardial ischaemia of non-obstructive origin as a cause of new onset anginal chest pain in the long COVID syndrome

Abstract Background New-onset chest pain occurs in around 20% of patients with long COVID syndrome (LCS). Being the vascular endothelium one of the targets of the SARS-CoV-2 virus, we hypothesized that new onset anginal symptoms in LCS could be due to endothelium dysfunction and other non-obstructive causes of myocardial ischaemia. Methods We investigated 11 consecutive patients who developed new onset anginal chest pain, suggestive of myocardial ischaemia, after documented SARS-CoV-2 infection. Intracoronary assessment included endothelium-dependent evaluation with acetylcholine testing (Ach), and endothelium-independent assessment with coronary flow reserve (CFR) and microcirculatory resistance (MR). Criteria for positiveness of these tests and medical treatment recommendation were obtained from 2019 ESC guidelines and 2020 EAPCI consensus document on ischaemia with non-obstructive coronary arteries (INOCA). Results Mean patient age was 56 years (SD ± 15); 10 (91%) were female. In the acute COVID-19 phase, 4 patients (36%) had had pulmonary infiltrates and 2 (18%) required hospitalization. Conclusive non-invasive tests were obtained in 7 (64%), showing exercise-related myocardial ischaemia in 6 (86%). Coronary angiography ruled out obstructive epicardial stenoses in all the patients. Ach testing revealed abnormal endothelium-dependent responses in 9 (82%) patients: 5 (56%) had epicardial vessel and 4 (44%) microvascular spasm. Endothelium-independent assessment was abnormal in 6 (54%) cases, with abnormal CFR in 2 (33%), abnormal MR in 2 (33) and both abnormal CFR and MR in 2 (33%) patients. The most frequent endotype was combined endothelium dependent- and independent abnormalities (6/9, 67%). Stratified medical treatment according to endotype led to significant improvement in Seattle Angina Scores for angina frequency (+22 points, p=0.013) and a notable trend towards angina stability (+25 points, p=0.093) at a mean follow-up time of 222 days. Conclusions Myocardial ischaemia of non-obstructive origin is common in patients with chest pain and LCS. Vasomotor abnormalities related to endothelial dysfunction occurred in 82% of patients, frequently associated to impaired microvascular vasodilation or high microvascular resistance. Stratified medical treatment led to significant improvement in angina stability and frequency. Funding Acknowledgement Type of funding sources: None.

Myocardial revascularization in ischaemic cardiomyopathy: routine practice vs. scientific evidence.

Factors contributing to the decision for coronary revascularization in patients with ischaemic cardiomyopathy. According to existing evidence, coronary artery bypass graft should be considered the revascularization strategy of choice in patients with ischaemic cardiomyopathy, improving prognosis although at prolonged follow-up. However, in patients with unfavourable clinical characteristics and unsuitable coronary anatomy, particularly in the presence of otherwise uncontrolled anginal chest pain, PCI may become a reasonable alternative for symptom control. CAD, coronary artery disease; EF, ejection fraction; ESVI, end-systolic volume index.

Research Progress of Imaging Methods for Detection of Microvascular Angina Pectoris in Diabetic Patients.

Diabetes is a complex metabolic disease characterized by hyperglycemia. Its complications are various, often involving the heart, brain, kidney, and other essential organs. At present, the number of diabetic patients in the world is growing day by day. The cardiovascular disease caused by diabetes has dramatically affected the quality of life of diabetic patients. It is the leading cause of death of diabetic patients. Diabetic patients often suffer from microvascular angina pectoris without obstructive coronary artery disease. Still, there are typical ECG ischemia and angina pectoris, that is, chest pain and dyspnea under exercise. Unlike obstructive coronary diseases, nitrate does not affect chest pain caused by coronary microvascular angina in most cases. With the increasing emphasis on diabetic microvascular angina, the need for accurate diagnosis of the disease is also increasing. We can use SPECT, PET, CMR, MCE, and other methods to evaluate coronary microvascular function. SPECT is commonly used in clinical practice, and PET is considered the gold standard for non-invasive detection of myocardial blood flow. This article mainly introduces the research progress of these imaging methods in detecting microvascular angina in diabetic patients.

Anomalous origin of the right coronary artery with interarterial course: red flag or innocent bystander?

Abstract Funding Acknowledgements Type of funding sources: None. Background Anomalous origin of the right coronary artery (right ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomographic angiography (CCTA) has led to increasing recognition of this condition, even among healthy individuals. This study sought to examine the prevalence, anatomical characteristics and outcomes of right ACAOS with IAC in patients undergoing CCTA for all-indications. Methods We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital between January 2012 and December 2020. Right ACAOS patients with IAC were analyzed for cardiac symptoms (anginal chest pain, syncope, aborted SCD) and long-term outcomes were evaluated for myocardial infarction, ischemic test results, revascularization procedures and all-cause or cardiovascular (CV) mortality. CCTAs were reviewed for proposed high-risk features (ie., take-off angle, length and severity of proximal narrowing, intramural course, interarterial length) and concomitant coronary artery disease (CAD). Association between high-risk features was analyzed. Long-term outcomes were evaluated. Results Among 10,928 patients referred for CCTA during the study period, we identified 28 patients (0.3% prevalence) with right ACAOS and IAC. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented cardiac symptoms. During a median follow-up of 44.1 ± 31.8 months, there were no CV deaths and only 1 patient (3.65%) underwent surgical revascularization. Baseline characteristics and CCTA findings are presented in figure 1. Conclusion Right ACAOS and IAC is an uncommon finding, with an observed prevalence of 0.3%. CCTA provides excellent anatomical characterization of anomalous vessels, including suggested high-risk features. In a population of asymptomatic patients who survived this condition well into adulthood, the risk of events was very low and medical follow up might be a reasonable option.

Role of Fibroblast Growth Factor-23 in Coronary Slow Flow Phenomenon Pathogenesis

The phenomenon of angina chest pain without significant epicardial coronary artery stenosis, but accompanied by a slowdown in coronary blood flow is often found in patients with symptoms of acute coronary syndrome who undergoing invasive coronary angiography. This phenomenon of slow coronary blood flow is then called the coronary slow flow phenomenon (CSFP). The pathogenesis mechanism of CSFP remains unclear. The pathogenesis of CSFP is thought to be multifactorial. Endothelial dysfunction, small vessel disease, inflammation, renin system angiotensin aldosterone, atherosclerosis are thought to be involved in the pathogenesis of CSFP. Cardiovascular disease incidence and death were associated with elevated levels of Fibroblast growth factor-23 (FGF-23). High levels of FGF-23 can lead to formation of blood vessel calcification, left ventricular hypertrophy, arterial stiffness, endothelial dysfunction, increased inflammatory markers and elevated levels of angiotensin II. It is suspected that FGF-23 has a role in this event other than as a regulator of bone and mineral metabolism. This literature review aims to determine the relationship between fibroblast growth factor-23 and the pathophysiology of CSFP. Based on the broad role of FGF-23, it is possible that FGF-23 is involved in the pathogenesis of CSFP.