Coronary Microvascular Dysfunction in Women

Purpose of ReviewPatients who are suspected of having symptoms from myocardial ischemia routinely undergo coronary angiography to evaluate for obstructive coronary artery disease (CAD). However, a substantial proportion of patients with ischemia are found to have no obstructive coronary arteries (INOCA), a condition that is associated with major adverse cardiovascular events and recurrent angina hospitalizations.Recent FindingsEpicardial coronary vascular dysfunction and coronary microvascular dysfunction (CMD) are prevalent in a majority of INOCA patients. CMD is prognostic in both men and women, although women have more angina and lower quality of life with this condition. CMD can be detected by non-invasive stress testing modalities, but coronary angiography with coronary function testing provides a comprehensive evaluation of vascular abnormalities in the diagnoses of CMD.SummaryTreatment of this challenging condition requires a tailored approach that includes targeting lifestyle, addressing risk factors, and use of anti-anginal strategies to manage symptoms and improve quality of life. This mini review highlights the diagnosis and management of CMD, a condition that is often underappreciated and underrecognized. In a patient with chest pain and no obstructive coronary artery disease, coronary vascular dysfunction in the epicardial vessels and/or the microcirculation should be considered as a potential explanation.Coronary microvascular dysfunction (CMD) is associated with major adverse cardiovascular events in both men and women.In the absence of obstructive coronary stenosis, CMD is diagnosed when coronary flow reserve is impaired or when there is high myocardial resistance.Treatment of angina in patients with CMD can improve symptoms and quality of life.