Coronary microvascular disease is a condition affecting smaller vessels of the coronary artery branches that cause a disturbance in microvasculature and perfusion of the myocardium. It is of clinical importance due to the risk of high morbidity and mortality, as well as a similarity in presentation with other vascular diseases of the coronary vessels.
Coronary microvascular disease (CMD) otherwise known as cardiac syndrome X is a pathology affecting the small arterioles branching from the coronary arteries that provoke disturbances in microcirculation. There are four types of CMD :
- CMD with absence of obstructive coronary artery disease (CAD) and myocardial disease;
- CMD linked to myocardial disease;
- CMD coexistent with CAD;
- medically induced CMD.
Risk factors for acquiring the disease are older age, hypertension, diabetes and insulin resistance, and dyslipidemia . Other minor risk factors are related to dysregulation of certain genes responsible for actions of the endocrine system such as estrogen and adrenergic receptor production. Disrupted nitric oxide metabolism, impaired synthesis of vasoactive substances, as well as disturbed cytokine production are also contributors to the pathogenesis of CMD .
Microvascular angina or ischemia exhibited as post sternal chest pain due to small vessel endothelial damage is characteristic for CMD. It is distinguished from CAD by the elimination of obstructive atherosclerotic plaques from angiography findings which would otherwise be strongly indicative of CAD . Moreover, microvascular angina is not alleviated with the administration of nitroglycerin like in Prinzmetal angina and presents at rest or at physical exertion in combination with dyspnoea . Interestingly, microvascular angina can also accompany psychological stress e.g. in Takotsubo or ballooning cardiomyopathy .
- Heart Disease
Some examples of cardiovascular diseases include ischemic heart disease, heart valve disease, cardiomyopathies, peripheral artery disease, congenital heart disease, and vascular disease of the kidneys. This study is located in Bethesda, Maryland. [nhlbi.nih.gov]
Attack, heart disease, Ischemic, Living Heart Disease, Microvascular Coronary Disease, Women Heart Disease on January 13, 2011| 2 Comments » February is fast approaching. [rebeccasheart.wordpress.com]
Family history of early heart disease. [daviddarling.info]
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CMD diagnosis is concluded with findings from imaging studies. Considering that electrocardiogram (ECG) examination reveals ST segment elevations in rare occasions, it is rather non-informative. ST segment depressions can also be recognized due to ischaemic processes during exertion  .
Magnetic resonance imaging (MRI) is useful to illustrate the microcirculation of the heart. This is done by administrating a dye into the coronary arteries and observing a phenomenon called myocardial blush .
Coronary blood flow characteristics are determined by a positron emission tomography (PET) which is a non-invasive imaging method. A drawback is that this method is deficient of sensitivity and specificity to discriminate between epicardial and microvascular involvement in CMD .
For the latter discrimination, an invasive method i.e. coronary angiography is necessary. Angiography can also participate in the differentiation of obstructive coronary artery disease-induced angina and that of microvascular angina type. Additionally, the assessment of lumen diameter can be made, narrowing of which by 50% is distinctive of unstable microvascular angina.
Intravascular ultrasound can assist in illustrating the atherosclerotic plaques not seen in angiography  . Intravascular ultrasound with doppler-derived coronary flow velocity calculations can estimate coronary flow reserve reduction, which is an important finding to conclude the CMD . Acetylcholine infusion into coronary arteries may be applied to assess the vasomotor reaction of the arteries .
Our results also indicate that both cardiac and forearm vascular abnormalities can be reversed by antihypertensive treatment with an ACE inhibitor. [ncbi.nlm.nih.gov]
It follows that considerable research is directed at establishing effective treatment for acute vascular events. Long-term treatment has also received considerable attention (e.g. for symptomatic relief). [ingentaconnect.com]
The mainstay of treatment is controlling risk factors with lipid lowering therapy and glycemic control. In many patients, traditional anti-ischemic treatment, including beta-blockers and calcium channel blockers, helps to relieve symptoms ( 1 ). [merckmanuals.com]
While no medical treatment is one-size-fits-all, women benefit from the same types of treatment for cardiovascular disease as men, when appropriately applied. Click here to learn about treatment options for cardiovascular disease. [secondscount.org]
Most individuals completely recover within a short amount of time with appropriate treatment. [advancingyourhealth.org]
Likewise, significant knowledge gaps exist about the risk factors, management, and prognosis of MVD. MVD is thought to be more common in women and has recently been labelled as 'women-specific IHD'. [zonmw.nl]
Prognosis is better than for patients with demonstrable coronary artery disease, although symptoms of ischemia may recur for years. The mainstay of treatment is controlling risk factors with lipid lowering therapy and glycemic control. [merckmanuals.com]
Thus, the FXIIIa within clots will serve as a diagnostic biomarker to determine biological aging to guide treatment, to evaluate the efficacy of fibrinolysis, and to predict the prognosis of pathology. [grantome.com]
Coronary microvascular disorders have a guarded prognosis particularly in women, whereas the role of endothelial dysfunction appears to be an important determinant to prognosis. [acc.org]
Symptoms can be debilitating and new data suggests that if left untreated, women with microvascular disease do not have as favorable a prognosis as previously believed. Their risk factors should be managed as aggressively as someone who has CHD. [sharecare.com]
Therefore, there is clear clinical relevance of the findings to increasing our understanding of the etiology of coronary microcirculatory disease in human diabetes. However, there are some limitations that should be noted. [diabetes.diabetesjournals.org]
In contrast, coronary microvascular disorders have a more heterogeneous etiology so that first line therapy is more empiric. [acc.org]
Clinical Trial: : http://www.clinicaltrials.gov NCT01027988 Keywords: imaging/image analysis: clinical • clinical (human) or epidemiologic studies: risk factor assessment • retina © 2012, The Association for Research in Vision and Ophthalmology, Inc., [iovs.arvojournals.org]
Aikawa, Kazuhiko ; Saitoh, Shu-ichi ; Muto, Mitsuru ; Osugi, Taku ; Matsumoto, Ken ; Onogi, Futoshi ; Maehara, Kazuhira ; Yaoita, Hiroyuki ; Maruyama, Yukio Pathophysiology and Natural History Abstract Author Information Authors The effect of oxidative [journals.lww.com]
Dit item is opengeklapt Over the last decade, coronary microvascular disease (MVD) has emerged as a central paradigm in the pathophysiology of ischemic heart disease (IHD) in the absence of obstruction in the coronary arteries. [zonmw.nl]
Coronary small vessel disease is also known as Microvascular angina, microvascular dysfunction, non-obstructive coronary disease, or in the past cardiac syndrome X Pathophysiology [ edit ] One cause of microangiopathy is long-term diabetes mellitus. [en.wikipedia.org]
The pathophysiology of angina involves a relative deficiency of myocardial oxygen supply (i.e. ischaemia) and typically occurs after physical activity and stress. [radcliffecardiology.com]
With improved clinical characterization of these patients and a better understanding of the underlying pathophysiological mechanisms, advances in effective therapies for these disorders should be achieved. [acc.org]
About the Emory Women’s Heart Center Emory Women’s Heart Center is a unique program dedicated to screening for, preventing and treating heart disease in women. [advancingyourhealth.org]
Prevention Treatment and prevention of coronary microvascular disease focuses primarily on controlling risk factors and symptoms. [ucirvinehealth.org]
Coverage begins with a review of risk factors and prevention, emphasizing lipid abnormalities, hypertension, smoking, diabetes, and obesity. [books.google.com]
How can coronary vascular disease be prevented? No specific studies have been done on how to prevent coronary microvascular disease (MVD). [daviddarling.info]
It aims at generating new comprehensive insights on the MVD to improve gender-specific prevention, diagnosis, treatment and counselling for MVD. [zonmw.nl]
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