Coronary Microvascular Dysfunction in Women

Patients 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.

Epicardial 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.

Treatment 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.