Debate: Ischemia without obstructive coronary artery disease. A non-invasive assessment may be sufficient in some cases

Abstract

QUESTION: Is there a specific profile of patients with angina and without obstructive coronary artery disease? ANSWER: Although we have been paying more attention to angina without obstructive coronary artery disease over the last few years (a more truthful denomination compared to ischemia with normal coronary arteries because it focuses on the clinical problem and also because many patients don’t have strictly normal coronary arteries) we still don’t know much about this syndrome. Syndrome X was the term coined back in 1973 after the group of patients with normal coronary arteries that was called group X.1 Actually this term is more appropriate since this is the letter used in algebra to represent something that remains unknown. Answering your question, it is more common in women; it is often exertional although a different kind of pattern has been reported too (first effort, at rest during certain hours, especially at night-time, exertional dyspnea); also, it is associated with known cardiovascular risk factors since most patients with angina and without obstructive coronary artery disease have coronary atherosclerosis.2 Obesity, the association with inflammatory diseases (such as systemic lupus erythematous), mood swings, intolerance to different drugs are not rare, and make us have to try several combinations...