Isquemia miocárdica y enfermedad coronaria microvascular. Myocardial ischemia and microvascular coronary disease.

Abstract

Some peculiarities of the coronary artery disease in woman are showed making reference to the epidemiologic situation in Cuba. The presence of typical exertion angina, exercise test with suggestive electrocardiographic alterations of ischemia and epicardium coronary arteries without significant lesions is more frequent in women. In about 50% of these patients, the chest pain is specifically attributable to changes in coronary microvasculature. The alteration of this microvasculature may be diagnosed directly only by assessment of coronary flow reserve using positron emission tomography (PET) with a high cost due to the necessary equipment and the ultra-short mean life of radioisotopes. Some considerations are showed on the ischemia diagnosis in these patients. To assess the functional repercussion of the coronary microvasculature disease and taking into account that in the daily clinical practice the diagnosis of microvascular angina is made by exclusion, an alternating variant may be the combination of myocardial perfusion scintigraphy by means of single-photon triggered emission tomography (to asses simultaneously perfusion and function) and the study of the endothelial function using brachial artery ultrasound (US). The results from different authors on this subject are mentioned including those achieved in the Cardiology and Cardiovascular Surgery Institute. Since the fact that the prognosis isn’t so benign as it was believed a few years ago, in the case of patients presenting with angina and normal epicardium coronary arteries, it is mandatory a clinical assessment (including a careful analysis of risk factors) and imaging to detect a functional significant ischemia.

Keywords

• Microvascular coronary disease
• myocardial perfusion scintigraphy
• endothelial function
• woman.