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Review
. 2020 Aug;28(Suppl 1):66-72.
doi: 10.1007/s12471-020-01451-9.

Ischaemia with no obstructive coronary arteries

R E Konst  1 , J G Meeder  2 , M E Wittekoek  3 , A H E M Maas  1 , Y Appelman  4 , J J Piek  5 , T P van de Hoef  5 , P Damman  1 , S E Elias-Smale  6
Affiliations
Review

Ischaemia with no obstructive coronary arteries

R E Konst et al. Neth Heart J. 2020 Aug.

Abstract

Ischaemia with no obstructive coronary arteries (INOCA) is a common ischaemic heart disease with a female preponderance, mostly due to underlying coronary vascular dysfunction comprising coronary microvascular dysfunction and/or epicardial coronary vasospasm. Since standard ischaemia detection tests and coronary angiograms are not suitable to diagnose coronary vascular dysfunction, INOCA is often overlooked in current cardiology practice. Future research, including large outcome trials, is much awaited. Yet, adequate diagnosis is possible and treatment options are available and vital to reduce symptoms and most probably improve cardiovascular prognosis. This review intends to give a brief overview of the clinical presentation, underlying pathophysiology, and the diagnostic and treatment options in patients with suspected INOCA.

Keywords: Coronary vascular dysfunction; Coronary vasospasm; Gender; INOCA; Microvascular angina.

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Conflict of interest statement

R.E. Konst, J.G. Meeder, M.E. Wittekoek, A.H.E.M. Maas, Y. Appelman, J.J. Piek, T.P. van de Hoef, P. Damman and S.E. Elias-Smale declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Various entities of ischaemic heart disease. Recommended treatment options for patients with INOCA, based on the results of the CorMicA trial [50]
Fig. 2
Fig. 2
Recommended treatment strategies for patients with INOCA, based on the results of the CorMicA trial [50]. Other options for the treatment of microvascular angina include imipramine and transcutaneous electrical nerve stimulation (TENS). (INOCA ischaemia and no obstructive coronary arteries, CAD coronary artery disease.)
See this image and copyright information in PMC

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