Author + information
- Received January 22, 2009
- Revision received March 10, 2009
- Accepted March 17, 2009
- Published online September 1, 2009.
- Richard O. Cannon III, MD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Richard O. Cannon III, National Institutes of Health, Building 10-CRC, Room 5-3330, 10 Center Drive, Bethesda, Maryland 20892-1650
Since initial reports over 4 decades ago, cases of patients with angina-like chest pain whose coronary angiograms show no evidence of obstructive coronary artery disease and who have no structural heart disease continue to be a common occurrence for cardiologists. Many features of this patient population have remained constant with successive reports over time: a female predominance, onset of symptoms commonly between 40 and 50 years of age, pain that is severe and disabling, and inconsistent responses to conventional anti-ischemic therapy. Because patients may have had abnormal noninvasive testing that led to performance of coronary angiography, investigators have sought to show an association of this syndrome with myocardial ischemia. Abnormalities in coronary flow and metabolic responses to stress have been reported by several groups, findings consistent with a microvascular etiology for ischemia and symptoms, but others have questioned the presence of ischemia, even in patients selected for abnormal noninvasive testing. Despite considerable efforts by many groups over 4 decades, the syndrome remains controversial with regard to pathophysiology, diagnosis, and management.
The content of this article represents the opinions of the author and not necessarily those of the National Heart, Lung, and Blood Institute. Dr. Cannon is supported by the Intramural Research Program of the National Heart, Lung, and Blood Institute, National Institutes of Health, and has previously served on the Data Safety and Monitoring Board of the WISE (Women's Ischemia Syndrome Evaluation) study.
- Received January 22, 2009.
- Revision received March 10, 2009.
- Accepted March 17, 2009.
- American College of Cardiology Foundation
- Focus on the Coronary Microcirculation
- The Coronary Microcirculation in Humans
- The Case for Myocardial Ischemia
- Magnetic Resonance Imaging (MRI) and Subendocardial Ischemia
- The Case Against Myocardial Ischemia
- Prognostic Implications of Coronary Endothelial Dysfunction
- Abnormal Cardiac Pain Perception: The Sensitive Heart
- Treatment Trials and Management Approaches
- Future Research Directions