Overview
When a Normal Angiogram Is Not a Normal Coronary Circulation
Chest pain can reflect inadequate myocardial perfusion even when angiography shows no major epicardial blockage.
Chest pain can reflect inadequate myocardial perfusion even when angiography shows no major epicardial blockage. Microvascular angina (MVA) is myocardial ischaemia caused by coronary microvascular dysfunction: the small coronary vessels may fail to dilate, offer excessive resistance, or constrict abnormally while the epicardial arteries remain non-obstructive. MVA is one endotype within angina or ischaemia with non-obstructive coronary arteries (ANOCA/INOCA). “Non-obstructive” describes the visible epicardial lumen; it does not mean that the patient’s symptoms are non-cardiac. A known diagnosis of MVA also does not protect a patient from a future acute coronary syndrome (ACS). A new, prolonged, crescendo, or rest-predominant episode requires urgent ACS assessment.