Mechanisms of Coronary Ischemia in Women.
Jingwen HuangSonali KumarOlga TolevaPuja K MehtaPublished in: Current cardiology reports (2022)
There are multiple mechanisms that contribute to MINOCA, including atherosclerotic plaque disruption, coronary artery spasm, coronary microvascular dysfunction (CMD), coronary embolism and/or thrombosis, and spontaneous coronary artery dissection. Non-coronary causes such as myocarditis or supply-demand mismatch should also be considered on the differential when there is an unexplained troponin elevation. Use of advanced imaging and diagnostic techniques to determine the underlying etiology of MINOCA is feasible and helpful, as this has the potential to guide management and secondary prevention. Failure to identify the underlying cause(s) may result in inappropriate treatment and inaccurate counseling to patients. MINOCA predominates in young women and is associated with a guarded prognosis. The diagnosis of MINOCA should prompt further investigation to determine the underlying cause of troponin elevation. Patients with INOCA and MINOCA are heterogeneous, and response to treatments can be variable. Large randomized controlled trials to determine longer-term optimal medical therapy for management of these conditions are under investigation.
Keyphrases
- coronary artery
- pulmonary artery
- coronary artery disease
- ejection fraction
- randomized controlled trial
- end stage renal disease
- newly diagnosed
- aortic stenosis
- healthcare
- oxidative stress
- pulmonary embolism
- chronic kidney disease
- polycystic ovary syndrome
- clinical trial
- heart failure
- pregnant women
- photodynamic therapy
- risk assessment
- left ventricular
- atrial fibrillation
- fluorescence imaging
- human health
- antiretroviral therapy