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How does microvascular angina affect blood flow? Understand its pathological mechanisms!
Microvascular angina (MVA), also known as cardiac syndrome X or coronary microvascular dysfunction (CMD), is a type of chest pain that is accompanied by signs of decreased blood flow in the heart tissue, but the coronary artery is normal.The use of this condition may lead to insufficient public awareness of its impact due to the use of the name, especially female patients may not be able to obtain proper diagnosis and treatment from cardiologists.In addition, studies have found that patients with microvascular angina are associated with an increased risk of other vasospasm disorders such as migraine and Raynaud phenomenon.
Microvascular angina is a heart-related pain that makes daily life difficult and can increase the risk of heart attacks and other heart problems.
Symptoms and Signs
Patients with this condition often experience symptoms of myocardial ischemia, such as heaviness, tightness, pressure or squeeze in the chest, which may be accompanied by sweating, nausea, shortness of breath and fatigue.In addition, microvascular angina does not usually cause abnormal functioning of ultrasonic heart examinations and the pain lasts longer than other heart diseases.Abnormal results of cardiac stress tests are usually similar to coronary artery disease, while approximately 30% of patients on myocardial perfusion imaging have abnormalities.
causes
Although there is no exact etiology definition, limited studies have pointed out that possible factors that cause microvascular angina include microvascular dysfunction and increased pain.The microvessels of the heart refer to extremely small blood vessels, and their stenosis can cause chest pain after hypoxia in specific areas of the myocardium.
Pathophysiology
This restorative disease is characterized by structural and functional changes in the heart microcirculation, including endothelial dysfunction, microvascular arterioles remodeling, perivascular fibrosis and increased microvascular resistance.When the blood vessels contract and fail to expand, the myocardial oxygen level drops, and the subsequent attacks of hypoxia and chest pain.Although many physiological mechanisms have been proposed, there is no conclusion yet.
Types of microvascular dysfunction
Microvascular dysfunction is mainly divided into structural subtypes and functional subtypes.Patients with structural subtypes exhibit persistent hypervascular tension and have low coronary blood flow reserves under stress.Patients with functional subtypes have lower angiotensin in the resting state, showing relatively preserved endothelial function, but are affected under external pressure.
Diagnosis and differential diagnosis
The diagnosis of microvascular angina usually requires medical examinations, including cardiac stress testing and coronary artery photography, and eliminate other conditions that may cause chest pain, such as variant angina and esophageal spasm.The predictive change in chest pain is a major feature of microvascular angina, and in other types of angina, the pain is usually predictable and transient.
Treatment
The primary measures for the treatment of microvascular angina include drug therapies such as calcium channel blockers (such as nifedipine and diltiazem) and beta-blockers.Patients should also make lifestyle changes, including diet, exercise and heartache management, such as cognitive behavioral therapy and meditation.In addition, taking nitrate drugs is a common method to relieve pain, but their efficacy in some patients seems to be limited.
Eccurrence and gender differences
It is not clear why women are more likely to develop microvascular angina than men, but studies have shown that it may be closely related to hormonal changes in women and other unique risk factors.
Microvascular angina pectoris, even in the absence of a clear diagnosis, can have a significant impact on the patient's daily life.Faced with such complex symptoms, how should we explore the potential mechanisms and best treatments of this disease in the future?
