Microvascular Dysfunction

• ⚠️ Can also be present in patients with obstructive CAD
  • ∴ unrecognized CMD may explain the 20-40% of patients who continue to experience angina following “technically successfully” revascularization
• Mechanisms of CMD
  • 
  • 
    • Figure Source: Box 1 of ¹
• CMD includes either
  • CFR <2.0 and/or
  • IMR ≥25 and/or
  • evidence of coronary endothelial dysfunction, typically demonstrated with intracoronary ACh → angina w/ ST-depression and epicardial artery constriction

Footnotes

1. Camici, P. G., d’Amati, G., & Rimoldi, O. (2014). Coronary microvascular dysfunction: mechanisms and functional assessment. Nature Reviews Cardiology, 12(1), 48–62. https://doi.org/10.1038/nrcardio.2014.160 ↩