(Epicardial and microvascular) angina or atypical chest pain: differential diagnoses with cardiovascular magnetic resonance

Author:

Baggiano Andrea1,Guglielmo Marco1,Muscogiuri Giuseppe1,Guaricci Andrea Igoren2,Del Torto Alberico,Pontone Gianluca1

Affiliation:

1. Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy

2. Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital “Policlinico” of Bari, Bari, Italy

Abstract

Abstract Angina pectoris is a chest discomfort caused by myocardial ischaemia, and it is classified as ‘typical’ or ‘atypical’ if specific features are present. Unfortunately, there is a heterogeneous list of cardiac diseases characterized by this symptom as onset sign. Mostly, angina is due to significant epicardial coronary artery stenosis, which causes inadequate oxygen supply increase after raised myocardial oxygen demand. In the absence of significant epicardial stenoses, another potential cause of angina is microvascular dysfunction, related to inadequate response of resistance coronary vessels to vasodilator stimuli. The unique capability of cardiovascular magnetic resonance (CMR) in providing extremely detailed morphological and functional information, along with precise stress perfusion defects and wall motion abnormalities depiction, translates it into the test with one of the best diagnostic performance and prognostic stratification among non-invasive cardiac imaging modality. Moreover, CMR is also extremely accurate in detecting non-ischaemic cardiac causes of chest pain (such as myocardial and pericardial inflammation, or stress-related cardiomyopathy), and is very useful in helping physicians to correctly approach patients affected by chest pain.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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