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31.22 Microvascular angina
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Published:July 2018
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This version:July 2020
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Abstract
Atherosclerotic disease of the epicardial coronary arteries has been accepted as the cause of angina pectoris for more than two hundred years while sudden, thrombotic occlusion of an epicardial coronary artery has been well established as the cause of myocardial infarction for more than one hundred years. However, the epicardial arteries, also known as conductance vessels, are only one segment of the arterial coronary circulation. These vessels give rise to smaller arteries and arterioles which in turn feed the capillaries and constitute the coronary microcirculation, the main site of regulation of myocardial blood flow. In the past two decades, a number of studies have demonstrated that abnormalities in the function and structure of the coronary microcirculation occur in many clinical conditions. In some instances these abnormalities represent epiphenomena, whereas in others they represent important markers of risk or may even contribute to the pathogenesis of myocardial ischaemia, thus becoming therapeutic targets.
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