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DOI: 10.1055/s-0028-1103385
© Georg Thieme Verlag Stuttgart · New York
Angina pectoris bei normalem Koronarangiogramm – Koronare Mikroangiopathie, epikardiale Erkrankungen und nichtkoronare Erkrankungen
Angina pectoris with normal coronary angiogram – Coronary microvascular dysfunction, epicardial disease and non–coronary diseasePublication History
Publication Date:
10 November 2008 (online)
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Etwa 20 % der Patienten, die wegen Angina pectoris und dem Verdacht auf eine koronare Herzerkrankung mit einem Herzkatheter invasiv untersucht werden, weisen im Koronarangiogramm – trotz einer möglichst optimalen Abklärung durch Anamnese, körperliche Untersuchung und nichtinvasive Diagnostik – normale Herzkranzgefäße auf. Die Ätiologie dieser Angina pectoris kann anatomisch in 3 Gruppen unterteilt werden: koronare Mikroangiopathien, epikardiale oder nichtkoronare Erkrankungen. Die mikrovaskuläre Dysfunktion kann Folge einer arteriellen Hypertonie, eines Diabetes mellitus, einer hypertrophen Kardiomyopathie oder einer entzündlichen Herzerkrankung sein. Epikardiale Erkrankungen, die eine solche Angina pectoris mit normalem Koronarangiogramm verursachen, können in endotheliale Dysfunktion, Koronararterienspasmen und Myokardbrücken unterschieden werden. Grundsätzlich muss bei einer Angina pectoris bei normalem Koronarangiogramm auch an eine Erkrankung anderer Organe gedacht werden. Differenzialdiagnostisch müssen daher pulmonale und gastrointestinale Erkrankungen sowie vertebragene und muskuläre Erkrankungen ausgeschlossen werden.
Approximately 20 % of patients with cardiac chest pain have a normal coronary angiogram despite a detailed non–invasive diagnostic. The etiologies of angina pectoris with normal coronarangiogram can be anatomically classified into three groups: coronary microvascular dysfunction, epicardial disease and non–coronary disease. Epicardial disease includes endothelial dysfunction, coronary artery spasm and coronary artery bridging. Microvascular dysfunction may be secondary to hypertension, cardiomyopathy or infiltrative disease. Noncoronary artery diseases, which cause angina pectoris are pulmonary, gastrointestinal or musculoskeletal diseases.
Key words
angina pectoris - normal coronary angiography - myocardial bridge - endothelial dysfunction - coronary artery spasm - coronary microvascular dysfunction
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1 Losartan Intervention For Endpoint reduction in hypertension
Korrespondenz
PD Dr. Christiana Mira Schannwell
Klinik für Kardiologie, Pneumologie und Angiologie Universitätsklinikum Düsseldorf
Moorenstraße 5
40225 Düsseldorf
Email: schannwell@med.uni-duesseldorf.de