Disfunción microvascular, angina vasoespástica e isquemia silente

  1. Viéitez Flórez, J.M. 1
  2. García Rivas, S. 1
  3. Monteagudo Ruiz, J.M. 1
  4. Zamorano Gómez, J.L. 1
  1. 1 Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
Revista:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Año de publicación: 2021

Título del ejemplar: Enfermedades cardiovasculares (III)

Serie: 13

Número: 37

Páginas: 2125-2133

Tipo: Artículo

DOI: 10.1016/J.MED.2021.06.020 DIALNET GOOGLE SCHOLAR

Otras publicaciones en: Medicine: Programa de Formación Médica Continuada Acreditado

Resumen

Casi dos tercios de los pacientes con angina no presentan lesiones obstructivas en la angiografía coronaria. Es importante descartar en estos pacientes la presencia de disfunción microvascular o angina vasoespástica. La disfunción microvascular coronaria engloba las alteraciones producidas en los vasos menores de 500 μm. Se pierde la capacidad de producir una correcta vasodilatación y no se puede aumentar el flujo coronario en situaciones de estrés, provocando isquemia. En los últimos años, se han desarrollado métodos de diagnóstico invasivo durante el cateterismo, el principal es la reserva de flujo coronario. El tratamiento está dirigido a mejorar la función endotelial. Se recomienda el uso de IECA/ARA II, bloqueadores beta-adrenérgicos (BBA) y estatinas. La angina vasoespástica se produce por una vasoconstricción de las arterias epicárdicas o de las arterias de la microcirculación (disfunción microvascular). Se debe descartar en pacientes con angina de reposo de predominio nocturno. Si se sospecha, está indicada una prueba de provocación durante el cateterismo con acetilcolina, ergonovina o sustancia P. Responden a calcioantagonistas y nitratos. También se recomiendan IECA y estatinas. Los BBA están contraindicados. Se denomina isquemia silente a la presencia de isquemia sin síntomas. Es más frecuente en pacientes diabéticos. El retraso diagnóstico que supone condiciona el pronóstico.

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Fuente de los datos: Dialnet