ABSTRACT

One of the most important causes of death is still myocardial ischemia which is caused by myocardial oxygen demand not supplied by coronary blood flow due to coronary artery disease in increased workload conditions. Stable coronary artery disease due to supply-demand imbalance in the myocardium caused by progressive coronary atherosclerosis detected at coronary angiography presents itself as recurrent episodes of chest pain, called angina pectoris. Unstable coronary artery disease due to plaque rupture which is associated with plaque complications accompanied by thrombosis and thrombolysis processes causes acute coronary syndromes. Besides, there is also a group in which ischemia and infarction develop without significant obstructive atherosclerotic coronary artery disease at coronary angiography. This term, called cardiac syndrome X, is used to describe the microvascular angina caused by coronary microvascular dysfunction due to structural and functional causes. Coronary microvascular disease caused by an increased vascular contraction in microvascular structures in response to exercise or pharmacologic agents, or failure of endothelium-dependent/independent vasodilatation, or a combination of such conditions, is responsible for the clinical findings in the symptomatic cases with normal coronary angiogram. In this review, the different aspects of coronary microvascular disease are aimed to be discussed in light of the current literature.