Microvascular angina and hypertension: a case report

Angina pectoris is one of the most frequent reasons for presentation in the emergency department worldwide and in half of these patients, especially in the young ones, coronary arteries are normal or have non-obstructive stenoses. First described as a clinical entity in 1988, microvascular angina now has precise criteria of diagnosis: symptoms of myocardial ischemia, absence of obstructive coronary artery disease and impaired coronary microvascular function (reduced coronary flow reserve, coronary microvascular spasm, increased microvascular resistance and/or coronary “slow flow” phenomenon). It is frequently associated with cardiovascular risk factors, including arterial hypertension, even in the absence of overt atherosclerotic disease. We present a case of a young female with typical rest angina; electrocardiogram changes are suggestive of myocardial ischemia and normal epicardial coronary arteries in the context of untreated hypertension. She received guideline medical treatment and we presented the patient’s inhospital evolution and at 6-month follow-up visit. Current recommendations for diagnosis, treatment and prognosis of microvascular angina are also discussed.