INOCA: Ischemia and Non-Obstructive Coronary Artery Disease
Summary:
INOCA refers to symptoms of ischemia without obstructive coronary artery disease (CAD) or flow-limiting disease on left heart catheterization. The prevalence is significant, affecting 3-4 million people in the US, with around 70% of anginal hospitalizations showing non-obstructive CAD findings. It predominantly impacts women (50-70%) compared to men (30-50%) and presents primarily as chest pain.
Epidemiology, Clinical Presentation, & Risk Factors:
- Prevalence: 3-4 million in the US; 70% of anginal hospitalizations are INOCA.
- Common Symptoms: Chest pain.
- Gender Distribution: Higher in women (50-70%) compared to men (30-50%).
- Risk Factors: Diabetes Mellitus, Hypertension, Aging, Dyslipidemia, Inflammatory Diseases.
Pathophysiology:
The pathophysiology of INOCA involves either endothelial-independent or endothelial-dependent mechanisms:
- Endothelial Independent: Involves vascular smooth muscle spasms (functional) and increased microvascular resistance (structural).
- Endothelial Dependent: Microvascular inflammation and functional vasodilation at rest contribute to microvascular dysfunction.
Produced by: Dr. Najah Khan, Edited by Dr. Evelyn Song
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