[Angina Pectoris and the Importance of Coronary Microcirculation in Practice].

Angina Pectoris and the Importance of Coronary Microcirculation in Practice Microvascular angina is a common manifestation of coronary microvascular dysfunction, particulary prevalent in post-menopausal women above the age of 50 and associated with impaired quality of life and poor clinical outcomes. However, microvascular angina remains largely undetected given the underuse of diagnostic tools for the assessment of coronary microvascular function. As a consequence, many of these patients suffering from coronary microvascular dysfunction fail to receive the appropriate medical treatment and remain in the long term symptomatic. Invasive coronary catheterization with measurement of coronary flow reserve and intracoronary acetylcholine provocation testing allows for the assessment of coronary microvascular dysfunction, and a therapy targeting specific physiological pathways can be implemented. A targeted therapy includes lifestyle modifications, secondary prevention measures, and anti-anginal medication. Ongoing clinical research in the field is expected to deliver novel diagnostic and therapeutic concepts for an improved management of patients with coronary microvascular disease.