Lanza G A, Cianflone D, Buffon A, Crea F, Maseri A
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma.
Cardiologia. 1993 Dec;38(12 Suppl 1):169-79.
The treatment of microvascular angina (anginal pain resulting from myocardial ischemia due to dysfunction of small coronary arteries) is empiric and often ineffective at present. The poor knowledge of the pathophysiologic mechanisms responsible for the microvascular dysfunction and the possible heterogeneous nature of the disease limit the possibility of a rational therapeutic approach to these patients. The failure of traditional antiischemic therapy is confirmed by the frequent unresponsiveness of angina and by the reduced exercise tolerance with administration of sublingual nitrates. Despite that, beta-blockers and calcium-antagonists, when given either alone or in combination, are beneficial in the control of symptoms in some patients. Alternative forms of treatment, based on some pathophysiological hypotheses and clinical observations, include xanthine derivatives, ACE-inhibitors, alpha-blocking agents, imipramine and, in women, oestrogens. The actual clinical usefulness of these drugs, however, is questionable at present, as their efficacy should be evaluated with more adequate studies in the future.
微血管性心绞痛（由小冠状动脉功能障碍导致心肌缺血引起的心绞痛）目前的治疗是经验性的，且往往无效。对微血管功能障碍的病理生理机制了解不足以及该疾病可能存在的异质性限制了对这些患者采取合理治疗方法的可能性。传统抗缺血治疗的失败体现在心绞痛频繁无反应以及舌下含服硝酸酯类药物时运动耐量降低。尽管如此，β受体阻滞剂和钙拮抗剂单独使用或联合使用时，对某些患者控制症状有益。基于一些病理生理假说和临床观察的替代治疗形式包括黄嘌呤衍生物、血管紧张素转换酶抑制剂、α受体阻滞剂、丙咪嗪，对女性患者而言还包括雌激素。然而，目前这些药物的实际临床效用存疑，因为其疗效未来应通过更充分的研究来评估。
