Isquemia miocárdica con coronarias de aspecto angiográfico normal. Enfoque diagnóstico.
Myocardial ischemia and coronary arteries with normal angiographic appearance. Diagnostic approach.
Resumen
Los pacientes con angina de pecho, evidencia de isquemia mio-cárdica y angiografía con coronarias no obstructivas, implican un verdadero reto diagnóstico. Estudios recientes han demostrado que, en esta entidad clíni-ca, el pronóstico no es tan benigno como se pensaba. El síndrome X cardíaco, actualmente más conocido como isquemia miocárdica y arterias coronarias no obstructivas (INOCA: Ischemia and No Obstructive Coronary Arteries), se ha enfocado predominantemente en la disfunción microvascular, sin embargo, los otros mecanismos causales como la enfermedad aterosclerótica oculta, el es-pasmo de coronarias epicárdicas y el síndrome del corazón sensible, siempre deben ser considerados. Esta revisión basada en la evidencia de los últimos 20 años, plantea una visión práctica del síndrome INOCA. Se aborda la inquietud y esfuerzos de los diferentes investigadores que estudian este síndrome, con la finalidad de lograr un protocolo diagnóstico adecuado, para así orientar mejor la terapéutica según el mecanismo fisiopatológico predominante.
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