Isquemia miocárdica con coronarias de aspecto angiográfico normal. Enfoque diagnóstico.

Myocardial ischemia and coronary arteries with normal angiographic appearance. Diagnostic approach.

  • Miguel López-Hidalgo Universidad de Carabobo
  • Antonio Eblen-Zajjur Universidad de Carabobo
Palabras clave: síndrome X cardíaco, disfunción microvascular coronaria, angina micro-vascular, espasmo coronario microvascular, enfermedad arterial coronaria, dolor torácico

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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Publicado
2021-02-23
Cómo citar
López-Hidalgo, M., & Eblen-Zajjur, A. (2021). Isquemia miocárdica con coronarias de aspecto angiográfico normal. Enfoque diagnóstico.: Myocardial ischemia and coronary arteries with normal angiographic appearance. Diagnostic approach. Investigación Clínica, 61(4), 376-392. https://doi.org/10.22209/IC.v61n4a06