Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/88671
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Type: Book chapter
Title: The coronary slow flow phenomenon
Author: Beltrame, J.
Ganz, P.
Citation: Chest pain with normal coronary arteries: a multidisciplinary approach, 2013 / Kaski, J., Eslick, G., Bairey Merz, C. (ed./s), vol.9781447148388, Ch.10, pp.101-117
Publisher: Springer London
Publisher Place: USA
Issue Date: 2013
ISBN: 1447148371
9781447148371
Editor: Kaski, J.
Eslick, G.
Bairey Merz, C.
Statement of
Responsibility: 
John Beltrame and Peter Ganz
Abstract: The coronary slow flow phenomenon (CSFP) is a microvascular coronary disorder, ­characterised angiographically by delayed contrast opacification of the distal vasculature in the absence of obstructive coronary artery disease. Its prevalence has been reported as 1–3 % of coronary angiograms performed. It often presents initially as an acute coronary syndrome with 8 % of patients having positive cardiac markers for myocardial infarction. Although transient T wave changes are frequently observed during the acute episode, only a third of patients have clinical evidence of inducible myocardial ischaemia. Both structural and functional studies have demonstrated the presence of microvascular coronary dysfunction however the underlying cause remains elusive. Possible pathogenetic mechanisms include a defective endothelial nitric oxide pathway, excessive endothelin mediated vasoconstriction, autonomic dysfunction, platelet dysfunction, metabolic derangements (associated with the metabolic syndrome and hyperhomocystinaemia), and vascular inflammation. The risk of future cardiac events following the initial presentation appears low however many patients continue to experience recurrent chest pain. Further well-controlled therapeutic studies are required to identify effective therapies for this disabling condition.
Keywords: Coronary slow flow phenomenon
Microvascular coronary dysfunction
Slow flow
Syndrome X
Syndrome Y
Microvascular angina
Coronary heart disease
Normal angiogram
Mibefradil
Nebivolol
Trimetazidine
Statins
Dipyridamole
Endothelin
Endothelial dysfunction
Coronary flow reserve
Microvascular disease
Description: Copyright © 2007 Elsevier B.V. All rights reserved.
Rights: © Springer-Verlag London 2013
DOI: 10.1007/978-1-4471-4838-8_10
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