TY - CHAP M1 - Book, Section TI - NONOBSTRUCTIVE ATHEROSCLEROTIC AND NONATHEROSCLEROTIC CORONARY HEART DISEASE A1 - Winchester, David E. A1 - Pepine, Carl J. A2 - Fuster, Valentin A2 - Harrington, Robert A. A2 - Narula, Jagat A2 - Eapen, Zubin J. PY - 2017 T2 - Hurst's The Heart, 14e AB - SummaryThis chapter discusses the pathophysiology, diagnosis, and treatment of nonobstructive atherosclerotic and nonatherosclerotic coronary heart diseases, including coronary microvascular dysfunction, epicardial coronary spasm, vasculitides, transplant vasculopathy, congenital abnormalities, and dissection and trauma (see accompanying Hurst's Central Illustration). Macrovascular diseases typically arise from pathological alterations of the intimal, medial, and/or adventitial layers of the coronary arteries, whereas microvascular disease mainly results from endothelial cell and/or vascular smooth muscle cell dysfunction. Nonobstructive coronary artery disease occurs more frequently in women than in men. Lack of available evidence means that guideline recommendations for treatments for coronary microvascular dysfunction and nonobstructive coronary artery disease are sparse; among the few recommended treatments, most have been adopted from the treatment of patients with angina pectoris related to obstructive coronary atherosclerosis. Treatment of patients with coronary spasm includes pharmacotherapy as well as elimination of risk factors. Immunomodulatory drugs are used to treat patients with vasculitides. Transplant vasculopathy has few therapeutic options, with repeat transplantation being the only definitive treatment; medical management may have some effect and percutaneous coronary intervention is an option for focal stenoses. Surgery or percutaneous interventions tend to be chosen as the treatment modality for most congenital abnormalities. Percutaneous and surgical treatments are options for dissection, but many are managed conservatively without need for revascularization. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1191187732 ER -