Ranolazine as Treatment of Microvascular Coronary Dysfunction in a Woman With Signs and Symptoms of Ischemia but No Obstructive Coronary Artery Disease

Abstract

Women often exhibit persistent symptoms, functional disability and a relatively high prevalence of microvascular coronary dysfunction (MCD) with no obstructive coronary artery disease (CAD) when evaluated for signs and symptoms of myocardial ischemia. A 27-year-old woman was referred by her treating cardiologist for symptoms of persistent chest pain for 10 years. Cardiac catheterization showed normal coronary arteries. Given the constellation of persistent chest pain and no obstructive CAD, a diagnosis of MCD was suspected, and she underwent coronary reactivity testing (CRT) with intracoronary infusions of adenosine, acetylcholine and nitroglycerin to test nonendothelial- and endothelial-dependent, micro- and macro-vascular coronary function. CRT results were consistent with a diagnosis of MCD. The patient was started on ranolazine, with significant improvement in symptoms. Cardiac magnetic resonance imaging (CMRI) after 3 months of treatment demonstrated improvement in perfusion compared to baseline.




J Med Cases. 2014;5(1):23-25
doi: http://dx.doi.org/10.4021/jmc1522w