This protocol applies to patients with Cardiac Syndrome X in whom endothelial dysfunction co-exists with coronary atherosclerosis — a clinically relevant combination that shapes both risk-factor management and symptomatic treatment strategy.
In patients with ANOCA/INOCA, coronary atherosclerosis and endothelial dysfunction frequently co-exist. Tailored counselling on lifestyle factors is warranted to address risk factors, reduce symptoms, and improve quality of life and prognosis.
The primary clinical target is control of anginal symptoms. Management in this setting involves lipid-modifying therapy alongside agents specifically directed at endothelial function. The complete regimen — including sequencing and all relevant options — is set out in the full structured protocol.
DOI: 10.1093/eurheartj/ehae177
In all patients with established ANOCA/INOCA due to the frequent presence of coronary atherosclerosis and endothelial dysfunction, tailored counselling on lifestyle factors is warranted to address risk factors, reduce symptoms, and improve QoL and prognosis.
For the management of endothelial dysfunction, ACE-I should be considered for symptom control.
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