Treatment of Cardiac Syndrome X with Anginal Symptoms and Microvascular Spasm on Acetylcholine Testing
This page covers the clinical management of Cardiac syndrome X (ICD BA86) in patients whose acetylcholine (Ach) provocation test has confirmed microvascular spasm — characterised by anginal symptoms and ischaemic ECG changes, with an angiographic coronary lumen reduction of less than 90%.
Clinical Scenario
This presentation is defined by the following features identified on Ach testing:
- Anginal symptoms during provocation
- Ischaemic ECG changes
- Angiographic coronary lumen reduction of < 90% — confirming microvascular (rather than macrovascular/epicardial) spasm
Clinical Goal
The primary therapeutic target in this setting is control of anginal symptoms.
Treatment Approach — Partial Overview
A calcium channel blocker is the recommended first-line pharmacological choice in patients with microvascular spasm following Ach testing — the complete protocol, including selection criteria, escalation pathway, and management sequence, is available in the full regimen …
References
DOI: 10.1093/eurheartj/ehae177
- If the lumen reduction is <90%, the diagnosis of microvascular spasm is made.
- In patients with either epicardial or microvascular spasm following Ach testing, calcium antagonists should be considered as first-line therapy.
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