日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Microvascular angina is defined as chest discomfort with normal epicardial coronary arteries, and it is caused by coronary microvascular dysfunction. It is relatively more prevalent in women who are perimenopausal or postmenopausal and is rare in young women. Here we report the case of a 16-year-old girl who presented with a complaint of chest discomfort during exercise and who was diagnosed with microvascular angina. Exercise stress induced chest discomfort, which was not relieved by administering nitroglycerin. Exercise thallium-201 myocardial scintigraphy showed a perfusion defect in the anteroseptal wall. Although no significant stenosis or vasospasm in the epicardial coronary arteries was observed on the angiography, the ergonovine stimulation test induced chest discomfort and delayed distal vessel opacification in the left anterior descending coronary artery. In addition to limiting exercise, concomitant treatment using carvedilol and diltiazem reduced the frequency of chest pain. The perfusion defect showed improvement. Because microvascular angina is very rare in young patients, they might be misdiagnosed. Recent evidence has challenged the assumption that microvascular angina is a benign condition; therefore, early treatment may be very important for young patients. Physicians who examine young patients with angina-like chest discomfort should be aware of the possibility of microvascular angina.