Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with exertional chest pain consistent with angina pectoris, despite evidence of normal coronary arteries on angiography. Symptoms are typically prolonged, often occurring after physical or emotional stress, and show a suboptimal response to standard sublingual nitrates. No evidence of epicardial coronary artery spasm or myocardial bridge.
Clinical Examination Findings
Cardiovascular examination reveals normal S1 and S2 heart sounds with no murmurs, rubs, or gallops. Peripheral pulses are symmetric and full. No signs of congestive heart failure, peripheral edema, or jugular venous distension. Resting ECG typically shows non-specific ST-T wave changes or remains within normal limits.
Treatment Protocol
Management focuses on symptom relief and risk factor modification. Initiate beta-blockers or calcium channel blockers to reduce myocardial oxygen demand. Consider ACE inhibitors or statins for endothelial protection. If refractory, consider low-dose imipramine or xanthine derivatives. Emphasize lifestyle modifications including regular aerobic exercise and stress management.