STABLE ANGINA IN SPECIAL SITUATIONS: INOCA

INOCA (ischemia with no obstructive arteries) is a heterogeneous condition clinically characterized by chest pain of ischemic etiology in the absence of obstructive coronary artery disease, which imposes significant impairment in quality of life, in addition to an increased risk of cardiovascular events. The mechanisms involved in the onset of symptoms and ischemia are not fully understood and appear to be multifactorial. Coronary microvascular dysfunction and epicardial coronary spasm, either alone or in combination, are well-docu-mented mechanisms. Confirmatory diagnosis can be performed through invasive tests for the characterization of INOCA endotypes, which are microvascular dysfunction and vasos-pasm. However, as it is an invasive evaluation of difficult access and high cost, diagnosis is presumptive in most cases. Treatment involves a multidisciplinary approach and should be guided by the pathophysiological mechanism involved and aims to improve symptoms, control cardiovascular risk factors, and identify precipitating factors.