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Canadian Journal of Cardiology

Stress echocardiography in the diagnosis of coronary microvascular ischemia – the forgotten old faithful tool?

      Ischemia is an imbalance between myocardial oxygen supply and demand, and includes both macrovascular and microvascular causes. When patients present with typical angina or equivalents, many tests can assess for ischemia. If positive and symptomatic despite medical therapy, patients are referred for coronary angiography. If no macrovascular ischemia is detected, workup for ischemia with no obstructive coronary artery disease (INOCA) and coronary microvascular dysfunction (CMD) should be performed if clinically indicated. Invasive and non-invasive modalities can be used to detect CMD. This review highlights the role of stress echocardiography as a non-invasive modality for the assessment of coronary microvascular dysfunction.

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