2023-10-04 14:43:39
In technical jargon they are called Inoca and Minoca, they are ‘invisible’ ischemias and infarctions. Boulders that cannot be seen, but weigh heavily on the everyday life of the affected patients, who live for years with pain and oppression, and in 3 out of 4 cases they even end up leaving their job, or are forced to reduce their workload. hours. The impact of these conditions on people’s existence has been photographed by recent research. And the topic is also under the spotlight these days, on the occasion of the 44th National Congress of the Italian Society of Interventional Cardiology (Gise), which is being held in Milan until Friday 6 October.
The research published in the International Journal of Cardiology was conducted on nearly 300 patients with Inoca, that is, ischemia without obstructive coronary artery disease, and found that 34% of them had lived with chest pain, tightness or discomfort for more than 3 years before receive a diagnosis. 78% were incorrectly told, at some point, that their symptoms were not heart-related. 75% were even forced to reduce their working hours or resign due to their condition. About 70% said their mental health and life prospects had worsened, and more than half (54%) said their symptoms had negatively affected their relationship with their partner or spouse.
Given the similarity of the symptoms and the diagnostic delay, the experts highlight, these results can also be extended to Minoca, i.e. myocardial infarction without obstruction. “Cardiovascular disorders continue to be one of the main causes of hospitalization and death for both men and women – states Giovanni Esposito, president of Gise and director of the Uoc of Cardiology, Hemodynamics and Utic of the Federico II University Hospital of Naples – In many cases, especially in women, myocardial ischemia and infarctions do not present significant occlusions in the arteries that supply the heart (obstructive coronary disease)”. Ischemia without obstructive coronary artery disease Inoca is a condition that primarily affects women, and is probably why for years many patients who presented to the hospital with chest pain were discharged and sent home because there was no obvious blockage in their coronary arteries, specialists explain.
“However – Esposito points out – in recent years Inoca has been recognized as a real condition and is now a topic of discussion in most world cardiology conferences. Today it is estimated that it may affect 62% of women who undergo angiography coronary artery disease for suspected angina, with a marked prevalence of those aged 45-65. In the past, we did not have the right tools to make the diagnosis, but now we know that the majority of these patients have coronary microvascular dysfunction, where the small vessels are unable to dilate fully to increase blood flow due to stress or exercise.Or they actually suffer from a constriction or vasospasm, where there may be significant narrowing of the coronary arteries and so patients experience chest pain”.
In some cases, ischemia can result in a true myocardial infarction, even in the absence of obvious obstructions of the coronary arteries, a condition called Minoca: it is estimated that it happens in 6% of cases, more frequently among women. “A subgroup of Minoca cases is due to spontaneous dissection of the coronary artery (Scad), which is a rupture that forms inside the wall of a coronary vessel – highlights Francesco Saia, president-elect of Gise and interventional cardiologist at the IRCCS University Hospital of Bologna, Policlinico Sant’Orsola – In most cases of Minoca, it is difficult to identify the cause. So it happens that, since there are no obstructions in the main coronary arteries, patients often leave the hospital unsure of what caused their Minoca heart attack and how to prevent another one.”
It is estimated that in the 4 years following such an event, there is a 13% chance of dying from any cause and a 7% chance of having another heart attack. “The good news is that with the large-scale application of refined coronary physiology and/or imaging techniques, the chances of obtaining a correct diagnosis and appropriate treatment increase in the majority of cases – concludes Saia – This topic has other implications, in addition to the clinical one. These procedures, in fact, do not have an ad hoc reimbursement. The Gise has been working for some time on an economic recognition that ensures that the application of these measures is not economically disadvantageous for healthcare facilities and that it is therefore expanded access throughout the national territory”.
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