{"id":7112,"date":"2025-05-22T14:03:35","date_gmt":"2025-05-22T11:03:35","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=7112"},"modified":"2025-05-22T14:03:35","modified_gmt":"2025-05-22T11:03:35","slug":"2025-summary-anoca-inoca-and-minoca-clinical-overview","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/2025-summary-anoca-inoca-and-minoca-clinical-overview\/","title":{"rendered":"2025 Summary: ANOCA, INOCA, and MINOCA \u2013 Clinical Overview"},"content":{"rendered":"
2025 Summary: ANOCA, INOCA, and MINOCA \u2013 Clinical Overview<\/div>\n
<\/div>\n
1-ANOCA (Angina with No Obstructive Coronary Arteries): Clinical term for chest pain without major coronary obstruction (<50%). May be ischemic or non-ischemic.<\/div>\n
2-INOCA (Ischemia with No Obstructive Coronary Arteries): Confirmed myocardial ischemia (via stress testing or imaging), but no significant CAD on angiography. Common in women.<\/div>\n
3- MINOCA(MI with Non-Obstructive Coronary Arteries): Fulfills MI criteria (troponin elevation, ECG changes) but coronary arteries show no >50% stenosis.<\/div>\n
4- Evaluation Strategy:<\/div>\n
\u00a0 – Rule out alternate diagnoses (e.g. PE, sepsis, myocarditis)<\/div>\n
\u00a0 – Use OCT\/IVUS for plaque disruption or SCAD<\/div>\n
\u00a0 – Cardiac MRI to distinguish takotsubo\/myocarditis<\/div>\n
\u00a0 – Use CFR, IMR, and provocative tests if available.<\/div>\n
5- Treatment:<\/div>\n
\u00a0 – Tailored by mechanism<\/div>\n
\u00a0 – Atherosclerotic: statins, ACEi, BB, antiplatelets<\/div>\n
\u00a0 – Vasospasm: CCBs, nitrates<\/div>\n
\u00a0 – Microvascular: BB, ACEi, statins<\/div>\n
\u00a0 – Avoid unnecessary dual antiplatelet therapy.<\/div>\n
6- Prognosis:<\/div>\n
\u00a0 – Previously thought benign, now known to have 4\u20135% 1-year mortality<\/div>\n
\u00a0 – Increased risk of recurrent angina, heart failure, especially in women.<\/div>\n
7- Clinical Tip:<\/div>\n
\u00a0 – INOCA and ANOCA are often underdiagnosed<\/div>\n
\u00a0 – Mislabeling as ‘non-cardiac chest pain’ leads to under-treatment<\/div>\n
<\/div>\n
8- Patient scenario:<\/div>\n
A 52-year-old woman comes to your clinic complaining of chest pain. Her ECG is non-diagnostic, and cardiac enzymes are slightly elevated. Coronary angiography shows no significant blockage (<50%).<\/div>\n
\u00a0 9- Quick Summary \u2013 INOCA, Microvascular Angina, and Variant Angina (Prinzmetal\u2019s):<\/div>\n
\u2022 INOCA stands for Ischemia with No Obstructive Coronary Arteries. It refers to chest pain or signs of myocardial ischemia without significant coronary artery blockages.<\/span><\/div>\n
\u2022 Microvascular angina is a subtype of INOCA caused by dysfunction of the small coronary vessels (microcirculation). It\u2019s often exercise-induced and not visible on traditional angiograms.<\/span><\/div>\n
\u2022 Variant angina (also called Prinzmetal\u2019s angina) is also a form of INOCA, but caused by spasm in the large epicardial coronary arteries, usually at rest and often with transient ST-elevation.<\/span><\/div>\n
<\/div>\n
Key difference:<\/div>\n
\u2022 Microvascular angina = small vessel dysfunction<\/span><\/div>\n
\u2022 Variant angina = large vessel (epicardial) spasm<\/span><\/div>\n
<\/div>\n
<\/div>\n
Now what?<\/div>\n
<\/div>\n
Step-by-step Evaluation:<\/div>\n
1. First, rule out other serious conditions:<\/span><\/div>\n
\u2022 Could it be pulmonary embolism, sepsis, or myocarditis?<\/span><\/div>\n
\u2192 Do basic labs, imaging, and consider Cardiac MRI to check for myocarditis or Takotsubo cardiomyopathy.<\/div>\n
2. If MI is suspected but arteries are clear:<\/span><\/div>\n
\u2022 Think about plaque rupture or SCAD (spontaneous dissection).<\/span><\/div>\n
\u2192 Use OCT or IVUS during angiography to detect subtle findings missed by standard imaging.<\/div>\n
3. If chest pain persists and ischemia is suspected:<\/span><\/div>\n
\u2022 Assess for microvascular angina or vasospasm.<\/span><\/div>\n
\u2192 Perform CFR (coronary flow reserve), IMR, or acetylcholine testing if available.<\/div>\n
<\/div>\n
Reference (2025):<\/div>\n
\u00a0 – 2025 ESC Insights on INOCA\/MINOCA: https:\/\/www.escardio.org\/Congresses-&-Events\/Congress-Resources\/2025\/inoca-minoca-clinical-management<\/a><\/div>\n
\u00a0 – AHA Scientific Statement: https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000000963<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

2025 Summary: ANOCA, INOCA, and MINOCA \u2013 Clinical Overview 1-ANOCA (Angina with No Obstructive Coronary Arteries): Clinical term for chest pain without major coronary obstruction (<50%). May be ischemic or non-ischemic. 2-INOCA (Ischemia with No Obstructive Coronary Arteries): Confirmed myocardial ischemia (via stress testing or imaging), but no significant CAD on angiography. Common in women. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-7112","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7112","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=7112"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7112\/revisions"}],"predecessor-version":[{"id":7113,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/7112\/revisions\/7113"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=7112"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=7112"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=7112"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}