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INOCA International Symptoms Tracker
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Transient myocardial ischemia is reversible with no residual damage, unless severe and prolonged enough to cause cell death. Inducible ischemia may get worse if the responsible mechanism changes.
The subendocardial layers of the left ventricular wall are more sensitive to ischemia. Infarcts start in the subendocardium and progressively extend to the mid and subepicardial layers if ischemia is severe and prolonged enough. It is not exclusive of microvascular dysfunction, but of any mechanism that may precipitate myocardial infarction .
Calcium transients are an essential mechanism in muscle cell contractile function. Calcium channel blockers reduce the tone of vascular smooth muscle cells, resulting in vasodilation and reduced resistance to flow and in the prevention of hypercontraction in response to stimuli.
Ranolazine is a metabolic modulator that favours cell utilisation of glucose instead of free fatty acids in ATP synthesis.
Angina reported hours after activity simply is not triggered by that activity but by other mechanisms. The heart does not “remember” what has he been doing hours before.