Ischemia With No Obstructive Coronary Artery Disease: Are Misdiagnosis and Undertreatment Always Behind the Corner?

Giulia Ghizzoni; Giulia Botti; Filippo Russo; Luca Ferri; Marco Ancona; Barbara Bellini; Ciro Vella; Domitilla Gentile; Matteo Montorfano; Alaide Chieffo

doi:10.1016/j.jaccas.2023.101978

Ischemia With No Obstructive Coronary Artery Disease: Are Misdiagnosis and Undertreatment Always Behind the Corner?

JACC Case Rep. 2023 Aug 10:22:101978. doi: 10.1016/j.jaccas.2023.101978. eCollection 2023 Sep 20.

Authors

Giulia Ghizzoni^{1

2}, Giulia Botti^{1

2}, Filippo Russo¹, Luca Ferri¹, Marco Ancona¹, Barbara Bellini¹, Ciro Vella¹, Domitilla Gentile^{1

2}, Matteo Montorfano^{1

2}, Alaide Chieffo^{1

2}

Affiliations

¹ Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
² University Vita-Salute San Raffaele, Milan, Italy.

Abstract

Ischemia with no obstructive coronary artery disease (INOCA) is not an uncommon diagnosis in patients presenting with chest pain who undergo clinically indicated coronary angiography. However, the symptoms reported by patients with INOCA may be heterogeneous, leading to misdiagnosis and undertreatment. Herein we report 3 clinical cases of INOCA misdiagnosis and describe how the cases were reinvestigated following the appropriate diagnostic pathway. (Level of Difficulty: Advanced.).

Keywords: INOCA; misdiagnosis; tailored therapy.

Publication types

Case Reports