What treatments are recommended for patients with ACS with angiographically normal coronary arteries?
If coronary angiography reveals normal coronary arteries and endothelial dysfunction is suspected, invasive physiological assessment such as coronary flow reserve measurement may be considered. Risk factor reduction and medical therapy with nitrates, beta blockers, and CCBs alone or in combination are considered for endothelial dysfunction. High doses of arginine have also been given. Imipramine or aminophylline have been used in patients with endothelial dysfunction for continued pain despite optimal medical therapy. In postmenopausal women, estrogen reverses acetylcholine-induced coronary arterial vasoconstriction, presumably by improving endothelium-dependent coronary vasomotion, and reduces frequency of chest pain. However, estrogen is not recommended because of its demonstrated increase in cardiovascular risk.