Affiliations: Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz and DZHK standort Rhein-Main, Germany
Correspondence:
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Corresponding author: Tommaso Gori, Kardiologie I, University Medical Center, Mainz, Germany. Tel.: +49 6131 176903; E-mail: tommaso.gori@unimedizin-mainz.de.
Abstract: Up to 50% of the patients undergoing coronary angiography present no epicardial disease. Most of these patients are women. Takotsubo cardiomyopathy, coronary microvascular dysfunction, and spontaneous coronary artery dissection are the most common syndromes that affect these patients. Their mechanisms are complex, with a interplay between neurohormonal factors and a number of other systems. The present review describes how changes in the estrogen state may lead to changes in vasomotor tone and endothelial dysfunction which result in coronary epicardial and microvascular spasm and coronary arterial wall instability in these three conditions. The sex-dependent differences in prevalence, pathogenesis, and prognosis are described.
