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Coronary artery endothelial dysfunction: Clinical aspects

R Jay Widmer, MD, PhD
Amir Lerman, MD
Frank W Sellke, MD
Filippo Crea, MD
Section Editor
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Deputy Editor
Gordon M Saperia, MD, FACC


The coronary arterial circulation, which consists of conductance and resistance vessels, plays a key role in the delivery of blood to the myocardium. The endothelium is the layer of cells that lines these blood vessels. This layer helps to maintain blood vessel (vascular) tone, regulates hemostasis, acts as barrier to potentially toxic materials, and regulates inflammation. Endothelial dysfunction is the inability of the endothelium to optimally perform one or more of these. Endothelial dysfunction plays a key role in determining myocardial ischemia in all clinical manifestations of ischemic heart disease. Dysfunction of the coronary arterial endothelium is an important determinant of microvascular dysfunction.

This topic will focus on clinical aspects of endothelial dysfunction, which is present in a few cardiac diseases, including large vessel (epicardial) coronary artery disease, small vessel disease (microvascular angina), and transplant vasculopathy. The discussion of the basic aspects of normal and abnormal endothelial function is found elsewhere. (See "Coronary artery endothelial dysfunction: Basic concepts".)


The following terms are defined as follows:

Coronary microvascular dysfunction – Microvascular dysfunction refers to the impairment of the delivery of blood to the myocardium due to one or more pathologic conditions occurring at the level of the pre-arterioles, arterioles, or capillaries. Patients may or may not be symptomatic. There are four broad categories [1]:

Endothelial dysfunction

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Literature review current through: Nov 2017. | This topic last updated: Nov 02, 2015.
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