MANEJO TERAPÊUTICO DA ANGINA VASOESPÁSTICA: ESTRATÉGIAS DE ESTABILIZAÇÃO E TERAPIA ANTITROMBÓTICA
DOI:
https://doi.org/10.56238/isevmjv5n1-019Palavras-chave:
Vasospastic Angina, Coronary Vasoconstriction, Calcium Channel Blockers, Antithrombotic Therapy, Provocative Testing, InflammationResumo
A angina vasoespástica (AVE) é uma entidade clínica relevante dentro do espectro das síndromes isquêmicas com artérias coronárias não obstrutivas, caracterizada por vasoconstrição transitória do leito coronariano epicárdico e/ou microvascular, com repercussão isquêmica variável. Apesar de frequentemente associada a dor torácica em repouso e alterações eletrocardiográficas transitórias, sua apresentação pode mimetizar síndromes coronarianas agudas e culminar em arritmias malignas, infarto e morte súbita. O diagnóstico permanece desafiador, sobretudo quando a cinecoronariografia não evidencia lesões significativas, exigindo alta suspeição clínica e, em centros selecionados, testes provocativos com acetilcolina e/ou ergonovina. No tratamento, bloqueadores de canais de cálcio constituem a base terapêutica, com nitratos como adjuvantes. Persistem controvérsias quanto ao papel de terapias antitrombóticas na AVE sem aterosclerose obstrutiva, especialmente em relação ao uso rotineiro de aspirina. Evidências recentes reforçam a importância da abordagem orientada, incorporando avaliação de disfunção vasomotora e biomarcadores de inflamação, além de potenciais implicações genéticas. Esta revisão narrativa sintetiza evidências contemporâneas sobre diagnóstico, terapias de primeira linha, racionalidade e limites do uso antitrombótico e o impacto da inflamação na fisiopatologia, apontando perspectivas futuras para um manejo mais preciso e individualizado.
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