Ep. 32 Coronary Microvascular Dysfunction: Optimizing Diagnosis & Management with Dr. Samit Shah

Small vessels can have a major impact. Are you missing the hidden culprit of chest pain? In this episode of BackTable Cardiology, host Dr. Hady Lichaa welcomes Yale Interventional Cardiologist Dr. Samit Shah to discuss Coronary Microvascular Dysfunction (CMD) and Angina with No Obstructive Coronary Arteries (ANOCA). Their discussion demonstrates how coronary function testing turns a historically vague diagnosis into actionable phenotyping that can dramatically improve treatment efficacy and patient symptoms. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:53 - Coronary Microvascular Dysfunction (CMD) Overview10:55 - Cath Lab Workflow Tips19:28 - Structural CMD: Discordant CFR and IMR Values26:59 - Vasospastic Phenotypes28:28 - Chest Pain Case: Syncope and Arrest Risk33:31 - Treatment and ACh Testing39:10 - Mixed Physiology Pharmacotherapy49:45 - Myocardial Bridge Workup55:19 - Workflow, Reimbursement, and Future Therapies58:11 - Closing and Signoff --- More about this episode Dr. Shah breaks down clinical presentations and cath lab findings of epicardial vasospasm, microvascular spasm, and endothelial dysfunction, outlining how phenotype and physiology influence treatment. He explains how to perform both Coronary Flow Reserve (CFR) and Index of Microcirculatory Resistance (IMR) testing, incorporating examples of interpretation of abnormal values. The physicians discuss COVADIS criteria for vasospastic angina, vasospasm and cardiac arrest considerations, and myocardial bridges in LAD-PCI. The episode covers door-to-discharge care for CMD: identification of phenotype via patient case walk-throughs, practical cath lab workflow, and recommendations for tailored pharmacotherapy. --- Resources Dr. Hady Lichaa’s Provider Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Samit Shah’s Provider Profile https://medicine.yale.edu/profile/samit-shah/ COVADIS Criteria for vasospastic anginahttps://covadis.online/definitions/ A doppler flow probe for canine main left coronary arterieshttps://journals.physiology.org/doi/abs/10.1152/jappl.1974.37.2.256?journalCode=jappl ChaMP-CMD: A Phenotype-Blinded, Randomized Controlled, Cross-Over Trialhttps://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066680 Presence and Relevance of Myocardial Bridge in LAD-PCI of CTO and Non-CTO Lesions https://pubmed.ncbi.nlm.nih.gov/38340105/ DEFINE GPS Trialhttps://clinicaltrials.gov/study/NCT04451044 --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app