457. Insights into INOCA and ANOCA with Dr. Claire Raphael

Non-obstructive coronary artery disease, including MINOCA, INOCA, and ANOCA, represents a significant clinical challenge where patients experience ischemia and chest pain despite "clean" angiograms. Interventional cardiologist Dr. Claire Raphael highlights that these conditions are frequently underdiagnosed, particularly in women, and are often driven by microvascular dysfunction or coronary spasm. Because these patients face a 1.4-fold increased risk of adverse cardiovascular events, clinicians must maintain a high index of suspicion. Effective evaluation requires advanced imaging like cardiovascular magnetic resonance to identify structural abnormalities or myocardial fibrosis, alongside invasive provocation testing. Management strategies prioritize risk factor control through statins, ACE inhibitors, and beta-blockers, supplemented by cardiac rehabilitation and, in refractory cases, novel interventions like the coronary sinus reducer. Reassurance and education remain essential to address patient anxiety and encourage safe physical activity.