Case of a 16-Year-Old Girl Diagnosed with Microvascular Angina on the Grounds of a Perfusion Defect in the Anteroseptal Wall Using Myocardial Scintigraphy

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Microvascular angina is defined as angina-like chest discomfort with normal epicardial coronary arteries, which is due to coronary microvascular dysfunction. The condition is most prevalent in perimenopausal or postmenopausal women, but is rare in young women. Here, we report the case of a 16-year-old female who complained of chest discomfort during exercise and was diagnosed with microvascular angina. Exercise stress-induced chest discomfort was not relieved by nitroglycerin treatment. Exercise thallium-201 myocardial scintigraphy showed a perfusion defect in the anteroseptal wall. Although there was no significant stenosis or vasospasm in the epicardial coronary arteries on angiography, an ergonovine spasm stimulation test induced chest discomfort and delayed distal vessel opacification in the left anterior descending coronary artery. Concomitant treatment using carvedilol and diltiazem in addition to exercise limitation reduced the frequency of chest pain. Improvement was also seen in exercise scintigraphy perfusion defects. Recent evidence challenges the assumption that microvascular angina is a benign condition; therefore, early treatment may be particularly important in young patients. Physicians who examine young patients with angina-like chest discomfort should consider a possible diagnosis of microvascular angina.