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Pharmacological Management of Cardiac Syndrome Y: A Focused Review

Ahmad Sharif-Yakan and Christoph A. Nienaber

The Coronary slow flow phenomenon or cardiac syndrome Y is a relatively newly described microvascular coronary artery disorder that is still not fully understood. It is thought to be caused by increased flow resistance in the microvascular coronary artery beds. Patients affected by the CSY are typically young patients who suffer from myocardial ischemia at rest. Ischemia is often recurrent and as a result, patients suffer from a poor quality of life. The management of patients diagnosed with CSY is especially challenging, owing to its poorly understood pathophysiology, relatively recent recognition as a separate microvascular coronary artery disorder and most importantly the lack of large, homogenous, randomized controlled trials that compares the efficacy of various pharmacological agents. In this review, we touch briefly on the clinical presentation and the pathophysiology of the CSY and then we examine, in depth, the currently available evidence for the management of patients affected by this disorder.