A Possible Etiopathogenic Role of Sickle Cell Anemia in Ischemia With Nonobstructive Coronary Arteries

Chest pain is a common clinical symptom, especially in patients with sickle cell anemia. Owing to the vast differential diagnosis, investigation can be challenging. Typical chest pain (angina) is often attributed to obstructive coronary artery disease, with patients being referred for exercise stress tests for confirmation. Microvascular angina is emerging as a cause of significant morbidity worldwide, clinically identical to obstructive coronary artery disease. Clinical assessment and exercise stress testing often give the same results, making differentiation difficult. Coronary angiography however shows either normal coronary arteries or a nonobstructive lesion. An incomplete understanding of the etiopathogenesis of microvascular angina may result in missed diagnosis and suboptimal treatment in some cases. Coronary microvascular dysfunction plays a key role in this phenomenon, driven by chronic inflammation, thrombotic microangiopathy, and endothelial dysfunction. This article reports the case of a young man with chest pain, linking the highlights of the pathophysiology of microvascular disease in sickle cell anemia to microvascular angina.