Myocardial ischemia in nonobstructive coronary arteries: A review of diagnostic dilemmas, current perspectives, and emerging therapeutic innovations

Table 11 Summary of adverse effects associated with myocardial infarction with nonobstructive coronary arteries therapies

Therapeutic modality	Adverse effects
Aspirin (long-term therapy)	Gastrointestinal bleeding, gastric ulceration, dyspepsia, increased hemorrhagic stroke risk, bronchospasm (in aspirin-sensitive asthma), renal dysfunction
P2Y12 inhibitors (clopidogrel, ticagrelor, prasugrel)	Bleeding (including gastrointestinal and intracranial), thrombocytopenia, dyspnea (ticagrelor), hypersensitivity reactions
Statin therapy	Myopathy, rhabdomyolysis, hepatic dysfunction, new-onset diabetes, cognitive effects (rare), gastrointestinal upset
ACE inhibitors/ARBs	Hypotension, cough (ACE inhibitors), angioedema, hyperkalemia, renal dysfunction, dizziness
Beta-blockers	Bradycardia, hypotension, fatigue, dizziness, depression, erectile dysfunction, worsening bronchospasm in asthma/COPD
Calcium channel blockers	Hypotension, peripheral edema, flushing, headache, constipation (especially with verapamil), dizziness, reflex tachycardia (dihydropyridines)
Short-acting nitrates	Headache, hypotension, dizziness, reflex tachycardia, methemoglobinemia (rare), flushing, nitrate tolerance
Thrombolytic/anticoagulant therapy	Major bleeding (gastrointestinal, intracranial, retroperitoneal), thrombocytopenia (heparin-induced), hypersensitivity reactions, hematoma at injection site
Vitamin K antagonists (Warfarin)	Bleeding complications need regular INR monitoring, skin necrosis (rare), drug interactions, purple toe syndrome
Unconventional agents for CMD	Dipyridamole: Headache, dizziness, hypotension, flushing, gastrointestinal discomfort
	Ranolazine: QT prolongation, dizziness, constipation, nausea, palpitations
	Imipramine: Anticholinergic effects, drowsiness, dry mouth, urinary retention
	Aminophylline: Arrhythmias, CNS stimulation, nausea, tremors, seizures (at high doses)
Dual antiplatelet therapy	Increased bleeding risk, anemia, epistaxis, easy bruising, dyspepsia
Invasive interventions (PCI/stenting)	Iatrogenic vessel injury, stent thrombosis, restenosis, arterial dissection, contrast-induced nephropathy, procedural bleeding, coronary spasm
Non-pharmacological approaches (cardiac rehabilitation, lifestyle modifications)	Minimal direct risks, but unsupervised activity may lead to musculoskeletal injury or cardiovascular events in high-risk individuals

ACE: Angiotensin-converting enzyme; ARBs: Angiotensin-receptor blockers; COPD: Chronic obstructive pulmonary disease; INR: International normalized ratio; CMD: Coronary microvascular dysfunction; CNS: Central nervous system; PCI: Percutaneous intervention.