Table 3. Medical therapy in the management of INOCA.

Diagnosis	Treatment	Mechanisms of effect
MVA	Beta-blockers (Nebivolol 2.5-10 mg daily)	– ↓ Myocardial oxygen consumption – Antioxidant properties
	Calcium channel blockers (Amlodipine 10 mg daily)	– Vascular smooth muscle relaxation – ↓ Myocardial oxygen consumption
	Ranolazine (375-750 mg twice daily or 500 mg-1 g twice daily in the USA)	– Improves microvascular perfusion reserve index in patients with MVA and reduced CFR
	Trimetazidine (35 mg twice daily)	– Increases cell tolerance to ischaemia by maintaining cellular homeostasis
	ACE inhibitors (Ramipril 2.5 -10 mg), ARBs	– Improve CFR – ↓ Workload – May improve small vessel remodelling
VSA	Calcium channel blockers (Amlodipine 10 mg or Verapamil 240 mg SR or Diltiazem 90 mg twice daily or 120-360 mg single or divided doses)	– ↓ Spontaneous and inducible coronary spasm via vascular smooth muscle relaxation – ↓ Oxygen demand
	Nitrates (Isosorbide mononitrate XL 30 mg)	– ↓ Spontaneous and inducible coronary spasm via large epicardial vasodilation – ↓ Oxygen demand
	Nicorandil (10-20 mg twice daily)	– Potassium channel activator with coronary microvascular dilatory effect
Both MVA + VSA	Calcium channel blockers (Amlodipine 10 mg or Verapamil 240 mg SR or Diltiazem 90 mg twice daily or 120-360 mg single or divided doses)	– Vascular smooth muscle relaxation – ↓ Myocardial oxygen consumption
	Nicorandil (10-20 mg twice daily)	– Potassium channel activator with coronary microvascular dilatory effect
	Trimetazidine (35 mg twice daily)	– Increases cell tolerance to ischaemia by maintaining cellular homeostasis
	ACE inhibitors (Ramipril 2.5-10 mg), ARBs	– Improve CFR – ↓ Workload – May improve small vessel remodelling
	Statins (Rosuvastatin 10-20 mg)	– Improve coronary endothelial function – Pleiotropic effects including reduced vascular inflammation
ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker; CFR: coronary flow reserve; MVA: microvascular angina; VSA: vasospastic angina