Coronary Slow Flow Phenomenon – Adding Myocardial Fibrosis to the Equation

Initially described more than 40 years ago by Tambe et al., coronary slow flow phenomenon (CSFP) is characterized by delayed contrast medium progression in the absence of obstructive coronary epicardial disease during invasive coronary angiography. CSFP typically affects young male smokers, who often presents with acute coronary syndrome (ACS) or recurrent refractory resting angina requiring hospital admission.^– Moreover, life-threatening arrhythmias and sudden cardiac death have also been associated with CSFP.

Despite increased awareness and research, CSFP remains an elusive and poorly understood condition, with many proposed pathogenic mechanisms including endothelial, vasomotor and microvascular dysfunction.^, Indeed, an abnormal regulation of microvascular tone that occurs only during resting conditions, while coronary flow reserve is within normal range, has been described in CSFP.

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