Occlusions of epicardial arteries might not directly induce symptoms in ischemic heart disease

It is accepted that primary occlusions of epicardial arteries by thromboses, stenotic coronary artery disease (CAD), and spasm directly induce symptoms in ischemic heart disease (IHD). Because of this acceptance, there has been little interest in alternate mechanisms for IHD – as the spasm of resistance vessel (S-RV) concept of IHD, which asserts that S-RV directly induces symptoms in IHD. To stimulate interest in the S-RV concept, evidence against the primacy of occlusions of epicardial arteries was presented, as well as evidence for this position to provide a balanced discussion; while the evidence was mixed, overall findings appeared to weigh significantly against the primacy of occlusions of epicardial arteries. Also, the S-RV concept was discussed; the discussion included presenting the theory's explanations for events in epicardial arteries, with the aim of demonstrating that the concept provides more consistent explanations than the standard position. It is suggested that there is sufficient information to warrant renewed consideration of the S-RV concept.