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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">spbmedicalrecords</journal-id><journal-title-group><journal-title xml:lang="ru">Новые Санкт-Петербургские врачебные ведомости</journal-title><trans-title-group xml:lang="en"><trans-title>New St. Petersburg Medical Records</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1609-2201</issn><publisher><publisher-name>Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.24884/1609-2201-2026-105-2-19-29</article-id><article-id custom-type="elpub" pub-id-type="custom">spbmedicalrecords-152</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>КЛИНИЧЕСКАЯ ЛЕКЦИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>CLINICAL LECTURE</subject></subj-group></article-categories><title-group><article-title>Микроваскулярная стенокардия: особенности патогенеза, диагностики и лечения (клиническая лекция)</article-title><trans-title-group xml:lang="en"><trans-title>Microvascular angina: pathogenesis, diagnostic and treatment difficulties (clinical lecture)</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7429-2331</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Нифонтов</surname><given-names>Е. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Nifontov</surname><given-names>E. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Нифонтов Евгений Михайлович, доктор медицинских наук, профессор кафедры терапии факультетской с курсом эндокринологии, кардиологии с клиникой имени академика Г. Ф. Ланга</p><p>197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8</p></bio><bio xml:lang="en"><p>Evgeniy M. Nifontov, Dr. of Sci. (Med.), Professor of the Department of Faculty Therapy with a course in Endocrinology and Cardiology with the clinic named after Acad. G. F. Lang</p><p>6–8 L'va Tolstogo St., Saint Petersburg, 197022</p></bio><email xlink:type="simple">evgnif57@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1419-6860</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Трусов</surname><given-names>И. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Trusov</surname><given-names>I. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Трусов Иван Сергеевич, кандидат медицинских наук, заведующий кардиологическим отделением № 1 НИИ сердечно-сосудистых заболеваний клиники Научноклинического исследовательского центра, доцент кафедры терапии факультетской с курсом эндокринологии, кардиологии с клиникой имени академика Г. Ф. Ланга</p><p>Санкт-Петербург</p></bio><bio xml:lang="en"><p>Ivan S. Trusov, Cand. of Sci. (Med.), Head of Cardiology Department № 1 of the Research Institute of Cardiovascular Diseases of the clinic of the Scientific and Clinical Research Center, Associate Professor of the Department of Faculty Therapy with a course in Endocrinology and Cardiology with the clinic named after Acad. G. F. Lang</p><p>Saint Petersburg</p></bio><email xlink:type="simple">dr.getsuga@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Pavlov University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2026</year></pub-date><pub-date pub-type="epub"><day>11</day><month>10</month><year>2026</year></pub-date><volume>0</volume><issue>2</issue><fpage>19</fpage><lpage>29</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Нифонтов Е.М., Трусов И.С., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Нифонтов Е.М., Трусов И.С.</copyright-holder><copyright-holder xml:lang="en">Nifontov E.M., Trusov I.S.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.docved.ru/jour/article/view/152">https://www.docved.ru/jour/article/view/152</self-uri><abstract><p>Микроваскулярная стенокардия представляет собой форму ишемической болезни сердца, при которой ишемия миокарда не связана со значимым стенозом эпикардиальных коронарных артерий и обусловлена нарушением функции коронарного микроциркуляторного русла. Заболевание характеризуется сложным патогенезом, включающим эндотелиальную дисфункцию, воспаление, ремоделирование сосудов и метаболические нарушения. В данной клинической лекции представлены особенности патогенеза, связанные с морфологическими и функциональными изменениями микрососудов и миокарда, клинические проявления, современные подходы к диагностике и лечению, а также принципы формулировки клинического диагноза.</p></abstract><trans-abstract xml:lang="en"><p>Microvascular angina is a form of ischemic heart disease in which myocardial ischemia is not associated with significant stenosis of the epicardial coronary arteries and is caused by dysfunction of the coronary microcirculatory bed. The disease is characterized by a complex pathogenesis, including endothelial dysfunction, inflammation, vascular remodeling, and metabolic disturbances. This clinical lecture presents the pathogenesis associated with morphological and functional changes in the microvessels and myocardium, clinical manifestations, modern approaches to diagnosis and treatment, and principles of clinical diagnosis.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>микроваскулярная стенокардия</kwd><kwd>ишемия</kwd><kwd>критерии COVADIS</kwd></kwd-group><kwd-group xml:lang="en"><kwd>microvascular angina</kwd><kwd>ischemia</kwd><kwd>COVADIS criteria</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Vrints C., Andreotti F., Koskinas K. C. et al. 2024 ESC Guidelines for the management of chronic coronary syndromes // European Heart Journal. 2024. Vol. 45, № 36. P. 3415–3537. https://doi.org/10.1093/eurheartj/ehae177.</mixed-citation><mixed-citation xml:lang="en">Vrints C., Andreotti F., Koskinas K. 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