Anginal syndrome with normal coronary arteriogram
Weiss, D.; Lorber, A.; Maisuls, E.; Palant, A.
Harefuah 112(8): 380-382
1987
ISSN/ISBN: 0017-7768 PMID: 3679000 Document Number: 291159
It has been estimated that up to 30% of those who undergo coronary angiography for evaluation of chest pain have angiographically normal coronary vessels. The nature of this condition is unknown and it has also been called "syndrome x". Chest pain can occur in patients with aortic stenosis, idiopathic hypertrophic subaortic stenosis, mitral value prolapse, nonobstructive cardiomyopathy and pulmonary hypertension. Explanations to account for these phenomena include misinterpretation of the coronary arteriograms, abnormal hemoglobin dissociation curves, lesions in small coronary arteries and psychosomatic factors. Coronary artery spasm could account for the precordial pain in some of these patients with normal coronary arteries. Tests used to evaluate the ischemic nature of anginal or atypical forms of chest pain include the electrocardiogram, stress-testing, blood lactate levels, lactate consumption, left ventricular end-diastolic pressure during atrial pacing, wall-motion disturbances shown by radioisotope tests and thalium-201 perfusion abnormality on exercise. During provocation of chest pain there appears to be elevation of coronary resistance, but no evidence of spasm of the epicardial coronary arteries. It was proved that ischemic pain during atrial pacing is due to a reduction in the vasodilatory reserve of the small coronary arteries. In patients with aortic stenosis and hypertension it was also demonstrated that the mechainsm involved in the development of chest pain was ischemia due to reduction in the vasodilatory reserve of the small vessels.