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Journal ArticleDOI

Angina Without Coronary Disease (sic)

01 Aug 1970-Circulation (Lippincott Williams & Wilkins)-Vol. 42, Iss: 2, pp 189-191
TL;DR: A puzzling group of individuals with chest pain has emerged in whom no arteriographic evidence of coronary disease can be demonstrated, and it is neither unfair nor inappropriate to indicate that some alleged examples of angina without coronary disease are wrong diagnoses.
Abstract: SINCE THE establishment of coronary arteriography as a widely used method for studying patients with ischemic heart disease,\" 2 a puzzling group of individuals with chest pain has emerged in whom no arteriographic evidence of coronary disease can be demonstrated.3-5 They have most often been women at or near middle age, although examples from both sexes and at all ages have been described. A sort of aura has developed about these patients, and the purpose of this communication is to consider some of the pertinent facts of the situation. I will intentionally omit the differential consideration of pain due to esophageal disease, hiatus hernia, pericarditis, and musculoskeletal disorders of the chest and instead will focus on those patients in whom such considerations have reasonably been excluded. Similarly, I will exclude (for the sake of this discussion) complicating factors from re.I life, such as aortic and mitral valvular disease. What are the etiologic possibilities which currently seem most plausible as explanations for angina without coronary disease? The diagnosis of angina pectoris due to ischemic heart disease is more easily and more accurately made with increasing experience of the physician, and it is neither unfair nor inappropriate to indicate that some alleged examples of angina without coronary disease are wrong diagnoses. For simplicity's sake let us consider only those examples in which the diagnosis of angina pectoris due to ischemic
Citations
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Journal ArticleDOI
01 Nov 1975-Chest
TL;DR: It appears reasonable to assume that a coronary spasm may be the cause of the acute reduction of coronary blood supply responsible for the transient myocardial ischemia in patients with so-called variant angina.

388 citations

Journal ArticleDOI
TL;DR: In this paper, a large-scale study of 200 patients with anginal pain and myocardial lactate production (myocardial ischemia) was performed, with an average age of 47 years.

381 citations

Journal ArticleDOI
TL;DR: Coronary spasm can be implicated as a cause of myocardial infarction in patients with normal coronary arteriograms who also have Prinzmetal's variant angina and no major coronary obstructions, and ergonovine maleate test is a safe, sensitive and specific method for reproducing coronary spasm.
Abstract: Ergonovine maleate was evaluated as a provocative agent for inducing coronary spasm during coronary arteriography. The study group consisted of 98 patients with either mild fixed obstructions of coronary luminal diameter (less than 50 percent) or normal coronary arteriograms. The test was considered positive if the drug precipitated severe coronary spasm. A positive ergonovine test occurred in 10 of 11 patients with Prinzmetal's variant angina (P < 0.02). Two of these patients had a transmural myocardial infarction in the distribution of the spastic artery. Ergonovine tests were negative in (1) the 15 control patients with no clinically suspected coronary artery disease (P < 0.001), (2) 63 of 66 patients with angina-like chest pain (P < 0.001), and (3) all 6 patients with myocardial infarction and no history of Prinzmetal's variant angina (P < 0.05). No major complications occurred as a result of this test. Thus, ergonovine maleate test is a safe, sensitive and specific method for reproducing coronary spasm in patients with Prinzmetal's variant angina and no major coronary obstructions. The results suggest that coronary spasm can be implicated as a cause of myocardial infarction in patients with normal coronary arteriograms who also have Prinzmetal's variant angina. Coronary spasm was not demonstrated in patients who had normal coronary arteriograms and a history of myocardial infarction as an isolated clinical event. Also, coronary spasm could not be demonstrated in the majority of patients who had angina-like chest pain and no major coronary obstruction.

372 citations

Journal ArticleDOI
TL;DR: It is concluded that many of patients referred for coronary arteriography because of chest pain remain limited in activity and may benefit from further efforts at comunication and rehabilitation.
Abstract: Approximately 10 per cent of patients referred for coronary arteriography because of chest pain have angiographically normal coronary arteries and no other heart disease. We examined the functional status of 57 patients who had undergone catheterization (23 men and 34 women), all of whom were told that their hearts were normal, that their pain was noncardiac, and that no limitation on activity was necessary. At a mean follow-up time of 16±7.7 months, 27 of the 57 patients (47 per cent) still described their activity as limited by chest pain (before catheterization, 42 of 57 or 74 per cent); 29 of 57 (51 per cent) were unable to work (before catheterization, 36 of 57 or 63 per cent); and 25 of 57 (44 per cent) still believed that they had heart disease (before catheterization, 45 of 57 or 79 per cent). Use of medical facilities was significantly reduced after catheterization (P<0.001). At follow-up the physician was more likely than the patient to believe that the symptoms had improved. We conclud...

369 citations

References
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Journal ArticleDOI
TL;DR: In documenting the wide distribution and severity of the arterial disease in patients with angina and abnormal electrocardiograms at rest and after exercise the reports parallel earlier views based on comparisons between clinical and morbid findings.
Abstract: CINE coronary arteriography affords a means of correlating clinical manifestations of coronary heart disease with responsible vascular abnormality in the living patient.1 2 3 4 5 Several of the comparative analyses have indicated that obstructing atherosclerosis can be demonstrated in at least 2 major coronary arteries in most patients with angina and abnormal electrocardiograms at rest and after exercise.1 2 3 4 In documenting the wide distribution and severity of the arterial disease in these patients the reports parallel earlier views based on comparisons between clinical and morbid findings.6 Obviously, the correlation does not hold when a significant anomaly of the coronary arteries, aortic regurgitation, aortic stenosis . . .

369 citations

Journal Article

205 citations


"Angina Without Coronary Disease (si..." refers background in this paper

  • ...such patients three etiologic considerations are (1) that myocardial ischemia is due to an abnormal affinity of hemoglobin for oxygen, the so-called stingy hemoglobin concept; (2) that myocardial ischemia is due to occlusive disease of the small coronary arteries; and (3) that the technic of coronary arteriography does not permit a definitive exclusion of conventional forms of coronary disease....

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Journal ArticleDOI
TL;DR: The clinical significance of pathology of the coronary arteries, including its possible role in a limited number of examples of angina pectoris, is discussed.
Abstract: Diseases which may damage and occlude small coronary arteries are reviewed with classification into three groups: embolic, inflammatory and noninflammatory. In the ventricular myocardium such diseases produce focal degeneration and fibrosis, ultimately leading to cardiac enlargement and failure. When the small arteries normally supplying the cardiac conduction system are involved, the consequences are arrhythmias, conduction disturbances, syncopal attacks and frequently sudden death. Many examples of obscure myocardiopathy may be due to hereditary medial necrosis of the small coronary arteries. The clinical significance of pathology of the coronary arteries, including its possible role in a limited number of examples of angina pectoris, is discussed.

180 citations