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Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 213))

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Abstract

Several pathophysiological explanations have been suggested for the pains in patients with angina pectoris despite normal coronary angiograms and without any specific cardiac, esophageal, musculo-skeletal, or psychiatric disorders. There are many clues indicating that this anginal syndrome is in fact many different syndromes giving rise to a similar symptomatology. However, a general abnormality of nociception could incorporate many of the results from previous studies [1].

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References

  1. Cannon RO, Benjamin SB. Chest pain as a consequence of abnormal visceral nociception. Dig Dis Sci 1993;38:193–6.

    Article  PubMed  Google Scholar 

  2. Melzack R. The puzzle of pain. Harmondsworth: Penguin; 1973.

    Google Scholar 

  3. Procacci P, Maresca M. Clinical aspects of heart pain. Advances in Pain Research and Therapy 1987;10:127–33.

    Google Scholar 

  4. Cervero F, Vecchiet L, Albe-Fessard D, Lindblom U, Giamberadino MA, editors.New trends in referred pain and hyperalgesia. Elsevier Science Publishers B.V. 1993; 4, Pathophysiology of referred pain and hyperalgesia from viscera. p. 35–46.

    Google Scholar 

  5. Malliani A, Lombardi F. Consideration of the fundamental mechanisms eliciting cardiac pain. Am Heart.1 1982;103:575–8.

    Article  CAS  Google Scholar 

  6. Ness TJ, Gebhart GF. Visceral pain: a review of experimental studies. Pain 1990;41:167–234.

    Article  PubMed  CAS  Google Scholar 

  7. Rosen SD, Paulesu E, Frith CD, Frackowiak RSJ, Davies GJ, Jones T, Camici PG. Central nervous pathways mediating angina pectoris. Lancet 1994;344:147–50.

    Article  PubMed  CAS  Google Scholar 

  8. Shapiro LM, Crake T, Poole Wilson PA. Is altered cardiac sensation responsible for chest pain in patients with normal coronary arteries? Clinical observation during cardiac catheterization. Br Med J Clin Res Ed 1988;296:170–1.

    Article  PubMed  CAS  Google Scholar 

  9. Cannon RO, Quyyumi AA, Schenke WH, Fananapazir L, Tucker EE, Gaughan AM, Gracely RH, Cattau EL, Epstein SE. Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. JACC 1990;16:1359–66.

    PubMed  Google Scholar 

  10. Chauhan A, Mullins PA, Thuraisingham SI, Taylor G, Petch MC, Schofield PM. Abnormal cardiac pain perception in syndrome X. JACC 1994;24:329–35.

    PubMed  CAS  Google Scholar 

  11. Sylven C, Beermann B, Jonzon B, Brandt R. Angina pectoris-like pain provoked by intravenous adenosine in healthy volunteers. Br Med J Clin Res Ed 1986;293:227–30.

    Article  PubMed  CAS  Google Scholar 

  12. Lagerqvist B, Sylven C, Beermann B, Helmius G, Waldenstrom A. Intracoronary adenosine causes angina pectoris like pain - an inquiry into the nature of visceral pain. Cardiovasc Res 1990;24:609–13.

    Article  PubMed  CAS  Google Scholar 

  13. Lagerqvist B, Sylven C, Waldenstrom A. Lower threshold for adenosine-induced chest pain in patients with angina and normal coronary angiograms. Br Heart J 1992;68:282–5.

    Article  PubMed  CAS  Google Scholar 

  14. Rosen SD, Uren NG, Kaski JC, Tousoulis D, Davies GJ, Camici PG. Coronary vaodilator reserve, pain perception, and sex in patients with syndrome X. Circulation 1994;90:50–60.

    Article  PubMed  CAS  Google Scholar 

  15. De-Caestecker JS, Blackwell JN, Brown J, Heading RC. The esophagus as a cause of recurrent chest pain: which patients should be investigated and which tests should be used? Lancet 1985;2:1143–6.

    Article  PubMed  CAS  Google Scholar 

  16. Brand DL, Martin D, Pope II CE. Esophageal manometrics in patients with angina-like chest pain. Digestive Diseases 1977;22:300–4.

    CAS  Google Scholar 

  17. Janssens J, Vantrappen G, Ghillebert G. 24-hour recording of esophageal pressure and pH in patients with noncardiac chest pain. Gastroenterology 1986;90:1978–84.

    PubMed  CAS  Google Scholar 

  18. Lam HG, Dekker W, Kan G, Breedijk M, Smout AJ. Acute noncardiac chest pain in a coronary care unit. Evaluation by 24-hour pressure and pH recording of the esophagus. Gastroenterology 1992;102:453–60.

    PubMed  CAS  Google Scholar 

  19. Peters L, Maas L, Petty D, Dalton C, Penner D, Wu W, Castell DO, Richter J. Spontaneous noncardiac chest pain. Evaluation by 24-hour ambulatory esophageal motility and pH monitoring. Gastroenterology 1988;94:878–86.

    PubMed  CAS  Google Scholar 

  20. Cohen S. Noncardiac chest pain. The crumbling of the sphinx. Dig Dis Sci 1989;34:1649–50.

    Article  PubMed  CAS  Google Scholar 

  21. Frøbert O, Funch-Jensen P, Jacobsen NO, Kruse A, Bagger JP. Upper endoscopy in patients with angina and normal coronary angiograms. Endoscopy 1995;27:365–70.

    Article  PubMed  Google Scholar 

  22. Frøbert O, Funch-Jensen P, Bagger JP. Diagnostic value of esophageal studies in patients with angina-like chest pain and normal coronary angiograms. Ann Intern med 1996;11:959–69.

    Google Scholar 

  23. Hewson EG, Sinclair JW, Dalton CB, Wu WC, Castell DO, Richter JE. Acid perfusion test: does it have a role in the assessment of non cardiac chest pain? Gut 1989;30:305–10.

    Article  PubMed  CAS  Google Scholar 

  24. Hewson EG, Dalton CB, Richter JE. Comparison of esophageal manometry, provocative testing, and ambulatory monitoring in patients with unexplained chest pain. Dig Dis Sci 1990;35:302–9.

    Article  PubMed  CAS  Google Scholar 

  25. De-Caestecker JS, Pryde A, Heading RC. Comparison of intravenous edrophonium and esophageal acid perfusion during esophageal manometry in patients with non-cardiac chest pain. Gut 1988;29:1029–34.

    Article  PubMed  CAS  Google Scholar 

  26. Cannon RO, Cattau ELJ, Yakshe PN, Maher K, Schenke WH, Benjamin SB, Epstein SE. Coronary flow reserve, esophageal motility, and chest pain in patients with angiographically normal coronary arteries. Am J Med 1990;88:217–22.

    Article  PubMed  Google Scholar 

  27. Nevens F, Janssens J, Piessens J, Ghillebert G, De Geest H, Vantrappen G. Prospective study on prevalence of esophageal chest pain in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia. Dig Dis Sci 1991;36:229–35.

    Article  PubMed  CAS  Google Scholar 

  28. Ghillebert G, Janssens J, Vantrappen G, Nevens F, Piessens J. Ambulatory 24 hour intraesophageal pH and pressure recordings v provocation tests in the diagnosis of chest pain of esophageal origin. Gut 1990;31:738–44.

    Article  PubMed  CAS  Google Scholar 

  29. Soffer EE, Scalabrini P, Wingate DL. Spontaneous noncardiac chest pain: value of ambulatory esophageal pH and motility monitoring. Dig Dis Sci 1989;34:1651–5.

    Article  PubMed  CAS  Google Scholar 

  30. Mellow MH, Simpson AG, Watt L, Schoolmeester L, Haye OL. Esophageal acid perfusion in coronary artery disease. Induction of myocardial ischemia. Gastroenterology 1983;85:306–12.

    PubMed  CAS  Google Scholar 

  31. Chauhan A, Petch MC, Schofield PM. Effect of esophageal acid instillation on coronary blood flow. Lancet 1993;341:1309–10.

    Article  PubMed  CAS  Google Scholar 

  32. Schofield PM, Whorwell PJ, Brooks NH, Bennett DH, Jones PE. Esophageal function in patients with angina pectoris: a comparison of patients with normal coronary angiograms and patients with coronary artery disease. Digestion 1989;42:70–8.

    Article  PubMed  CAS  Google Scholar 

  33. Breumelhof R, Nadorp JH, Akkermans LM, Smout AJ. Analysis of 24-hour esophageal pressure and pH data in unselected patients with noncardiac chest pain. Gastroenterology 1990;99:1257–64.

    PubMed  CAS  Google Scholar 

  34. Richter JE, Hackshaw BT, Wu WC, Castell DO. Edrophonium: a useful provocative test for esophageal chest pain. Ann Intern med 1985;103:14–21.

    PubMed  CAS  Google Scholar 

  35. Limburg M, Beekhuis H, Van Dijk RB, Kleibeuker JH. Noncardiac chest pain: Is the esophagus really a frequent source? Scand J Gastroent 1990;25:793–8.

    Article  PubMed  CAS  Google Scholar 

  36. Gayheart PA, Gwirtz PA, Bravenec JS, Longlet N, Jones CE. An alpha-adrenergic coronary constriction during esophageal distention in the dog. J Cardiovasc Pharmacol 1991;17:747–53.

    Article  PubMed  CAS  Google Scholar 

  37. Frobert O, Arendt-Nielsen L, Bak P, Funch-Jensen P, Bagger JP. Pain perception and brain evoked potentials in patients with angina despite normal coronary angiograms. Heart 1996;75:436–41.

    Article  PubMed  CAS  Google Scholar 

  38. Chudler EH, Dong WK. The assessment of pain by cerebral evoked potentials. Pain 1983;16:221–44.

    Article  PubMed  CAS  Google Scholar 

  39. Frobert O, Arendt-Nielsen L, Bak P, Andersen OK, Funch-Jensen P, Bagger JP. Electrical stimulation of the esophageal mucosa: Perception and brain evoked potentials. Scand J Gastroenterol 1994;29:776–81.

    Article  PubMed  CAS  Google Scholar 

  40. Nachlas IW. Pseudo-angina pectoris originating in the cervical spine. JAMA 1934;103:323–5.

    Article  Google Scholar 

  41. Allison DR. Pain in the chest wall simulating heart disease. Br Med J 1950;1:332–6.

    Article  PubMed  CAS  Google Scholar 

  42. Davis D, Ritvo M. Osteoarthritis of the cervicodorsal spine (radiculitis) simulating coronary-artery disease. Clinical and roentgenologic findings. N Engl J Med 1948;238:857–66.

    Article  PubMed  CAS  Google Scholar 

  43. Arroyo JF, Jolliet P, Junod AF. Costovertebral joint dysfunction: another misdiagnosed cause of atypical chest pain. Postgrad Med J 1992;68:655–9.

    Article  PubMed  CAS  Google Scholar 

  44. Wolf E, Stem S. Costostemal syndrome: its frequency and importance in differential diagnosis of coronary heart disease. Arch Intern Med 1976;136:189–91.

    Article  PubMed  CAS  Google Scholar 

  45. Travell J, Rinzler SH. The myofascial genesis of pain. Postgraduate Medicine 1952;11:425–34.

    PubMed  CAS  Google Scholar 

  46. Epstein SE, Gerber LH, Borer JS. Chest wall syndrome. A common cause of unexplained chest pain. JAMA 1979;241:2793–7.

    Article  PubMed  CAS  Google Scholar 

  47. Wise CM, Semble EL, Dalton CB. Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: a study of 100 patients. Arch Phys Med Rehabil 1992;73:147–9.

    PubMed  CAS  Google Scholar 

  48. Turiel M, Galassi AR, Glazier JJ, Kaski JC, Maseri A. Pain threshold and tolerance in women with syndrome X and women with stable angina pectoris. Am J Cardiol 1987;60:503–7.

    Article  PubMed  CAS  Google Scholar 

  49. Sampson JJ, Cheitlin MD. Pathophysiology and differential diagnosis of cardiac pain. Progr Card Dis 1971;13:507–31.

    Article  CAS  Google Scholar 

  50. Frøbert O, Mølgaard H, Bøcker HE, Bagger JP. Autonomic balance in patients with angina and normal coronary angiogram. Eur Heart J 1995;16:1356–60.

    PubMed  Google Scholar 

  51. Arendt-Nielsen L, Drewes AM, Hansen JB, Tage-Jensen U. Gut pain reactions in man: an experimental investigation using short and long duration transmucosal electrical stimulation. Pain 1997;69:255–62.

    Article  PubMed  CAS  Google Scholar 

  52. Eliasson T, Albertsson P, Hardhammar P, Emanuelsson H, Augustinsson LE, Mannheimer C. Spinal cord stimulation in angina pectoris with normal coronary arteriograms. Coron Artery Dis 1993;4:819–27.

    Article  PubMed  CAS  Google Scholar 

  53. Kaski JC, Crea F, Nihoyannopoulos P, Hackett D, Maseri A. Transient myocardial ischemia during daily life in patients with syndrome X. Am J Cardiol 1986;58:1242–7.

    Article  PubMed  CAS  Google Scholar 

  54. Levy RD, Shapiro LM, Wright C, Mockus L, Fox KM. Syndrome X: the hemodynamic significance of ST segment depression. Br Heart J 1986;56:353–7.

    Article  PubMed  CAS  Google Scholar 

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Frøbert, O., Arendt-Nielsen, L., Bagger, J.P. (1999). Abnormal Pain Processing in Syndrome X. In: Kaski, J.C. (eds) Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management. Developments in Cardiovascular Medicine, vol 213. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5181-2_5

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  • DOI: https://doi.org/10.1007/978-1-4615-5181-2_5

  • Publisher Name: Springer, Boston, MA

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