Advertisement

Esophageal Abnormalities and “Linked-Angina” in Syndrome X

  • Anoop Chauhan
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 213)

Abstract

Approximately 10–30% of patients undergoing coronary angiography for the investigation of chest pain have normal coronary arteries [1, 2, 3]. Patients with angina pectoris and normal coronary angiogram who also have a positive exercise test are often defined as “syndrome X”. The spectrum of current controversy regarding the pathophysiology of syndrome X is wide [4,5]. Many syndrome X patients have an abnormal coronary flow reserve (microvascular angina) which provides support for an ischemic basis for this syndrome. However, many patients also have esophageal dysfunction. Esophageal abnormalities, which have been commonly reported in patients with chest pain and normal coronary arteries [6, 7, 8], can cause symptoms that closely mimic the chest pain produced by coronary artery disease, due to the common innervation of the heart and the esophagus. This chapter will focus on the relationship between cardiac and esophageal chest pain. The content of this work will be based on a prospective study that we carried out to ascertain the relative prevalence of abnormalities of esophageal function (motility and reflux disorders) and coronary flow reserve in strictly characterized syndrome X patients.

Keywords

Chest Pain Coronary Flow Reserve Coronary Blood Flow Lower Esophageal Sphincter Pressure Normal Coronary Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Dart AM, Alban Davies H, Dalai J, Ruttley M, Henderson AH. “Angina” and normal coronary arteriograms: a follow-up study. Eur Heart J 1980; 1: 97–100.PubMedGoogle Scholar
  2. 2.
    Kemp HG, Vokonas PS, Cohn PF, Gorlin R. The anginal syndromes associated with normal coronary arteriograms: Report of a six year experience. Am J Med 1973; 54: 735–742.PubMedCrossRefGoogle Scholar
  3. 3.
    Kemp HG, Kronmal EA, Vlietsra RE, et al. Seven year survival of patients with normal or near normal coronary arteriograms: A CASS registry study. J Am Coll Cardiol 1986; 7: 479–483.PubMedCrossRefGoogle Scholar
  4. 4.
    Cannon RO, Camici PG, Epstein SE. Pathophysiological dilemma of syndrome X. Circulation 1992; 85: 883–892.PubMedCrossRefGoogle Scholar
  5. 5.
    Chauhan A. Syndrome X: Angina and Normal Coronary Angiography. Postgraduate Medical J 1995; 71: 341–345CrossRefGoogle Scholar
  6. 6.
    DeMeester TR, O’Sullivan GC, Bermudez G, et al. Esophageal function in patients with angina-type chest pain and normal coronary angiograms. Ann Surg 1982; 196: 488–498.PubMedCrossRefGoogle Scholar
  7. 7.
    Schofield PM, Brooks NH, Colgan S, et al. Left ventricular function and esophageal function in patients with angina pectoris and normal coronary angiograms. Br Heart J 1987; 58: 218–214.PubMedCrossRefGoogle Scholar
  8. 8.
    Brand DC, Martin D, Pope C. Esophageal manometrics in patients with angina-like chest pain. Dig Dis Sci 1977; 22: 300–304.CrossRefGoogle Scholar
  9. 9.
    Chauhan A, Petch MC, Schofield PM. Esophageal stimulation can affect coronary blood flow. Lancet 1993; 341: 1309–1310.PubMedCrossRefGoogle Scholar
  10. 10.
    Chauhan A, Mullins PA, Petch MC, Schofield PM. Is coronary flow reserve in response to papaverine really normal in syndrome X? Circulation 1994; 89: 1998–2004.PubMedCrossRefGoogle Scholar
  11. 11.
    Richter JE, Bradley LA, DeMeester TR, Wu WC. Normal 24 hour ambulatory esophageal pH values. Influence of study center, pH electrode, age, and gender. Dig Dis Sci 1992; 37: 849–56.PubMedCrossRefGoogle Scholar
  12. 12.
    Johnson LF, DeMeester TR. Twenty-four hour pH monitoring of the distal esophagus: A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 1974; 62: 325–332.PubMedGoogle Scholar
  13. 13.
    Smith KS, Papp C. Episodic, postural and linked angina. Br Med J 1962; ii: 1425–30.CrossRefGoogle Scholar
  14. 14.
    Evans W. Faults in the diagnosis of cardiac pain. Br Med J 1959; 1: 249–254.PubMedCrossRefGoogle Scholar
  15. 15.
    Dart AM, Alban Davies H, Lowndes RH, Dalai J, Ruttley M, Henderson AH. Esophageal spasm and angina: diagnostic value of ergometrine provocation. Eur Heart J 1980; 1; 91–95.PubMedGoogle Scholar
  16. 16.
    Koch KL, Curry RC, Feldman RL, et al. Ergonovine induced esophageal spasm in patients with chest pain resembling angina pectoris. Dig Dis Sci 1982; 27: 1073–1080.PubMedCrossRefGoogle Scholar
  17. 17.
    Bexton JR, Nathan AW, Hellestrand KJ, Camm AJ. Paroxysmal atrial tachycardia provoked by swallowing. Br Med J 1981; 282: 952CrossRefGoogle Scholar
  18. 18.
    Serebro HA. The prognostic significance of the viscerocardiac reflex phenomenon. S Afr Med J 1976; 50: 769–772.PubMedGoogle Scholar
  19. 19.
    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.PubMedGoogle Scholar
  20. 20.
    Bennett JR, Atkinson M. Esophageal acid perfusion in the diagnosis of precordial pain. Lancet 1966; ii: 1150–1152.CrossRefGoogle Scholar
  21. 21.
    Morrison LM, Swaim WA. Role of the gastrointestinal tract in production of cardiac symptoms. JAMA 1940; 114: 217–223.CrossRefGoogle Scholar
  22. 22.
    Alban Davies II, Page Z, Rush EM, Brown EM, Lewis MJ, Petch MC. Esophageal stimulation lowers exertional angina threshold. Lancet 1985; i: 1011–14.CrossRefGoogle Scholar
  23. 23.
    Kenigsberg K, Griswold PG, Buckley B, Gootman N, Gootman P. Cardiac effects of esophageal stimulation: Possible relationship between gastroesophageal reflux (GER) and Sudden Infant Death Syndrome (SIDS). J Paed Surg 1983; 18: 542–545.CrossRefGoogle Scholar
  24. 24.
    Fontan JP, Heldt GP, Heyman MB, Marin MS, Tooley WH. Esophageal spasm associated with apnoea and bradycardia in an infant. J Pediatr 1984; 73: 52–55.Google Scholar
  25. 25.
    Herbst JJ, Minton SD, Book LS. Gastroesophageal reflux causing respiratory distress and apnea in newborn infants. J Pediatr 1979; 95: 763.PubMedCrossRefGoogle Scholar
  26. 26.
    Bortolotti M, Cirignotta F, Labo G. Atrioventricular block induced by swallowing in a patient with diffuse esophageal spasm. JAMA 1982; 248: 2297–2299.PubMedCrossRefGoogle Scholar
  27. 27.
    Von Bergmann G. Das “epiphrenale Syndrome”, Seine Beziehung zur Angina Pectoris and zum Kardiospasms. Deutch Med Wschr 1932;58: 605–09CrossRefGoogle Scholar
  28. 28.
    Gilbert NC, LeRoy GV, Fenn GK. The effect of distension of abdominal viscera on the blood flow in the circumflex branch of the left coronary artery of the dog. Am Heart J 1940; 20: 519–24.CrossRefGoogle Scholar
  29. 29.
    Wilson RF, Laxson DD, Lesser JR, White CW. Intense microvascular constriction after angioplasty of acute thrombotic coronary arterial lesions. Lancet 1989; i: 807–11.CrossRefGoogle Scholar
  30. 30.
    Pupita G, Maseri A, Kaski JC, et al. Myocardial ischemia caused by distal coronary artery constriction in stable angina pectoris. N Eng J Med 1990; 323: 514–20.CrossRefGoogle Scholar
  31. 31.
    Clarke JG, Davies GJ, Kerwin R, et al. Coronary artery infusion of neuropeptide Y in patients with angina pectoris. Lancet 1987; 1: 1057–59.PubMedCrossRefGoogle Scholar
  32. 32.
    Larkin SW, Clarke JG, Keogh BE, et al. Intracoronary endothelin induces myocardial ischemia by small vessel constriction in the dog. Am J Cardiol 1989; 64: 956–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Chauhan A, Mullins P, Taylor G, Petch MC, Schofield PM. The effect of hyperventilation and mental stress on coronary blood flow in Syndrome X patients. British Heart Journal 1993; 69(6): 516–524.PubMedCrossRefGoogle Scholar
  34. 34.
    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: 1242–1247.PubMedCrossRefGoogle Scholar
  35. 35.
    Cannon RO, Cattau EL, Yakshe PN, et al. Coronary flow reserve, esophageal motility, and chest pain in patients with angiographically normal coronary arteries. Am J Cardiol 1990; 88: 217–222.Google Scholar
  36. 36.
    Chauhan A, Mullins PA, Gill R, Taylor G, Petch MC, Schofield PM. Esophageal dysfunction and coronary flow reserve in syndrome X. Postgraduate Medical J 1996;72:99–104.CrossRefGoogle Scholar
  37. 37.
    Cannon RO, Quyyumi AA, Schenke WH et al. Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. J Am Coll Cardiol 1990; 16: 1359–1366.PubMedCrossRefGoogle Scholar
  38. 38.
    Chauhan A, Mullins PA, Thuraisingham SI, Taylor G, Petch MC, Schofield PM. Abnormal cardiac pain perception in syndrome X. J Am Coll Cardiol 1994; 24: 329–335.PubMedCrossRefGoogle Scholar
  39. 39.
    Rosano GMC, Ponikowski P, Adamopoulos S, Collins P, Poole-Wilson PA, Coats A, Kaski JC. Abnormal autonomic control of the cardiovascular system in syndrome X. Am J Cardiol 1994; 73: 1174–1179.PubMedCrossRefGoogle Scholar
  40. 40.
    Dean JD, Jones CJ, Hutchison SJ, Peters JR, Henderson AH. Hyperinsulinaemia and microvascular angina (“syndrome X”). Lancet 1991; 337: 456–457.PubMedCrossRefGoogle Scholar
  41. 41.
    Chauhan A, Foote J, Petch MC, Schofield PM. Hyperinsulinaemia, coronary artery disease and syndrome X. J Am Coll Cardiol 1994; 23: 364–368.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Anoop Chauhan

There are no affiliations available

Personalised recommendations