Esophageal Abnormalities and “Linked-Angina” in Syndrome X
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.
KeywordsChest Pain Coronary Flow Reserve Coronary Blood Flow Lower Esophageal Sphincter Pressure Normal Coronary Artery
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