Persistent Chest Pain and No Obstructive Coronary Artery Disease

Phan, Anita; Shufelt, Chrisandra; Merz, C. Noel Bairey

doi:10.1001/jama.2009.425

Cited by 69 publications

(44 citation statements)

References 50 publications

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“…At the same time, an attenuated increase or a decrease in coronary blood flow (CBF) in response to endothelial-dependent vasodilators such as acetylcholine or substance P denotes an impairment in microvascular endothelial-dependent CFR, also known as microvessel "endothelial dysfunction" (9)(10)(11)(12)(13). These coronary microvascular abnormalities are functionally meaningful, as they mediate ischemia and cause angina in patients with obstructed and angiographically unobstructed coronary arteries (14,15). This "microvascular angina" often resembles classical stable angina caused by physiologically significant narrowing of epicardial vessels.…”

mentioning

confidence: 99%

Prevalence of Coronary Microvascular Dysfunction Among Patients With Chest Pain and Nonobstructive Coronary Artery Disease

Sara

Widmer

Matsuzawa

et al. 2015

JACC: Cardiovascular Interventions

427

315

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mentioning

confidence: 99%

Prevalence of Coronary Microvascular Dysfunction Among Patients With Chest Pain and Nonobstructive Coronary Artery Disease

Sara

Widmer

Matsuzawa

et al. 2015

JACC: Cardiovascular Interventions

427

315

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“…For this special CAD group, significantly higher psychological scores on indices of anxiety and depression compared with patients with chest pain and angiographically proven CAD have been found in previous studies (32). In addition to obtaining endoscopic and/or pH monitoring evidence of GERD, further investigation of factors such as depression and anxiety disorders has been suggested (33). We plan to investigate this CAD group in our next study.…”

Section: Mehta Et Al Investigated Only 24 Patients (24)mentioning

confidence: 71%

Acid Reflux in Patients with Coronary Artery Disease and Refractory Chest Pain

Liu

Chen

et al. 2013

Intern. Med.

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Objective To investigate the influence of acid reflux on chest pain and ischemic events and the effects of cardiac drugs on acid reflux in patients with coronary artery disease (CAD) and refractory chest pain. Methods Simultaneous 24-hour esophageal pH monitoring and 24-hour continuous electrocardiogram (ECG) (Holter) results were obtained for 64 patients. Ischemic events and cardiac drug prescriptions were compared between the patients with and without gastroesophageal reflux disease (GERD). Patients fulfilling the GERD criteria received 14-day therapy with omeprazole at a dose of 20 mg bid. The results of the 24-hour pH monitoring, Holter and the SF-36 questionnaire were compared before treatment and again after two weeks of therapy. Results GERD was identified in 38 (69%) patients, with 49% of all chest pain occurring in association with acid reflux. A higher incidence (p=0.033) and longer duration (p=0.040) of ischemic events were observed in the GERD (+) patients. More frequent combined use of cardiac drugs was found in the GERD (+) patients. However, fewer ischemic events and greater total SF-36 survey scores were noted after PPI therapy in the GERD (+) patients. Conclusion Acid reflux is common in patients with CAD and refractory chest pain. Refractory chest pain in patients with CAD can be partially noncardiac chest pain (NCCP) secondary to acid reflux. The combined use of common cardiac drugs may predispose or aggravate GERD. Short-term proton pump inhibitor (PPI) therapy not only restores a normal esophageal pH, but also significantly improves the general health-related quality of life (HRQL) of patients.

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“…One challenging scenario that often stumps clinicians occurs in a patient with typical anginal chest pain and objective evidence of myocardial ischemia who has a normal coronary arteriogram. 18,19 Rarefaction of skin capillaries has been reported in these individuals 18 ; further studies potentially using IHDVPS are needed to determine whether cardiac capillary rarefaction accounts for these unexplained reductions in myocardial blood flow.…”

Section: Capillary Rarefactionmentioning

confidence: 99%