Possible causes of symptoms in suspected coronary heart disease but normal angiograms

Abstract

In patients with suspected coronary heart disease and normal angiograms, hypertension, neuromuscular disorders, tachycardiomyopathy, hypothyroidism, and hemochromatosis should be considered as possible causes.

Seroprevalence of Antibodies to Microorganisms Known To Cause Arterial and Myocardial Damage in Patients with or without Coronary Stenosis

“…In 48 of the 62 patients with normal coronary angiograms, one or more causes of cardiac symptoms could be assessed: arterial hypertension (n ϭ 44), hemochromatosis (n ϭ 2), hypothyroidism (n ϭ 3), tachycardiomyopathy (n ϭ 5), and neuromuscular disorder (n ϭ 7). In the remaining 14 patients with normal coronary angiograms, the cause of exertional dyspnea and anginal chest pain remained unknown (Table 1) (17). The seroprevalence of antibodies known to cause arterial and myocardial damage is listed on Table 3.…”

“…During this visit, patients with normal coronary angiograms underwent extensive investigations, including a medical history, physical examination, 12-lead electrocardiogram (ECG), transthoracic 2-D, M-mode and Doppler echocardiography, and blood tests (blood sedimentation rate, red and white blood cell counts, thrombocyte count, transferrin saturation, creatine kinase, ␥-glutamyl-transpeptidase, calcium, potassium, thyroid stimulating hormone, and analysis of the hemochromatosis gene mutations C282Y and H63D). Based on these investigations, possible causes of dyspnea and anginal chest pain were assessed according to predefined criteria (Table 1) (17). Patients with coronary heart disease underwent clinical examination and exercise testing 3 months after PTCA.…”

“…Therefore, a prospective study was carried out with patients with exertional dyspnea or anginal chest pain who underwent a coronary angiography because of suspected coronary heart disease based on pathologic findings on stress test, scintigraphy, and echocardiography. Aims of the study were (i) to compare the seroprevalence of specific antibodies to microorganisms known to cause arterial and myocardial damage between patients with normal angiograms and patients with coronary heart disease and (ii) to assess the seroprevalence of antibodies to microorganisms known to cause arterial and myocardial damage in patients with normal angiograms with regard to (a) possible causes of exertional dyspnoea and anginal chest pain, like arterial hypertension, hemochromatosis, hypothyroidism, hypoparathyroidism, tachycardiomyopathy, amyloidosis, and neuromuscular disorders, and (b) echocardiographic findings (17).…”

Panhypopituitarism Mimicking Acute Coronary Syndrome

“…An abnormal ST-T segment in hypothyroidism can indicate either depression, inversion, or elevation (18). Hypothyroidism is known to be a possible cause of symptoms in cases of suspected coronary heart disease with normal angiogram findings (19). Although the precise mechanism underlying the ST-T elevation in this case was unclear, hypothyroid is known to cause coronary endothelial dysfunction directly via an effect on the coronary vascular bed (20) or indirectly via low-grade inflammation (21) or by weakening the effect of the beta adrenergic hormone (22).…”

An atypical case of typical chest pain

“…Hypothyroid patients presenting with symptoms and ECG abnormalities suggestive of coronary artery disease have been described in several reports. Since hypothyroidism is shown to be a possible etiology in subjects with symptoms suggestive of ischemic heart disease and normal coronary angiograms [9], a thyroid hormone deficiency should always be considered in this setting.…”