Author + information
- Received February 9, 1990
- Revision received May 1, 1990
- Accepted May 15, 1990
- Published online November 15, 1990.
- Richard O. Cannon III, MD, FACC∗,1,
- Arshed A. Quyyumi, MD1,
- William H. Schenke, BA1,
- Lameh Fananapazir, MD1,
- Eben E. Tucker, MD1,
- Alexandra M. Gaughan, MA∗,
- Richard H. Gracely, PhD∗,
- Edward L. Cattau Jr., MD† and
- Stephen E. Epstein, MD, FACC1
- ↵∗Address for reprints: Richard O. Cannon III, MD, Building 10, Room 7B15, National Institutes of Health, Bethesda, Maryland 20892.
The causes of chest pain in patients found to have angiographically normal coronary arteries during cardiac catheterization remain controversial. Cardiac sensitivity to catheter manipulation, pacing at various stimulus intensities and intracoronary injection of contrast medium was examined in several groups of patients who underwent cardiac catheterization. Right heart (especially right ventricular) catheter manipulation and pacing and intracoronary contrast medium provoked chest pain typical of that previously experienced in 29 (81%) of 36 patients with chest pain and angiographically normal coronary arteries and 15 (46%) of 33 symptomatic patients with hypertrophic cardiomyopathy. In contrast, only 2 (6%) of 33 symptomatic patients with coronary artery disease experienced their typical chest pain with these sensitivity tests (p < 0.001). None of 10 patients with valvular heart disease but without a chest pain syndrome experienced any sensation with these tests.
Cutaneous pain threshold testing demonstrated that patients with chest pain and normal coronary arteries had a higher pain threshold to thermal stimulation compared with patients who had coronary artery disease or hypertrophic cardiomyopathy. No relation existed between cardiac sensitivity and cutaneous sensitivity testing.
Thus, patients who have chest pain despite angiographically normal coronary arteries may have abnormal cardiac sensitivity to a variety of stimuli. This increased sensitivity may be of causal importance to their chest pain syndrome or may contribute to their perception of ischemia-induced pain. The same phenomenon was also commonly seen in symptomatic patients with hypertrophic cardiomyopathy. Whether this phenomenon represents abnormal activation of pain receptors within the heart or abnormal processing of visceral afferent neural impulses in the peripheral or central nervous system is unknown.
- Received February 9, 1990.
- Revision received May 1, 1990.
- Accepted May 15, 1990.