Author + information
- Received October 12, 1993
- Revision received February 7, 1994
- Accepted March 16, 1994
- Published online August 1, 1994.
- Anoop Chauhan, MD, MRCP∗,1,
- Paul A. Mullins, MRCP,
- Surin I. Thuraisingham, MRCP,
- Gerard Taylor,
- Michael C. Petch, MD, FACC and
- Peter M. Schofield, MD, FACC
- ↵∗Address for correspondence: Dr. A. Chauhan, Regional Cardiac Unit, Papworth Hospital, Cambridge, CB3 8RE, England, United Kingdom.
Objectives. The purpose of this study was to determine whether a diminished cardiac pain threshold contributes to chest pain in patients with syndrome X.
Background. There have been some reports of an altered pain perception in syndrome X.
Methods. Intracardiac catheter manipulation was performed in four groups of patients (syndrome X [group 1, 36 patients]; mitral valve disease and normal coronary arteries [group 2, 36 patients]; mitral valve disease and coronary artery disease [group 3, 36 patients]; and heart transplant recipients with normal coronary arteries [group 4, 36 patients]). Coronary flow was measured in patients with syndrome X and in transplant recipients by use of an intracoronary Doppler catheter positioned in the left anterior descending coronary artery at intracardiac catheter manipulation. Coronary flow reserve in response to papverine was also measured in patients with syndrome X and in transplant recipients.
Results. Intracardiac stimulation produced typical anginal chest pain in 34 group 1 (syndrome X) patients (94%). However, chest was produced only in five patients (14%) in group 2, seven patients (19%) in group 3 and no patients in group 4. There were no significant changes in coronary blood flow velocity associated with chest pain in group 1 patients. Coronary flow reserve in response to a hyperemic dose of intracoronary papaverine was significantly lower in the syndrome X group. There was no significant difference in the prevalence with which the stimulation tests produced chest in patients with syndrome X with an impaired coronary flow reserve or a positive radionuclide scan.
Conclusions. The results of our study suggest that abnormal cardiac pain perception is a fundamental abnormality in syndrome X.
- Received October 12, 1993.
- Revision received February 7, 1994.
- Accepted March 16, 1994.