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Leite WF, dos Santos Povoa RM, Caixeta AM, Amodeo C, Szarf G, Bombig MTN, Izar MCO, Gioia LN, Ribeiro WN, Fonseca FAH. Chest Pain in Acute Myocardial Infarction and Its Association With the Culprit Artery and Fibrotic Segment Identified by Cardiac Magnetic Resonance. Cardiol Res 2023; 14:97-105. [PMID: 37091885 PMCID: PMC10116939 DOI: 10.14740/cr1468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/18/2023] [Indexed: 04/25/2023] Open
Abstract
Background It is still very controversial whether the characteristics of pain in the acute myocardial infarction could be related to the culprit coronary artery. There are no data about associations of pain with the ST-segment elevation myocardial infarction (STEMI) and left ventricular (LV) fibrotic segments. Methods Data from 328 participants who had STEMI and were included in the B and T Types of Lymphocytes Evaluation in Acute Myocardial Infarction (BATTLE-AMI) study were analyzed. The culprit artery was identified by coronary angiography and the injured myocardial segments by cardiac magnetic resonance. The statistical significance was established by P value < 0.05. Results A total of 223 patients (68%) were selected. Association was not observed between chest pain and the culprit artery (P = 0.237), as well as between pain irradiation and the culprit artery (P = 0.473). No significant difference was observed in the pain localization in relation to the segments in the short axis basal, mid, apical, and long axis, except for the mid inferior segment. The data were not considered clinically relevant because this association was observed in only one of 17 segments after multiple comparisons. Conclusions In patients with STEMI, no associations were observed between the location or irradiation of acute chest pain and/or adjacent areas and the culprit artery, or between pain and segmental myocardial fibrosis in the LV.
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Affiliation(s)
- Weverton Ferreira Leite
- Department of Hypertensive Heart Disease, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, SP, Brazil
- Corresponding Author: Weverton Ferreira Leite, Department of Hypertensive Heart Disease, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Paraiso, Sao Paulo - SP, CEP 01321-000, Brazil.
| | - Rui Manuel dos Santos Povoa
- Department of Hypertensive Heart Disease, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, SP, Brazil
| | - Adriano Mendes Caixeta
- Department of Hemodynamics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, SP, Brazil
| | - Celso Amodeo
- Department of Hypertensive Heart Disease, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, SP, Brazil
| | - Gilberto Szarf
- Department of Magnetic Resonance, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, SP, Brazil
| | - Maria Teresa Nogueira Bombig
- Department of Hypertensive Heart Disease, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, SP, Brazil
| | - Maria Cristina Oliveira Izar
- Department of Lipids, Atherosclerosis and Vascular Biology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, SP, Brazil
| | | | - Wilma Noia Ribeiro
- Department of Coronary Artery Disease, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, SP, Brazil
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Lowenstern A, Alexander KP, Pagidipati NJ, Hill CL, Pellikka PA, Cooper LS, Alhanti B, Hoffmann U, Mark DB, Douglas PS. Presenting Symptoms in Patients Undergoing Coronary Artery Disease Evaluation: Association With Noninvasive Test Results and Clinical Outcomes in the PROMISE Trial. Circ Cardiovasc Qual Outcomes 2022; 15:e008298. [PMID: 35369715 PMCID: PMC9117448 DOI: 10.1161/circoutcomes.121.008298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients evaluated for coronary artery disease have a range of symptoms and underlying risk. The relationships between patient-described symptoms, clinician conclusions, and subsequent clinical management and outcomes remain incompletely described. METHODS In this secondary analysis, we examined the association between 4 types of presenting symptoms (substernal/left-sided chest pain, other chest/neck/arm pain, dyspnea, and other symptoms) and patient risk, noninvasive test results, clinical management, and outcomes for stable outpatients randomized in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial. Multivariable regression models were used to evaluate differences in noninvasive test result, all-cause death/myocardial infarction/unstable angina hospitalization and cardiovascular death/myocardial infarction by symptom type. RESULTS Among 9996 patients, most presented with chest pain (47.2% substernal, 29.2% other), followed by dyspnea (14.9%), and other symptoms (8.7%). Patients with dyspnea were older (median age 63 versus 60, P≤0.02) with higher baseline risk (78.2% with atherosclerotic cardiovascular disease >7.5% versus 67.6%, P≤0.02). Using patients with substernal chest pain as a reference, there was no difference in noninvasive test positivity across symptom groups (all P>0.05), but test-positive patients with dyspnea (adjusted odds ratio, 0.66 [95% CI, 0.51-0.85]) or other symptoms (adjusted odds ratio, 0.65 [95% CI, 0.47-0.90]) were less likely to be referred for cardiac catheterization. While symptom type alone was not associated with outcomes, symptom presentation with chest pain or dyspnea did modify the association between a positive noninvasive test and clinical outcome (interaction P=0.025 for both all-cause death/myocardial infarction/unstable angina hospitalization and cardiovascular death/MI). CONCLUSIONS Among low-risk outpatients evaluated for coronary artery disease, typicality of symptoms was not closely associated with higher baseline risk but was related to differences in processes of care and the prognostic value of a positive test. Adverse events were not associated with clinician risk estimates or symptoms alone. These unexpected findings highlight the limitation of relying solely on symptom presentation or clinician risk estimation to evaluate patients for suspected coronary artery disease. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01174550.
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Affiliation(s)
- Angela Lowenstern
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.).,Vanderbilt University Medical Center (A.L.)
| | - Karen P Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - Neha J Pagidipati
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - C Larry Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
| | | | - Lawton S Cooper
- National Heart, Lung, and Blood Institute, Bethesda, MD (L.S.C.)
| | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - Udo Hoffmann
- Massachusetts General Hospital, Harvard Medical School, Boston (U.H.)
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.L., K.P.A., N.J.P., C.L.H., B.A., D.B.M., P.S.D.)
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Shimada T, Ishibashi Y, Murakami Y, Sano K, Tsukihashi H, Okada S, Kawakami K, Murakami R. Myocardial ischemia due to vasospasm of small coronary arteries detected by methylergometrine maleate stress myocardial scintigraphy. Clin Cardiol 2009; 22:795-802. [PMID: 10626082 PMCID: PMC6655961 DOI: 10.1002/clc.4960221208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Recently, several case reports have implicated vasospasm of small coronary arteries in vasospastic angina pectoris. Vasospasm of small coronary arteries was also considered from angiographic findings in patients with atypical chest pain. In Syrian hamster, vasospasm in small coronary arteries was considered to be the cause of dilated cardiomyopathy. HYPOTHESIS This study was undertaken to determine whether vasospasm in small coronary arteries can be induced by methylergometrine maleate stress thallium-201 (201Tl) myocardial scintigraphy. METHODS Twenty-five patients with chest pain, all of whom had intact coronary arteries, were studied. After intracoronary methylergometrine maleate injection, coronary arteriograms also looked normal in all cases. Thallium-201 myocardial scintigraphy was carried out immediately after intracoronary methylergometrine maleate injection in four patients with chest pain. In the remaining 21 patients with chest pain, methylergometrine maleate was given intravenously within up to 2 weeks before 201Tl myocardial scintigraphy. RESULTS In the intracoronary injection study, one patient had chest discomfort after methylergometrine maleate injection, and ST-segment elevation was observed on electrocardiogram (ECG). Of the 21 patients with chest pain, 11 patients felt angina-like chest pain after intravenous injection of methylergometrine maleate, but their ECGs showed no ischemic changes. Stress 201Tl myocardial scintigrams showed methylergometrine maleate-induced perfusion defects with complete redistribution in 3 of 4 patients in the intracoronary injection study and in 12 of 21 patients in the intravenous injection study. These findings suggest that vasospasm in small coronary arteries caused myocardial ischemia in 15 of 25 patients (60%) with chest pain. CONCLUSION Vasospasm in small coronary arteries may be involved in the myocardial ischemia of some patients with chest pain who do not show any large coronary artery vasospasm.
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Affiliation(s)
- T Shimada
- Department of Internal Medicine, Shimane Medical University, Japan
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Abstract
OBJECTIVE To describe factors influencing chest pain expression in patients with cardiac or noncardiac disease. METHODS The authors conducted a case presentation and review of literature. RESULTS Causes of chest pain are diverse. Psychologic factors influence chest pain expression commonly in patients with or without cardiac disease. CONCLUSIONS Physicians and other therapists must be aware of psychologic influences on chest pain expression to provide optimal treatment to their patients.
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Affiliation(s)
- David S Sheps
- University of Florida and the Malcom Randall VA Medical Center, P.O. Box 100181, Gainesville, FL 100181-0181, USA.
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Kodama-Takahashi K, Ohshima K, Yamamoto K, Iwata T, Hamada M, Hiwada K, Murakami E. Occurrence of transient U-wave inversion during vasospastic anginal attack is not related to the direction of concurrent ST-segment shift. Chest 2002; 122:535-41. [PMID: 12171828 DOI: 10.1378/chest.122.2.535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES We sought to assess the incidence of transient U-wave inversion during vasospasm of the left anterior descending coronary artery (LAD) with ST-segment depression as opposed to that with ST-segment elevation. DESIGN Retrospective study. SETTING Cardiology division of acute-care hospitals. PATIENTS We studied 49 patients with vasospastic angina whose vasospasm was induced in the LAD, not in the left circumflex coronary artery, by intracoronary injection of acetylcholine. MEASUREMENTS AND RESULTS The ECG traces obtained during acetylcholine-induced vasospasm of the LAD were examined. Based on the direction of ST-segment shift, the patients were categorized into two groups: the ST-segment elevation group (n = 27) and the depression group (n = 22). There were no differences in age, gender, or cardiovascular risk factors between the two groups. The distribution of the spastic site in the LAD was also similar. A total reduction in luminal diameter during a provoked attack was more often observed in the ST-segment elevation group than in the ST-segment depression group (37% vs 9%, p = 0.02). Collateral circulation to the LAD was found in only one patient in each group. There were no differences between the two groups in heart rate, systolic BP, and double product of heart rate and systolic BP during the attack. The incidence of acetylcholine-induced anginal attack with U-wave inversion in the ST-segment depression group was nearly as high as that in the ST-segment elevation group (77% vs 78%, p > 0.99). CONCLUSIONS The development of transient U-wave inversion during vasospasm of the LAD induced by intracoronary injection of acetylcholine does not depend on the magnitude of myocardial ischemia as judged by the direction of ST-segment shift.
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Affiliation(s)
- Michael A Chizner
- The Heart Center of Excellence, North Broward Hospital District, Fort Lauderdale, Florida, USA
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Antón Sanz M, Calso AS. El dolor torácico en urgencias del hospital, ¿lo manejamos adecuadamente?”. Semergen 2002. [DOI: 10.1016/s1138-3593(02)74124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- M A Chizner
- Heart Center of Excellence, North Broward Hospital District, Fort Lauderdale, Florida, USA
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Everts B, Karlson BW, Währborg P, Hedner T, Herlitz J. Localization of pain in suspected acute myocardial infarction in relation to final diagnosis, age and sex, and site and type of infarction. Heart Lung 1996; 25:430-7. [PMID: 8950121 DOI: 10.1016/s0147-9563(96)80043-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To describe the localization of pain in consecutive patients admitted to the coronary care unit for possible acute myocardial infarction (AMI) and to relate it to the development of AMI, age, and gender. DESIGN Prospective evaluation. SETTING Sahlgrenska Hospital, covering half the area of the city of Göteborg, with half a million inhabitants. SUBJECTS Nine hundred three consecutive patients admitted to the coronary care unit for possible AMI between 24 and 87 years old with a mean age of 64 years. OUTCOME MEASURES Localizations of pain according to a self-constructed figure. Patient were approached between 1 and 14 days after onset of symptoms and asked to describe the localization of pain according to the figure, including nine positions on the chest, left and right arm, neck, and back. RESULTS AMI developed in 50% of patients during the first 3 days in hospital. Patients in whom AMI developed localized their pain to an extent similar to those without AMI in seven of nine chest areas. However, patients with AMI reported pain in the upper right square of the chest more frequently (p < 0.001) and in the middle left square of the chest less frequently (p < 0.01) than did patients without AMI. Pain in both the right (p < 0.001) and left arms (p < 0.01) was more frequently reported by patients who had AMI. Among patients with AMI, women reported pain in the neck (p < 0.05) and in the back (p < 0.01) more frequently than did men. Compared with elderly patients, younger patients reported pain more frequently in the left arm (p < 0.01), right arm (p < 0.01), and neck (p < 0.05). CONCLUSIONS Among consecutive patients with possible AMI admitted to the coronary care unit, patients who had confirmed AMI reported pain in both arms more frequently than did patients without AMI. However, both groups described their chest surface distribution of pain similarly in the majority of positions, thereby indicating that the localization of chest pain is of limited use in predicting which patients will eventually have AMI.
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Affiliation(s)
- B Everts
- Department of Medicine, Central Hospital, Uddevalla, Sweden
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11
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Berger JP, Buclin T, Haller E, Van Melle G, Yersin B. Right arm involvement and pain extension can help to differentiate coronary diseases from chest pain of other origin: a prospective emergency ward study of 278 consecutive patients admitted for chest pain. J Intern Med 1990; 227:165-72. [PMID: 2313224 DOI: 10.1111/j.1365-2796.1990.tb00138.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In a prospective study of 278 consecutive patients admitted to an emergency ward for chest pain, the 115 clinical and paraclinical parameters available at the time of admission were evaluated by computer comparison with the final diagnoses. The most valuable items for making the diagnosis were classified according to their sensitivity, specificity and predictive value. Among the 278 patients, 100 individuals had myocardial infarctions (MI), 47 had unstable angina, 25 had stable angina and 106 patients had a non-coronary disease. The twelve most sensitive items for distinguishing MI from other conditions were the following: sudden onset of pain (70%); duration of more than 60 min (88%); constriction and squeezing (79%); oppression (75%); prior anginal attacks (61%); sex male (72%); age over 60 years (74%); abnormal heart auscultation (62%); abnormal electrocardiogram (ECG) (98%); segment (ST) disturbances (86%); increased glucose level (77%); CKMB fraction greater than 6% of total creatine kinase (CK) level (63%). Among the twelve most specific items, also with the best positive predictive value, irradiation in the right arm is of most importance; among the 51 patients with right arm involvement, 48 suffered from a coronary disease and 41 from a myocardial infarction. The largest extension of pain was reported in the latter group. It is concluded that chest pain with a wide irradiation involving the right arm strongly suggests that a myocardial infarction is ongoing.
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Affiliation(s)
- J P Berger
- Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Switzerland
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12
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Abstract
Chest pain is a common complaint of patients seen in the emergency department. The causes are legion, and range from the non-life threatening to the potentially catastrophic. Thallium heart scanning was done prospectively in 20 patients with a "classic" history for myocardial infarction (eight patients) or atypical chest pain and/or associated symptoms plus an abnormal ECG (12 patients) to discern a subset of patients from whom thallium scintography may be indicated in the emergency department. Although further investigation is needed, our preliminary study suggests that myocardial scanning with thallium can be a safe, fairly rapid, and useful objective parameter in the emergency department detection of suspected myocardial infarction, and in differential diagnosis of chest pain when other data such as the history, physical examination, ECG, or enzymes are inconclusive.
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Affiliation(s)
- S E Mace
- Department of Emergency Medicine, Mt Sinai Medical Center, Cleveland
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13
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Mukerji V, Alpert MA, Hewett JE, Parker BM. Can Patients with Chest Pain and Normal Coronary Arteries Be Discriminated from Those with Coronary Artery Disease Prior to Coronary Angiography? Angiology 1989. [DOI: 10.1177/0003319789040004065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To determine whether the precatheterization clinical data in patients with chest pain could be used to discriminate patients with normal coronary arteries (NCA) from those with coronary artery disease, the authors compared 125 con secutive patients with < 30% stenosis of all major coronary arteries and 125 patients with > 60% stenosis of one or more major coronary arteries. Clinical characteristics that occurred more frequently in patients with NCA were: non exertional pain, pain to the left of the sternum, sharp pain, associated palpita tions, absence of typical relief with sublingual nitroglycerin, pain commencing less than one week or more than ten years prior to coronary angiography, a normal electrocardiogram, and negative results from a treadmill stress test or from thallium scintigraphy. However, none of these clinical features, either sin gly or in combination, could be used to identify the patients with NCA with certainty.
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Affiliation(s)
- Vaskar Mukerji
- Departments of Medicine, University of Missouri Health Sciences Center, and Harry S Truman Memorial Veterans Hospital, Columbia, MO
| | - Martin A. Alpert
- Departments of Medicine, University of Missouri Health Sciences Center, and Harry S Truman Memorial Veterans Hospital, Columbia, MO
| | - John E. Hewett
- Departments of Medicine, University of Missouri Health Sciences Center, and Harry S Truman Memorial Veterans Hospital, Columbia, MO
| | - Brent M. Parker
- Departments of Medicine, University of Missouri Health Sciences Center, and Harry S Truman Memorial Veterans Hospital, Columbia, MO
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Foreman RD. Organization of the Spinothalamic Tract as a Relay for Cardiopulmonary Sympathetic Afferent Fiber Activity. ACTA ACUST UNITED AC 1989. [DOI: 10.1007/978-3-642-74058-9_1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Wilson DB, Vacek JL. Angina and coronary artery disease. Manifestations and management. Postgrad Med 1988; 84:77-86. [PMID: 3054851 DOI: 10.1080/00325481.1988.11700495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- D B Wilson
- University of Kansas Medical Center, Division of Cardiovascular Diseases, Kansas City 66103
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Taguchi H, Masuda T, Yokota T. Cardiac sympathetic afferent input onto neurons in nucleus ventralis posterolateralis in cat thalamus. Brain Res 1987; 436:240-52. [PMID: 3435826 DOI: 10.1016/0006-8993(87)91668-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neurons receiving cardiac sympathetic afferent input were studied in the nucleus ventralis posterolateralis (VPL) of the cat thalamus. Animals were anesthetized with urethan-chloralose. Units in the VPL were classified into 3 classes; low-threshold mechanoreceptive (LTM), nociceptive specific (NS) and wide dynamic range (WDR) units. Units driven by electrical stimulation of the left inferior cardiac nerve (ICN) were not included in the population of LTM units, but 43.5% of NS units and 68.8% of WDR units were excited by this stimulation. Units exclusively responsive to cardiac sympathetic afferents were not found. Both NS and WDR units were located in the shell region of the caudal VPL. NS units responsive to cardiac sympathetic afferents had a circumscribed cutaneous receptive field in the area corresponding to tactile dermatomes C5-T13. WDR units receiving cardiac sympathetic afferent input had at least a part of their receptive fields in the same area. These results suggest that the shell region of the caudal VPL constitutes a thalamic link in a cardiac pain pathway, and that cardiac and cutaneous pain systems share a common projection locus in the VPL.
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Affiliation(s)
- H Taguchi
- Department of Physiology, Medical College of Shiga, Otsu, Japan
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Affiliation(s)
- R A Blacky
- Department of Internal Medicine (Division of Cardiology), Naval Hospital, San Diego, California
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Conte MR, Orzan F, Magnacca M, Brusca A, Zara P, Mioli PR, Todros L. Atypical chest pain: coronary or esophageal disease? Int J Cardiol 1986; 13:135-42. [PMID: 3793274 DOI: 10.1016/0167-5273(86)90138-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Retrosternal pain can be caused both by cardiac and esophageal disease. This work presents the results of cardiac and esophageal investigations in 55 patients, who had atypical chest pain. Isolated esophageal disease was found in 45% of the subjects while 14.5% had significant coronary arterial disease. Both diseases were found in 10.9% of the patients and neither disease in 29%. We conclude that esophageal disease is very frequent in patients with atypical chest pain but it does not always completely account for the symptoms. Such patients should, in our opinion, be submitted to an electrocardiographic stress test. If the result is positive or non-diagnostic, coronary cineangiography should be performed, irrespective of the results of esophageal investigations. If the electrocardiographic stress test is negative, coronary investigations can be deferred. Esophageal investigations can account for the symptoms in about half of such cases.
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Foreman RD, Blair RW, Ammons WS. Neural mechanisms of cardiac pain. PROGRESS IN BRAIN RESEARCH 1986; 67:227-43. [PMID: 3823474 DOI: 10.1016/s0079-6123(08)62765-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Ducrotte P, Berland J, Denis P, Galmiche JP, Cribier A, Letac B, Pasquis P. Coronary sinus lactate estimation and esophageal motor anomalies in angina with normal coronary angiogram. Dig Dis Sci 1984; 29:305-10. [PMID: 6705641 DOI: 10.1007/bf01318514] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Twenty-three patients (ages 44-82) with angina-like chest pain with a negative stress test and a normal coronary angiogram were studied for myocardial lactate metabolism during atrial pacing and for esophageal motor function with manometric measurements and acid infusion test. Eight patients had an abnormal myocardial lactate metabolism during maximal atrial pacing. Esophageal motor anomalies were observed in six of these eight patients and nine of the 15 subjects with normal myocardial lactate metabolism. The frequency and type of these anomalies were not different between the two groups of patients. Perfusion of acid into the esophagus reproduced the spontaneous pain syndrome in three patients, independent of any simultaneous motor dysfunction. These results suggest that esophageal motor anomalies must be interpreted with caution in patients with angina-like chest pain before affirming the exclusively esophageal origin of the pain.
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