By Juan Carlos Kaski (auth.), Juan Carlos Kaski MD, MRCP, FACC, FESC (eds.)
This e-book is well timed and demanding. inside of its pages are commentaries and critiques at the clinical history and explanatory principles for a posh of signs and investigations referred to as syndrome X. the most common reason by way of a long way of angina pectoris is coronary artery obstruction as a result of atheromatous lesions either in the wall of the artery and intruding into the lumen; in such sufferers it's anticipated that there might be ST phase melancholy on atrial pacing or on an workout attempt indicating myocardial ischemia. Syndrome X was once a time period first utilized in an article written through Kemp in 1973. He was once concerning sufferers in crew X in a paper from Arbogast and Bourassa. sufferers in staff X had 3 beneficial properties, specifically angina as judged on a scientific background, adjustments of the ST phase at the electrocardiogram in the course of atrial pacing and delicate unobstructed coronary arteries (presumed general) as assessed by means of the means of coronary angiography. The adjustments at the electrocardiogram, conventionally indicative of myocardial ischemia, couldn't be defined at the foundation of any abnormality of the coronary arteries and Kemp named the advanced of fmdings syndrome X due to this seeming paradox and the shortcoming of a unmarried rationalization. within the final thirty-one years there was monstrous medical curiosity during this syndrome giving upward push to a lot of guides. The identify syndrome X has resulted in significant confusion. Physicians are acquainted with the X chromosome and with X associated congenital disorders.
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Additional resources for Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management
69. suppl3: 70-73. Peters L, Maas L, Petty 0, et al. Spontaneous noncardiac chest pain: evaluation by 24-hour ambulatory esophageal motility and pH monitoring. Gastroenterology 1988;94:878-886. Richter JE, Dalton CB, Bradley LA. Oral nifedipine in the treatment of non-cardiac chest pain in patients with the nutcracker oaesophagus. Gastroenterology 1987;93:21-24. Clouse RE, Lustman PJ, Eckert TC. Low dose trazodone for symptomatic patients with esophageal contraction abnormalities: a double-blind placebo-controlled trial.
T: 0 Figure 3. Mean scores on SCL-90R somatisation subscale items by chest pain outcome group Table 2. DSM-IIIR diagnoses in 40 NCA patients at II year follow-up ANXIETY GROUP: n=14 Generalized anxiety disorder Panic disorder without agoraphobia Panic disorder with agoraphobia Agoraphobia Simple phobia 3 2 2 2 5 AFFECTIVE GROUP: n=6 Bipolar II disorder Major depression Dysthymia I 3 2 SOMATOFORM GROUP n=7 Somatization disorder Undifferentiated somatoform disorder Hypochondriasis 3 2 2 22 of 40 patients had at least one current diagnosis: 27 diagnoses in total Summary These findings suggest that a substantial subgroup of patients with chest pain and normal coronary arteries will experience continued pain and incapacity associated with a number of other physical symptoms and psychological distress; that much of this is detectable one year after angiography ; and that it persists as long as 11 years later 24 in spite of further medical attention [59,60].
The range and variety of the possible factors, both physical and psychological, which might be at work in any given case of chest pain and normal coronary arteries, is clearly very wide. Only an interactive model of the type put forward can accommodate them all: unicausal models are unduly restrictive. 302-306 for review]. Most of these have characterized the extent of functional disability, and described the proportion of patients who continue to report chest pain and other physical symptoms. Relatively few have outlined the psychological and social consequences of a diagnosis of NCA.