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Alternative Mechanisms for Myocardial Ischemia in Syndrome X - New Diagnostic Markers

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Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 213))

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Abstract

Exertional chest pain, positive exercise test responses and the presence of transient ST segment depression during Holier monitoring strongly suggest the occurrence of myocardial ischemia in syndrome X. However, carefully conducted studies have failed to show: (i) myocardial lactate production during pacing [1,2]; (ii) increases in pulmonary pressure during spontaneous episodes of transient ST segment depression [3]; (iii) abnormalities of left ventricular wall motion as assessed by two-dimensional echocardiography during dipyridamole testing [4]; (iv) decreases in coronary sinus blood oxygen saturation [5] or of pH [6] during atrial pacing; (v) regional perfusion abnormalities during positron emission tomography [7]. Yet, a sizable proportion of patients with syndrome X exhibit an alteration of coronary circulation as suggested by: (i) an abnormally small increase in coronary flow in response to dipyridamole or pacing [8,9], particularly after ergonovine administration [10]; (ii) heterogeneous myocardial perfusion both at rest and during dipyridamole infusion as assessed by positron emission tomography [11,12] and (iii) a regional reduction of thallium uptake during exercise or dipyridamole infusion [13-15].

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Authors
  1. Filippo Crea
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  2. Antonio Buffon
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  3. Achille Gaspardone
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  4. Gaetano Lanza
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Editor information

Editors and Affiliations

  1. St George’s Hospital Medical School, London, UK

    Juan Carlos Kaski MD, MRCP, FACC, FESC (BHF Sugden Reader in Clinical Cardiology and Consultant Cardiologist, Head of Coronary Artery Disease Research Group) (BHF Sugden Reader in Clinical Cardiology and Consultant Cardiologist, Head of Coronary Artery Disease Research Group)

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Crea, F., Buffon, A., Gaspardone, A., Lanza, G. (1999). Alternative Mechanisms for Myocardial Ischemia in Syndrome X - New Diagnostic Markers. In: Kaski, J.C. (eds) Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management. Developments in Cardiovascular Medicine, vol 213. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5181-2_11

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  • DOI: https://doi.org/10.1007/978-1-4615-5181-2_11

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-7360-5

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