Abstract
The long term prognosis of patients with chest pain and normal coronary arteries, is good and similar to that of the general population with regard to survival and occurrence of major cardiovascular effects. However, despite the good prognosis, quality of life in syndrome X patients is often poor, as discussed by Atienza et al in another chapter of this book. Indeed, approximately 75% of syndrome X patients continue to report chest pain at follow-up, and in 20-30% the chest pain remains unchanged or deteriorates [1–4]. Despite reassurance, a large proportion of patients continue to see a doctor, attend casualty departments and have repeat hospitalizations and diagnostic examinations, including repeat coronary angiography [2–4]. About 50% of patients with angina and normal coronary arteriograms remain out of work as they are extremely limited in their daily activities, with relevant socio-economical implications [2,4].
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Romeo F, Rosano GMC, Martuscelli E, Lombardo L, Valente A: Long-term follow-up of patients initially diagnosed with syndrome X. Am J Cardiol 1993;71:669–673
Ockene IS, Shay MJ, Alpert JS, Weiner BH, Dalen JE: Unexplained chest pain in patients with normal coronary arteriograms: a follow-up study of functional status. N Engl J Med 1980;303:1249–1252
Kemp HG, Jr., Vokonas PS, Cohn PF, Gorlin R: The anginal syndrome associated with normal coronary arteriograms. Report of a six year experience. Am J Med 1973;54:735–742
Kaski JC, Rosano GMC, Collins, P.; Nihoyannopoulos, P.; Maseri, A.; Poole-Wilson, P.A. Cardiacsyndrome X: clinical characteristics and left ventricular function. Long term follow-up study. J Am Coll Cardiol 1995; 25: 807–814
Romeo F, Gaspardone A, Ciavolella M, Gioffrè P, Reale A: Verapamil versus acebutolol for syndrome X. Am J Cardiol 1988;62:312–313
Montorsi, F. Fabbiocchi, A. Loaldi, L. Annoni, A. Polese, N. De Cesare, and M. Guazzi. Coronary adrenergic hyperrreactivity in patients with syndrome X and abnormal electrocardiogram at rest. Am.iCardiol. 68:1698–1703, 1991.
Fragasso G, Chierchia S, Pizzetti G, Rossetti E, Carlino M, Gerosa S, Carandente O, Fedele A, Cattaneo N: Impaired left ventricular filling dynamics in patients with angina pectoris and angiographically normal coronary arteries; effect of beta-adrenergic blockade. Heart 1997; 77: 32–39
Leonardo F, Fragasso G, Rosano GMC, Pagnotta P, Chierchia SL. Effect of atenolol on QT interval and dispersion in patients with syndrome X. Am J Cardiol 1997; 80: 789–90.
Cannon RO, Watson RM, Rosing DR, Epstein SE: Efficacy of calcium channel blocker therapy for angina pectoris resulting from small-vessel coronary artery disease and abnormal vasodilator reserve. Am J Cardiol 1985;56:242–246
Montorsi P, Manfredi M, Loaldi A, Fabbiocchi F, Polese A, de Cesare N, Bartorelli A, Guazzi MD: Comparison of coronary vasomotor responses to nifedipine in syndrome X and in Prinzmetal’s angina pectoris. Am J Cardiol 1989;63:1198–1202
Montorsi P, Cozzi S, Loaldi A, Fabbiocchi F, Polese A, de Cesare N, Guazzi MD: Acute coronary vasomotor effects of nifedipine and therapeutic correlates in syndrome X. Am J Cardiol 1990;66:302–307
Bugiardini R, Borghi A, Biagetti L, Puddu P: Comparison of verapamil versus propranolol therapy in syndrome X. Am J Cardiol 1989;63:286–290
Lanza GA, Manzoli A, Bia E, et al. Deficient NO production does not play a role in syndrome X. (Abstr) Eur Heart J 1993; 14: 98
Buffon A, Conti E, Finocchiaro ML, Beltrame JF, Cianflone D, Crea F, Maseri A. Paradoxical effect of intracoronary nitrates on coronary blood flow in patients with syndrome X. Eur Heart J 1997; 18:169
Pasceri V, Colonna G, Ierardi C, Natali R, Mustilli M, Maceri A, Lanza GA. Effect of standard antiischemic drugs on anginal episodes in patients with syndrome X. Eur Heart J 1997; 18:629
Emdin M, Picano E, Lattanzi F, L’Abbate A: Improved exercise capacity with acute aminophylline administration in patients with syndrome X [see comments]. J Am Coll Cardiol 1989;14:1450–1453
Elliott PM, Krzyzowska-Dickinson K, Calvino R, Hann C, Kaski JC. Effect of oral aminophylline in patients with angina and normal coronary arteriograms (cardiac syndrome X). Heart 1997; 77: 523–526
Galassi AR, Kaski JC, Pupita G, Vejar M, Crea F, Maceri A: Lack of evidence for alpha-adrenergic receptor-mediated mechanisms in the genesis of ischemia in syndrome X. Am J Cardiol 1989;64:264–269
Lorenzoni R, Rosen SD, Camici PG. Effect of selective a1 blockade on resting and hyperemic myocardial blood flow in normal humans. AM J Physiol 1996; 271: H1302–H1306.
Xiang JZ, Linz W, Becker H: Effects of converting enzyme inhibitors ramipril and enalapril on peptide actions and sympathetic neurotransmission in the isolated heart. Eur J Pharmacol 1984;113:215–223
Mancini GB, Henry GC, Macaya C, O’Neill BJ, Pucillo AL, Carere RG, Wargovich TJ, Mudra H, Löscher TF, Klibaner MI, Haber HE, Uprichard ACG, Pepine CJ, Pitt B. Angiotensin-converting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patients with coronary artery disease. The TREND (Trial on Reversing ENdothelial Dysfunction) study. Circulation 94:258–265, 1996.
Kaski JC, Rosano G, Gavrielides S, Chen L: Effects of Angiotensin-converting enzyme inhibition on exercise-induced angina and ST segment depression in patients with microvascular angina. J Am Coll Cardiol 1994;23:652–657
Cannon RO, Quyyumi AA, Mincemoyer R, Stine AM, Gracely RH, Smith WB, Geraci MF, Black BC, Uhde TW, Waclawiw MA, Mahrer K, Benjamin SB: Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med 1994;330:1411–1417
Cox ID, Hann CM, Kaski JC. Low dose imipramine does not improve quality of life in patients with angina and normal coronary angiograms. Eur Heart J 1998;19:250–255
Sarrel PM, Lindsay DC, Rosano GMC, Poole-Wilson PA: Angina and normal coronary arteries in women. Gynecological findings. Am J Obstet Gynecol 1992;167:467–471
Williams JK, Adams MR, Klopfenstein HS: Estrogen modulates responses of atherosclerotic coronary arteries. Circulation 1990;81:1680–1687
Rosano GMC, Collins P, Kaski JC, Lindsay D, Sarrel PM, Poole-Wilson PA. Syndrome X is associated with oestrogen deficiency. Eur Heart J 1995; 16: 610–614
Rees MC, Barlow DH: Absence of sustained reflex vasoconstriction in women with menopausal flushes. Hum Reprod 1988;3:823–825
Rosano GMC, Sarrel PM, Poole-Wilson PA, Collins P: Beneficial effect of oestrogen on exercise-induced myocardial ischemia in women with coronary artery disease. Lancet 1993;342:133–136
Rosano GMC, Peters N, Lefroy D, Lindsay D, Sarrel PM, Collins P, Poole-Wilson PA. 17-beta estradiol therapy lessens angina in postmenopausal women with syndrome X. J Am Coll Cardiol 1996; 28: 1500–5
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1999 Springer Science+Business Media New York
About this chapter
Cite this chapter
Rosano, G.M.C., Fragasso, G., Chierchia, S.L. (1999). Treatment of Patients with Angina and Normal Coronary Arteriograms. 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_19
Download citation
DOI: https://doi.org/10.1007/978-1-4615-5181-2_19
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4613-7360-5
Online ISBN: 978-1-4615-5181-2
eBook Packages: Springer Book Archive