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Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management pp 101–114Cite as

Endothelin: An Important Mediator in the Pathophysiology of Syndrome X?

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

Abstract

Angina pectoris with normal coronary arteries is a common clinical entity with up to 30% of patients undergoing invasive assessment for anginal chest pain having normal coronary angiograms [1,2]. The term cardiac syndrome X to describe patients with chest pain and normal coronaries was first introduced by Kemp in 1973 [3] and is now generally confined to patients with exertional angina, completely normal coronary angiograms and a positive electrocardiographic response (> 0.1 mV of ST segment depression) to exercise testing [4]. The pathophysiology of chest pain in this patient group appears to be heterogeneous and remains the subject of considerable debate [5–7]. A non-cardiac source of pain, often originating in the gastrointestinal or musculoskeletal system, may be identified by further investigation. However, around 20% of patients appear to have objective evidence of myocardial ischemia in most series, and a mechanism involving a primary cardiac abnormality remains the most likely explanation for the symptoms in this subgroup.

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Authors
  1. Ian D. Cox
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  2. Juan Carlos Kaski
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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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Cox, I.D., Kaski, J.C. (1999). Endothelin: An Important Mediator in the Pathophysiology of Syndrome X?. 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_9

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