Skip to main content
SpringerLink
Log in

Neuroimaging of Heart Pain

  • Chapter
The Nervous System and the Heart

Abstract

In the normal heart, both intrinsic mechanisms (such as coronary vascular autoregulation and Starling mechanical properties) and extrinsic (mainly neurohumoral) influences allow adaptation to a wide range of demand for output of blood (1). Even under resting conditions, oxidative metabolism is crucial to the function of the heart; indeed, mitochondria comprise one-third of the mass of the myocardial cells. Oxygen extraction is near maximal even under resting conditions at 60–70% and is only increased to 80% with severe exercise. Therefore, the increased oxygen required during exercise has to be obtained from an increase in myocardial blood flow (MBF) (2). In circumstances of cardiac disease, especially (and in the West, most commonly) coronary artery disease (CAD), the limits of adaptation are much more closely confined. Critical stenosis of an epicardial artery, whether such a stenosis is static or dynamic, sharply reduces coronary vasodilator reserve (CVR, the ratio of maximal MBF/ resting MBF) in the myocardial territory supplied by the stenosed vessel (3). [With respect to vulnerability to reduction in perfusion or to increase in demand, it is well established that the subendocardium is at greater risk than the subepicardium; this issue has been reviewed in extenso by Hoffman (2) and will not be discussed further here.] MBF and, therefore, oxygen supply cannot increase adequately to satisfy the increased myocardial demand, and aerobic metabolism can no longer be sustained downstream. The regional contractile function is compromised.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Opie, L. H. (1991) The Heart. Physiology and Metabolism. Raven, New York, pp. 52–66.

    Google Scholar 

  2. Hoffman, J. I. E. (1987) Transmural myocardial perfusion. Prog. Cardiovasc. Dis. 29, 429–464.

    Article  PubMed  CAS  Google Scholar 

  3. Uren, N. G., Melin, J. A., De Bruyne, B., Wijns, W., Baudhuin, T., and Camici, P. G. (1994) Relation between myocardial blood flow and the severity of coronary artery stenosis. N. Engl. J. Med. 330, 1782–1788.

    Article  PubMed  CAS  Google Scholar 

  4. Malliani, A. (1995) The conceptualisation of cardiac pain as a nonspecific and unreliable alarm system, in Visceral Pain, Progress in Pain Research and Management, vol. 5 ( Gebhart, G. F., ed.), IASP, Seattle, WA, pp. 63–74.

    Google Scholar 

  5. Spyer, K. M. (1992) Central nervous control of the cardiovascular system, in Autonomic Failure. A Textbook of Clinical Disorders of the Autonomic Nervous System. (Bannister, R. and Mathias, C. J., eds.), Oxford University Press, Oxford, pp. 54–77.

    Google Scholar 

  6. Cechetto, D. F. (1995) Supraspinal mechanisms of visceral representation, in Visceral Pain, Progress in Pain Research and Management, vol. 5 ( Gebhart, G. F., ed.), IASP, Seattle, WA, pp. 261–290.

    Google Scholar 

  7. Meller, S. T. and Gebhart, G. F. (1992) Visceral pain: a review of experimental studies. Neuroscience 48, 501–524.

    Article  PubMed  CAS  Google Scholar 

  8. Mancia, G. and Mark, A. L. (1983) Arterial baroreflex in humans, in Handbook of Physiology. The Cardiovascular System III ( Shepherd, J. T., Abboud, F. M., and Geiger, S. R., eds.), American Physiological Society, Bethesda, MD, pp. 755–793.

    Google Scholar 

  9. Pagani, M., Somers, V., Furlan, R., Dell’Orto, S., Conway, J., Baselli, G., et al. (1988) Changes in autonomic regulation induced by physical training in mild hypertension. Hypertension 12, 600–612.

    Article  PubMed  CAS  Google Scholar 

  10. Dampney, R. A. L. (1994) Functional organization of central pathways regulating the cardiovascular system. Physiol. Rev. 74, 323–364.

    Article  PubMed  CAS  Google Scholar 

  11. White, J. C. (1957) Cardiac pain. Anatomic pathways and physiologic mechanisms. Circulation 16, 644–655.

    Article  PubMed  CAS  Google Scholar 

  12. François-Franck, C. A. (1899) Signification physiologique de la résection du sympathetique dans la maladie de Basedow, l’épilepsie, l’idiotie et le glaucome. Bull. Acad. Med. Paris 41, 565–574.

    Google Scholar 

  13. Mannheimer, C., Augustinsson, L. E., Carlsson, C. A., Manhem, K., and Wilhelmsson, C. (1988) Epidural spinal electrical stimulation in severe angina pectoris. Br. Heart J. 59, 56–61.

    Article  PubMed  CAS  Google Scholar 

  14. Hill, J. A. and Pepine, C. J. (1986) Myocardial ischaemia and chest pain: a misunderstood and oversimplified relationship? Cardiol. Clin. 4, 621–625.

    PubMed  CAS  Google Scholar 

  15. Rosen, S. D., Paulesu, E., Frith, C. D., Jones, T., Davies, G. J., Frackowiak, R. S. J., et al. (1994) Central neural correlates of angina pectoris as a model of visceral pain. Lancet 344, 147–150.

    Google Scholar 

  16. Rosen, S. D., Paulesu, E., Nihoyannopoulos, P., Tousoulis, D., Frackowiak, R. S. J., Frith, C. D., et al. (1996) Silent ischaemia as a central problem: regional brain activation compared in silent and painful myocardial ischaemia. Ann. Intern. Med. 124, 939–949.

    Google Scholar 

  17. Fox, P. T., Raichle, M. E., Mintun, M. A., and Dence, C. (1988) Nonoxidative glucose consumption during focal physiologic neural activity. Science 241, 462–464.

    Article  PubMed  CAS  Google Scholar 

  18. Raichle, M. (1987) Circulatory and metabolic correlates of brain function in normal humans, in Handbook of Physiology. Section 1: The Nervous System. Vol. V. Higher Functions of the Brain Part 2 ( Mountcastle, V. B., Plum, F., and Geiger, S. R., eds.), American Physiological Society, Bethesda, MD, pp. 643–674.

    Google Scholar 

  19. Mata, M., Fink, D. G., Ganier, H., Smith, C. B., Davidsen, L., Sawaki, H., et al. (1980) Activity-dependent energy metabolism in rat posterior pituitary primarily reflects sodium pump activity. J. Neurochem. 34, 213–215.

    Google Scholar 

  20. Friston, K. J. and Frackowiak, R. S. J. (1991) Imaging functional anatomy, in Brain Work and Mental Activity, Alfred Benzon Symposium Vol. 31 ( Lassen, N. A. Ingvar, D. H., Raichle, M. E., and Friberg, L., eds.), Munksgaard, Copenhagen, pp. 267–279.

    Google Scholar 

  21. Friston, K. J., Frith, C. D., Liddle, P. F., Lammertsma, A. A., Dolan, R. D., and Frackowiak, R. S. J. (1990) The relationship between local and global changes in PET scans. J. Cereb. Blood Flow Metab. 10, 458–466.

    Article  PubMed  CAS  Google Scholar 

  22. Friston, K. J., Frith, C. D., Liddle, P. F., and Frackowiak, R. S. J. (1991) Comparing functional (PET) images: assessment of significant change. J. Cereb. Blood Flow Metab. 11, 690–699.

    Article  PubMed  CAS  Google Scholar 

  23. Spinks, T. J., Jones, T., Bailey, D. L., et al. (1992) Physical performance of a positron tomograph for brain imaging with retractable septa. Phys. Med. Biol. 37, 1637–1655.

    Article  PubMed  CAS  Google Scholar 

  24. Takao, Y., Kamisaki, Y., and Itoh, T. (1992) Beta adrenergic regulation of amine precursor amino-acid transport across the blood-brain barrier. Eur. J. Pharmacol. 215, 245–251.

    Article  PubMed  CAS  Google Scholar 

  25. Opie, L. H. (1991) Drugs and the Heart. W. B. Saunders, Philadelphia, p. 143.

    Google Scholar 

  26. Talairach, J. and Tournoux, P. (1988) A Co-planar Stereotactic Atlas of the Human Brain. Thieme, Stuttgart.

    Google Scholar 

  27. Friston, K. J., Passingham, R. E., Nutt, J. G., Heather, J. D., Sawle, G. V., and Frackowiak, R. S. J. (1989) Localisation in PET images: direct fitting of the intercommissural (AC-PC) line. J. Cereb. Blood Flow Metab. 9, 690–695.

    Article  PubMed  CAS  Google Scholar 

  28. Camici, P. G., Araujo, L. I., Spinks, T., Lammertsma, A. A., Kaski, J. C., Shea, M. J., et al. (1986) Increased uptake of 18F-fluorodeoxyglucose in postischemic myocardium of patients with exercise-induced angina. Circulation 74, 81–88.

    Google Scholar 

  29. Heberden, W. (1772) Some account of a disorder of the breast. Med. Trans. Roy. Coll. Phys. London 2, 59–67.

    Google Scholar 

  30. Warren, J. (1812) Remarks on angina pectoris. N. Engl. J. Med. Surg. 1, 1–11.

    Article  Google Scholar 

  31. Babey, A. M. (1939) Painless acute infarction of the heart. N. Engl. J. Med. 220, 410–412.

    Article  Google Scholar 

  32. Kannel, W. B. and Abbott, R. D. (1984) Incidence and prognosis of unrecognised myocardial infarction. An update on the Framingham study. N. Engl. J. Med. 311, 1144–1147.

    Article  PubMed  CAS  Google Scholar 

  33. Epstein, S. E., Quyyumi, A. A., and Bonow, R. O. (1988) Current concepts, myocardial ischemia: silent or symptomatic. N. Engl. J. Med. 318, 1038–1043.

    Article  PubMed  CAS  Google Scholar 

  34. Schang, S. J. and Pepine, C. J. (1977) Transient asymptomatic ST segment depression during daily activity. Am. J. Cardiol. 39, 396–402.

    Article  PubMed  Google Scholar 

  35. Deanfield, J. E., Maseri, A., Selwyn, A. P., Ribeiro, P., Chierchia, S., Krikler, S., et al. (1983) Myocardial ischaemia during daily life in patients with stable angina: its relation to symptoms and heart rate changes. Lancet 2, 753–758.

    Article  PubMed  CAS  Google Scholar 

  36. Quyyumi, A. A., Mockus, L., Wright, C., and Fox, K. M. (1985) Morphology of ambulatory ST segment changes in patients with varying severity of coronary artery disease: investigation of the frequency of nocturnal ischaemia and coronary artery spasm. Br. Heart J. 53, 186–193.

    Article  PubMed  CAS  Google Scholar 

  37. Gottlieb, S. 0., Weisfeldt, M. L., Ouyang, P., Mellits, E. D., and Gerstenblith, G. (1986) Silent ischemia as a marker for early unfavorable outcome in patients with unstable angina. N. Engl. J. Med. 314, 1214–1219.

    Article  PubMed  CAS  Google Scholar 

  38. Tzivoni, D., Gavish, A., Zin, D., Gottlieb, S., Moriel, M., Keren, A., et al. (1988) Prognostic significance of ischemic episodes in patients with previous myocardial infarction. Am. J. Cardiol. 62, 661–664.

    Article  PubMed  CAS  Google Scholar 

  39. Gottlieb, S. 0., Gottlieb, S. H., Achuff, S. C., Baumgardner, R., Mellits, E. D., Weisfeldt, M. L., et al. (1988) Silent ischemia on Holter monitoring predicts mortality in high risk post infarction patients. J. Am. Med. Assoc. 259, 1030–1035.

    Article  CAS  Google Scholar 

  40. Warnes, C. A. and Roberts, W. C. (1984) Sudden coronary death: relation of amount and distribution of coronary narrowing at necropsy to previous symptoms of myocardial ischemia, left ventricular scarring and heart weight. Am. J. Cardiol. 54, 65–73.

    Article  PubMed  CAS  Google Scholar 

  41. Hong, R. A., Bhandari, A. K., McKay, C. R., Au, P. K., and Rahimtoola, S. H. (1987) Life threatening ventricular tachycardia and fibrillation induced by painless myocardial ischemia during exercise testing. J. Am. Med. Assoc. 257, 1937–1940.

    Article  CAS  Google Scholar 

  42. Glazier, J. J., Chierchia, S., Brown, M. J., and Maseri, A. (1986) Importance of generalized defective perception of painful stimuli as a cause of silent myocardial ischemia in chronic stable angina pectoris. Am. J. Cardiol. 58, 667–672.

    Article  PubMed  CAS  Google Scholar 

  43. Chierchia, S., Lazzari, M., Freedman, S. B., Bencivelli, W., and Maseri, A. (1983) Impairment of myocardial perfusion and function during painless myocardial ischemia. J. Am. Coll. Cardiol. 1, 924–930.

    Article  PubMed  CAS  Google Scholar 

  44. Klein, J., Chao, S. Y., Berman, D. S., and Rozanski, A. (1994) Is ‘silent’ myocardial ischemia really as severe as symptomatic ischemia? The analytical effect of patient selection biases. Circulation. 89, 1958–1966.

    Article  PubMed  CAS  Google Scholar 

  45. Langer, A., Freeman, M., Josse, R., Steiner, G., and Armstrong, P. (1991) Detection of silent myocardial ischemia in diabetes mellitus. Am. J. Cardiol. 67, 1073–1078.

    Article  PubMed  CAS  Google Scholar 

  46. Shakespeare, C. F., Katritsis, D., Crowther, A., Cooper, I. C., Coltart, J. C., and Webb-Peploe, M. M. (1994) Differences in autonomic function in patients with silent and symptomatic myocardial ischaemia. Br. Heart J. 71, 22–29.

    Article  PubMed  CAS  Google Scholar 

  47. Woolf, C. J. and Wall, P. D. (1983) Endogenous opioid peptides and pain mechanisms: a complex relationship. Nature 306, 739–740.

    CAS  Google Scholar 

  48. Sheps, D. S., Maixner, W., and Hinderliter, A. L. (1989) Mechanisms of pain perception in patients with silent myocardial ischemia. Am. Heart J. 119, 983–987.

    Article  Google Scholar 

  49. Droste, C. and Roskamm, H. (1990) Pain perception and endogenous pain modulation in angina pectoris, in Silent Myocardial Ischemia: A Critical Appraisal (Kellerman, J. J. and Braunwald, E., eds.), Advances in Cardiology Vol. 37, Karger, Basel, pp. 142–164.

    Google Scholar 

  50. Van Rijn, T. and Rabkin, S. W. (1986) Effect of naloxone on exercise-induced angina pectoris: a randomized, double blind crossover trial. Life Sci. 38, 609–615.

    Article  PubMed  Google Scholar 

  51. Ellestad, M. H. and Kuan, P. (1984) Naloxone and asymptomatic ischemia: failure to induce angina during exercise testing. Am. J. Cardiol. 54, 982–984.

    Article  PubMed  CAS  Google Scholar 

  52. Heller, G. V., Garber, C. E., Connolly, M. J., Allen-Rowlands, C. F., Siconolfi, S. F., Gann, D. S., et al. (1987) Plasma [3-endorphin levels in silent myocardial ischemia induced by exercise. Am. J. Cardiol. 59, 735–739.

    Article  PubMed  CAS  Google Scholar 

  53. Falcone, C., Specchia, G., Rondanelli, R., Guasti, L., Corsico, G., Codega, S., et al. (1988) Correlation between beta-endorphin plasma levels and anginal symptoms in patients with coronary artery disease. J. Am. Coll. Cardiol. 11, 719–723.

    Article  PubMed  CAS  Google Scholar 

  54. Barsky, A. J., Hochstrasser, B., Coles, A., Zisfein, J., O’Donnell, C., and Eagle, K. A. (1990) Silent myocardial ischemia: Is the person or the event silent? J. Am. Med. Assoc. 264, 1132–1135.

    Article  CAS  Google Scholar 

  55. Wall, P. D. (1978) The gate control theory of pain mechanisms. A re-examination and a restatement. Brain 101, 1–18.

    Article  PubMed  CAS  Google Scholar 

  56. Neafsey, E. J., Terreberry, R. R., Hurley, K. M., Ruit, K. G., and Frysztak, R. J. (1993) Anterior cingulate cortex in rodents: connections, visceral control functions and implications for emotion, in Neurobiology of Cingulate Cortex and Limbic Thalamus: A Comprehensive Handbook ( Vogt, B. A. and Gabriel, M., eds.), Birkhäuser, Boston, pp. 206–223.

    Google Scholar 

  57. Terreberry, R. R. and Neafsey, E. J. (1983) Rat medial frontal cortex: a visceral motor region with a direct projection to the solitary nucleus. Brain Res. 278, 245–249.

    Article  PubMed  CAS  Google Scholar 

  58. Hurley, K. M., Herbert, H., Moga, M. M., and Saper, C. B. (1991) Efferent projections of the inferolimbic cortex of the rat. J. Comp. Neurol. 308, 249–276.

    Article  PubMed  CAS  Google Scholar 

  59. Vogt, B. A. and Pandya, D. N. (1987) Cingulate cortex of the rhesus monkey: II. cortical afferents. J. Comp. Neurol. 262, 271–289.

    Article  PubMed  CAS  Google Scholar 

  60. Van Hoesen, G. W., Morecraft, R. J., and Vogt, B. A. (1993) Connections of the monkey cingulate cortex, in Neurobiology of Cingulate Cortex and Limbic Thalamus: A Comprehensive Handbook ( Vogt, B. A. and Gabriel, M., eds.), Birkhäuser, Boston, pp. 249–284.

    Google Scholar 

  61. Malliani, A. (1987) Pathophysiology of ischemic cardiac pain, in Silent Ischemia ( von Arnim, T. and Maseri, A., eds.), Steinkopff, Darmstadt, pp. 19–24.

    Google Scholar 

  62. Jones, A. K. P., Brown, W. D., Friston, K. J., Qi, L. Y., and Frackowiak, R. S. J. (1991) Cortical and subcortical localization of response to pain in man using positron emission tomography. Proc. Roy. Soc. Lond. B 244, 39–44.

    Article  CAS  Google Scholar 

  63. Talbot, J. D., Marrett, S., Evans, A. C., Meyer, E., Bushnell, M. C., and Duncan, G. H. (1991) Multiple representations of pain in human cerebral cortex. Science 251, 1355–1358.

    Article  PubMed  CAS  Google Scholar 

  64. Morecraft, R. J., Geula, C., and Mesulam, M. M. (1992) Cytoarchitecture and neural afferents of orbitofrontal cortex in the brain of the monkey. J. Comp. Neurol. 323, 341–358.

    Article  PubMed  CAS  Google Scholar 

  65. Gabriel, M., Kubota, Y., Sparenborg, S., Straube, K., and Vogt, B. A. (1991) Effects of cingulate cortical lesions on avoidance learning and training-induced activity in rabbits. Exp. Brain Res. 86, 585–600.

    Article  PubMed  CAS  Google Scholar 

  66. Keefer, C. S. and Resnik, W. H. (1928) Angina pectoris: a syndrome caused by anoxemia of the myocardium. Arch. Intern. Med. 41, 769–807.

    Article  Google Scholar 

  67. Cannon, R. O., Camici, P. G., and Epstein, S. E. (1992) Pathophysiological dilemma of syndrome X. Circulation 85, 883–892.

    Article  PubMed  Google Scholar 

  68. Rosen, S. D. and Camici, P. G. (1994) Syndrome X: background clinical aspects, pathophysiology and treatment. G. Ital. Cardiol. 24, 779–790.

    PubMed  CAS  Google Scholar 

  69. Epstein, S. E. and Cannon, R. O. (1986) Site of increased resistance to coronary flow in patients with angina pectoris and normal epicardial coronary arteries. J. Am. Coll. Cardiol. 8, 459–461.

    Article  PubMed  CAS  Google Scholar 

  70. Cannon, R. O., Schenke, W. H., Leon, M. B., Rosing, D. R., Urqhart, J., and Epstein, S. E. (1987) Limited coronary flow reserve after dipyridamole in patients with ergonovine-induced coronary vasoconstriction. Circulation 75, 163–174.

    Article  PubMed  Google Scholar 

  71. Green, L. H., Cohn, P. F., Holman, B. L., Adams, D. F., and Markis, J. E. (1978) Regional myocardial blood flow in patients with chest pain syndromes and normal coronary arteriograms. Br. Heart J. 40, 242–249.

    Article  PubMed  CAS  Google Scholar 

  72. Opherk, D., Zebe, H., Weihe, E., Mall, G., Dürr, C., Gravert, B., et al. (1981) Reduced coronary dilatory capacity and ultrastructural changes in the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation 63, 817–825.

    Article  PubMed  CAS  Google Scholar 

  73. Chauhan, A., Mullins, P. A., Taylor, G., Petch, M. C., and Schofield, P. M. (1993) Effect of hyperventilation and mental stress on coronary blood flow in syndrome X. Br. Heart J. 69, 516–524.

    Article  PubMed  CAS  Google Scholar 

  74. Holdright, D. R., Lindsay, D. C., Clarke, D., Fox, K., Poole-Wilson, P. A., and Collins, P. (1993) Coronary flow reserve in patients with chest pain and normal coronary arteries. Br. Heart J. 70, 513–519.

    Google Scholar 

  75. Geltman, E. M., Henes, C. G., Sennef, M. J., Sobel, B. E., and Bergman, S. R. (1990) Increased myocardial perfusion at rest and diminished perfusion reserve in patients with angina and angiographically normal coronary arteries. J. Am. Coll. Cardiol. 16, 586–595.

    Google Scholar 

  76. Camici, P. G., Gistri, R., Lorenzoni, R., Sorace, O., Michelassi, C., Bongiorni, M. G., et al. (1992) Coronary reserve and exercise ECG in patients with chest pain and normal coronary angiograms. Circulation 86, 179–186.

    Article  PubMed  CAS  Google Scholar 

  77. Rosen, S. D., Uren, N. G., Kaski, J.-C., Tousoulis, D., Davies, G. J., and Camici, P. G. (1994) Coronary vasodilator reserve, pain perception and gender in patients with syndrome X. Circulation 90, 50–60.

    Article  PubMed  CAS  Google Scholar 

  78. Nihoyannopoulos, P., Kaski, J.-C., Crake, T., and Maseri, A. (1991) Absence of myocardial dysfunction during pacing stress in patients with syndrome X. J. Am. Coll. Cardiol. 18, 1463–1470.

    Google Scholar 

  79. Panza, J. A., Laurienzo, J. M., Curiel, R. V., Unger, E. F., Quyyumi, A. A., Dilsizian, V., et al. (1997) Investigation of the mechanism of chest pain in patients with angiographically normal coronary arteries using transesophageal dobutamine stress echocardiography. J. Am. Coll. Cardiol. 29 293–301.

    Google Scholar 

  80. Camici, P. G., Marraccini, P., Lorenzoni, R., Buzzigoli, G., Pecori, N., Perissinotto, A., et al. (1991) Coronary hemodynamics and myocardial metabolism in patients with syndrome X: response to pacing stress. J. Am. Coll. Cardiol. 17, 1461–1470.

    Article  PubMed  CAS  Google Scholar 

  81. Rosano, G. M., Kaski, J. C., Arie, S., Pereira, W. I., Horta, P., Collins, P., et al. (1996) Failure to demonstrate myocardial ischaemia in patients with angina and normal coronary arteries. Evaluation by continuous coronary sinus pH monitoring and lactate metabolism. Eur. Heart J. 17, 1175–1180.

    Google Scholar 

  82. Tousoulis, D., Crake, T., Lefroy, D., Galassi, A. R., and Maseri, A. (1993) Left ventricular hypercontractility and ST segment depression in patients with syndrome X. J. Am. Coll. Cardiol. 22, 1607–1613.

    Article  PubMed  CAS  Google Scholar 

  83. Spinelli, L., Ferro, G., Genovese, A., Cinquegrana, G., Spadafora, M., and Condorelli, M. (1990) Exercise-induced impairment of diastolic time in patients with X syndrome. Am. Heart J. 119, 829–833.

    Article  PubMed  CAS  Google Scholar 

  84. Rosano, G. M., Ponikowski, P., Adamopoulos, S., Collins, P., Poole-Wilson, P. A., Coates, A. J. S., et al. (1994) Abnormal autonomic control of the cardiovascular system in syndrome X. Am. J. Cardiol. 73, 1174–1179.

    Article  PubMed  CAS  Google Scholar 

  85. Rosen, S. D., Guzzetti, S., Cogliati, C., Lombardi, F., Camici, P. G., and Malliani, A. (1996) Autonomic dysregulation in syndrome X: power spectral analysis of the ambulatory ECG. J. Amb. Monit. 9, 119–131.

    Google Scholar 

  86. Rosen, S. D., Boyd, H., Rhodes, C. G., Kaski, J.-C., and Camici, P. G. (1996) Myocardial (3-adrenoceptor density and plasma catecholamines in patients with Syndrome X. Am. J. Cardiol. 78, 37–42.

    Article  PubMed  CAS  Google Scholar 

  87. Meeder, J. G., Blanksma, P. K., van der Wall, E. E., Willemsen, A. T. M., Pruim, J., Anthonio, R. L., et al. (1997) Coronary vasomotion in patients with syndrome X: evaluation with positron emission tomography and parametric myocardial perfusion imaging. Eur. J. Nucl. Med. 24, 530–537.

    PubMed  CAS  Google Scholar 

  88. Shapiro, L. M., Crake, T., and Poole-Wilson, P. (1988) A. Is altered cardiac sensation responsible for chest pain in patients with normal coronary arteries? Clinical observation during cardiac catheterisation. Br. Med. J. 296, 170–171.

    Article  CAS  Google Scholar 

  89. Cannon, R. O., Quyyumi, A. A., Schenke, W. H., Fananapazir, L., Tucker, E. E., Gaughan, A. M., et al. (1990) Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. J. Am. Coll. Cardiol. 16, 1359–1366.

    Article  PubMed  Google Scholar 

  90. Chauhan, A., Mullins, P. A., Thuraisingham, S. I., Taylor, G., Petch, M. C., and Schofield, P. M. (1994) Abnormal cardiac pain perception in syndrome X. J. Am. Coll. Cardiol. 24, 329–335.

    Article  PubMed  CAS  Google Scholar 

  91. Lagerqvist, B., Sylvén, C., Beerman, B., Helmius, G., and Waldenstrom, A. (1990) Intracoronary adenosine causes angina pectoris like pain—an inquiry into the nature of visceral pain. Cardiovasc. Res. 24, 609–613.

    Article  PubMed  CAS  Google Scholar 

  92. Eriksson, B., Svedenhag, J., Martinsson, A., and Sylvén, C. (1995) Effect of epinephrine infusion on chest pain in syndrome X in the absence of signs of myocardial ischemia. Am. J. Cardiol. 75, 241–245.

    Article  PubMed  CAS  Google Scholar 

  93. Lagerqvist, B., Sylvén, C., and Waldenstrom, A. (1992) Lower threshold for adenosine-induced chest pain in patients with angina and normal coronary angiograms. Br. Heart J. 68, 282–285.

    Article  PubMed  CAS  Google Scholar 

  94. Picano, E., Lattanzi, F., Masini, M., Distante, A., and L’Abbate, A. (1987) Usefulness of a high dose dipyridamole echocardiography test for diagnosis of syndrome X. Am. J. Cardiol. 60, 508–512.

    Article  PubMed  CAS  Google Scholar 

  95. Lucarini, A., Picano, E., Marini, C., Favilla, S., Salvetti, A., and Distante, A. (1992) Activation of sympathetic tone during dipyridamole test. Chest 102, 444–447.

    Article  PubMed  CAS  Google Scholar 

  96. Anon. WHO/ISH Meeting: Guidelines for the treatment of mild hypertension. Hypertension 5,394–397.

    Google Scholar 

  97. Rose, G., McCartney, P., and Reid, D. D. (1977) Self-administration of a questionnaire on chest pain and intermittent claudication. Br. J. Prevent. Soc. Med. 31, 42–48.

    CAS  Google Scholar 

  98. Spinks, T. J., Jones, T., Bailey, D. L., Townsend, D. W., Grootoonk, S., Bloomfield, P. M., et al. (1992) Physical performance of a positron tomograph for brain imaging with retractable septa. Phys. Med. Biol. 37, 1637–1655.

    Google Scholar 

  99. Rosen, S. D. and Camici, P. G. (1998) Insights into the pathophysiology of syndrome X obtained using positron emission tomography (PET), in Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management ( Kaski, J.-C., ed.), Kluwer, Dordrecht.

    Google Scholar 

  100. Luria, A. R. and Simernitskaya, E. G. (1977) Interhemispheric relations and the functions of the minor hemisphere. Neuropsychologia 15, 175–178.

    Article  PubMed  CAS  Google Scholar 

  101. Rosen, S. D., Dritsas, A., Bourdillon, P. J., and Camici, P. G. (1994) Analysis of the electrocardiographic QT interval in patients with syndrome X. Am. J. Cardiol. 73, 971–972.

    Article  PubMed  CAS  Google Scholar 

  102. Oppenheimer, S. M. and Cechetto, D. F. (1990) Cardiac chronotropic organization of the rat insular cortex. Brain Res. 533, 66–72.

    Article  PubMed  CAS  Google Scholar 

  103. Oppenheimer, S. M., Gelb, A., Girvin, J. P., and Hachinski, V. (1992) Cardiovascular effects of human insular cortex stimulation. Neurology 42, 1727–1732.

    Article  PubMed  CAS  Google Scholar 

  104. Oppenheimer, S. M., Cechetto, D. F., and Hachinski, V. (1990) Cerebrogenic cardiac arrhythmias: cerebral ECG influences and their role in sudden death. Arch. Neurol. 17, 513–519.

    Article  Google Scholar 

  105. Burch, G. E., Meyers, R., and Abildskov, J. A. (1954) A new electrocardiographic pattern observed in cerebrovascular accidents. Circulation 9, 719–723.

    Article  PubMed  CAS  Google Scholar 

  106. Henry, P. L. (1993) The false positive ST segment response to stress testing: limitations of a technology. Am. Coll. Cardiol. Curr. J. Rev. 3, 68–70.

    Google Scholar 

  107. Poole-Wilson, P. A. (1984) Potassium and the heart. Clin. Endocrinol. Metab. 13, 249–268.

    Article  PubMed  CAS  Google Scholar 

  108. Gardin, J. M., Isner, J. M., Ronan, J. A., and Fox, S. M. (1980) Pseudoischemic “false positive” ST-segment changes induced by hyperventilation in patients with mitral valve prolapse. Am. J. Cardiol. 45, 952–958.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Stuart D. Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Psychiatry, University of Groningen, Groningen, The Netherlands

    Gert J. Ter Horst PhD

Rights and permissions

Reprints and permissions

Copyright information

© 2000 Springer Science+Business Media New York

About this chapter

Cite this chapter

Rosen, S.D. (2000). Neuroimaging of Heart Pain. In: Ter Horst, G.J. (eds) The Nervous System and the Heart. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-713-0_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-713-0_10

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-139-4

  • Online ISBN: 978-1-59259-713-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation