By Juan Carlos Kaski (auth.), Juan Carlos Kaski (eds.)
Angina pectoris with common coronary arteriograms is a standard entity which has questioned cardiologists nearly because the introduction of coronary arteriography. regardless of significant advances within the realizing of the pathophysiology of angina lately and a large number of reports at the topic, the reason and mechanisms underlying the syndrome of angina with general coronary arteries stay unknown. certainly, result of investigations are debatable and hypothesis nonetheless prevails in regards to the nature of the so known as `Syndrome X'.
virtually each vital point of Syndrome X has been tackled within the e-book and the reader is uncovered not just to the cardiologists' opinion, but additionally to the authoritative perspectives of the gastroenterologists, gynaecologists and psychiatrists, super good represented during this monograph. The booklet offers with `cardiologists' Syndrome X' and never the metabolic entity termed `Syndrome X'. the potential connection among the 2, despite the fact that, is mentioned.
Angina with basic Coronary Arteries: Syndrome X contributes to the certainty of Syndrome X and is helping clinicians deal with their Syndrome X-patients larger and investigators to open new avenues for examine.
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Extra info for Angina Pectoris with Normal Coronary Arteries: Syndrome X
Lee and her co-workers 122 found an improved outcome in terms of decreased episodes of pain, use of medical services and physical limitation, but only in those patients with a positive response to intravenous edrophonium. Richter and others found that during a placebo-controlled trial of nifedipine in symptomatic patients with a nutcracker oesophagus, improvement with time occurred independent of the drug effects in most patients 112 . Patients in Richter's study formed a highly selected group who had oesophageal manometry performed repeatedly, together with frequent visits to hospital as part of the trial.
Coronary artery spasm and oesophageal spasm have been observed together in patients with normal coronary arteries using methacholine challenge 136 or with hyperventilation137. These findings suggest that some important questions remain to be answered in collaborative studies between cardiologists and gastroenterologists. Do, for instance, some patients have a generalised abnormality of smooth muscle function? In patients with oesophageal causes for pain, gastro-oesophageal reflux and diffuse oesophageal spasm may give rise to ST-segment and T wave changes on electrocardiography42.
The published evidence is controversial, some studies comprising small numbers of patients and others, inadequate characterisation of oesophageal abnormalities. However, most studies have detected abnormalities in 42 - 75% of patients with coronary artery disease72-76 with one dissenting study in which only 10% of patients with coronary artery disease had oesophageal motility disorders77. Thus, the mere demonstration of an oesophageal abnormality does not ensure that symptoms arise from the oesophagus, and ideally the abnormality needs to be demonstrated in temporal association with the patient's symptoms.
Angina Pectoris with Normal Coronary Arteries: Syndrome X by Juan Carlos Kaski (auth.), Juan Carlos Kaski (eds.)