Angina Pectoris With Normal Coronary Arteries Syndrome X

Written by leading authorities in the field, Chest Pain with Normal Coronary Arteries comprehensively reviews the clinical presentation and the pathogenesis of the condition, as well as its management. This book provides a practical tool for the clinician and a bank of information and new ideas for research scientists and clinical researchers interested in understanding the causes and mechanisms of chest pain with normal coronary arteries. Whether the pain be of gastroenterologic, cardiac or endocrine in origin, the book focuses on effective diagnosis, treatment and management of different pathologies in patients. Chest Pain with Normal Coronary Arteries is an essential read for all clinicians involved in managing patients with chest pain, and those that should be aware of non-cardiac chest pain.

Angina pectoris with normal coronary arteriograms is a common entity which has puzzled cardiologists almost since the advent of coronary arteriography. Despite major advances in the understanding of the pathophysiology of angina in recent years and a multitude of studies on the subject, the cause and mechanisms underlying the syndrome of angina with normal coronary arteries remain unknown. Indeed, results of investigations are controversial and speculation still prevails regarding the nature of the so called `Syndrome X'. Almost every important aspect of Syndrome X has been tackled in the book and the reader is exposed not only to the cardiologists' opinion, but also to the authoritative views of the gastroenterologists, gynaecologists and psychiatrists, extremely well represented in this monograph. The book deals with `cardiologists' Syndrome X' and not the metabolic entity termed `Syndrome X'. The possible connection between the two, however, is discussed. Angina with Normal Coronary Arteries: Syndrome X contributes to the understanding of Syndrome X and helps clinicians manage their Syndrome X-patients better and investigators to open new avenues for research.

This title discusses the magnitude of the problem of angina pectoris. The author also goes on to describe the characteristics and clinical profile of patients with angina in a contemporary population. The different types and multiple mechanisms of angina pectoris are described, while the clinical presentation, typical and atypical features and complications (MI, HF) and clinical management and outcomes are evaluated. The author also evaluates the various antianginal therapies used in special populations: the elderly, post revascularised patients, patients with LVSD or HF, patients with CKD, patients with diabetes.

This book is timely and challenging. Within its pages are commentaries and opinions on the scientific background and explanatory ideas for a complex of symptoms and investigations known as syndrome X. The commonest cause by far of angina pectoris is coronary artery obstruction due to atheromatous lesions both within the wall of the artery and intruding into the lumen; in such patients it is expected that there maybe ST segment depression on atrial pacing or on an exercise test indicating myocardial ischemia. Syndrome X was a term first used in an editorial written by Kemp in 1973. He was referring to patients in group X in a paper from Arbogast and Bourassa. Patients in group X had three features, namely angina as judged on a clinical history, alterations of the ST segment on the electrocardiogram during atrial pacing and smooth unobstructed coronary arteries (presumed normal) as assessed by the technique of coronary angiography. The changes on the electrocardiogram, conventionally indicative of myocardial ischemia, could not be explained on the basis of any abnormality of the coronary arteries and Kemp named the complex of fmdings syndrome X because of this seeming paradox and the lack of a single explanation. In the last thirty-one years there has been substantial scientific interest in this syndrome giving rise to a large number of publications. The name syndrome X has led to considerable confusion. Physicians are familiar with the X chromosome and with X linked congenital disorders.

In the past two decades a number of studies have shown that abnormalities in the function and structure of coronary microcirculation can be detected in several cardiovascular diseases. On the basis of the clinical setting in which it occurs, coronary microvascular dysfunction (CMD) can be classified into four types: CMD in the absence of any other cardiac disease; CMD in myocardial diseases; CMD in obstructive epicardial coronary artery disease; and iatrogenic CMD. In some instances CMD represents an epiphenomenon, whereas in others it represents an important marker of risk or may contribute to the pathogenesis of myocardial ischemia, thus becoming a possible therapeutic target. This book provides an update on coronary physiology and a systematic assessment of microvascular abnormalities in cardiovascular diseases, in the hope that it will assist clinicians in prevention, detection and management of CMD in their everyday activity.

This book provides up-to-date research on Angina pectoris, which is commonly known as angina, and is a chest pain due to ischemia (a lack of blood and hence oxygen supply) of the heart muscle, generally due to obstruction or spasm of the coronary arteries (the heart's blood vessels). Coronary artery disease, the main cause of angina, is due to atherosclerosis of the cardiac arteries. The term derives from the Greek ankhon (strangling) and the Latin pectus (chest), and can therefore be translated as a strangling feeling in the chest. It is common to equate severity of angina with risk of fatal cardiac events. There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e. there can be severe pain with little or no risk of a heart attack, and a heart attack can occur without pain).

Coronary artery disease continues to be a major cause of morbidity and mortality in the United States and throughout the world. This issue of the Heart Failure Clinics provides a contemporary and concise, yet extensive, review on all aspects of the management of patients with coronary artery disease. Topics include but are not limited to: Epidemiology, Traditional and Novel Risk Factors in Coronary Artery Disease; Acute Coronary Syndromes: Unstable Angina and Non–ST Elevation Myocardial Infarction; Calcium Scoring and Cardiac Computed Tomography; Coronary Artery Disease and Diabetes Mellitus; Cardiac Syndrome X; and Revascularization Options: Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention.