Chest Pain With Normal Coronary Arteries

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.

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.

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.

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.

A guide to the techniques and analysis of clinical data. Each of the seventeen sections begins with a drawing and biographical sketch of a seminal contributor to the discipline. After an introduction and historical survey of clinical methods, the next fifteen sections are organized by body system. Each contains clinical data items from the history, physical examination, and laboratory investigations that are generally included in a comprehensive patient evaluation. Annotation copyrighted by Book News, Inc., Portland, OR

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.

The Social Security Administration (SSA) uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they cannot work at all and thus immediately qualify for benefits. In this report, the IOM makes several recommendations for improving SSA's capacity to determine disability benefits more quickly and efficiently using the Listings.

With coronary heart disease one of the biggest killers in the Western world, this book will help people of all ages understand what coronary heart disease is and what can be done to prevent it, or at least, delay it for as long as possible. Highly accessible, and written by two experienced heart doctors, the text is designed to help dispel fears of the condition and allow readers to take control of their health and future, whether they are patients or practitioners.