Coronary
ischemic disease (CID) is a worldwide frequent pathology with increasing
prevalence. Angina pectoris (AP) is a cardinal symptom of CID. Typical AP meets
all of the following criteria: retrosternal chest discomfort of characteristic
quality and duration; provoked by exertional or emotional stress; is relieved
by rest and/or nitrates within minutes.
It
was stated that ‘no patient with AP failed to show occlusion in at least one of
the major coronary arteries’ and flow-limiting coronary artery disease (CAD)
causing ischemia was accepted as the cause of AP. However, this assumption is
not unconditional because AP may also occur in other diseases, such as e.g.
hypertrophic cardiomyopathy, severe aortic stenosis, profound anemia, and
carboxy hemoglobin intoxication.
In
1967 two papers described patients with typical AP and sometimes dyspnea and
neurovegetative symptoms (e.g. perspiration, tachycardia and dizziness) without
epicardial CAD (CAD). This cardiac pathology is usually called cardiac
syndrome
X (CSX) and is not rare.
Case
Report
A
53-year old Caucasian woman had stable typical AP which was questionably
relieved by sublingual nitroglycerin. Her father died at the age of 55 years
because of acute myocardial infarction. The patient had no other cardiovascular
risk factors. The resting ECG showed ischemic changes. Plasma levels of
troponin, measured during and several hours after episodes of AP, were not
increased. Echocardiography detected only a moderately impaired left
ventricular relaxation. Read more..............
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