title: Relation between stimulation site of cardiac afferent nerves by adenosine and distribution of cardiac pain: results of a study in patients with stable angina.
abstract: OBJECTIVE
  The purpose of this study was to establish whether stimulation of cardiac sensory receptors in different myocardial regions results in different distributions of cardiac pain.
  
  
  BACKGROUND
  Previous studies have shown that adenosine provokes cardiac pain through stimulation of sensory receptors in the absence of myocardial ischemia. In this study adenosine was used to obtain a regional stimulation of cardiac sensory receptors.
  
  
  METHODS
  Increasing doses of adenosine (0.25, 0.5 and 1 mg/min) were selectively infused into the right and then into the left coronary artery in 26 patients with stable angina.
  
  
  RESULTS
  No patient developed ischemic electrocardiographic changes during either adenosine infusion. Eighteen patients experienced cardiac pain during both infusions. Despite the stimulation of sensory receptors in different myocardial regions, 13 patients experienced cardiac pain in the same body area. Adenosine-induced pain was always similar to the anginal pain. By contrast, the remaining five patients experienced adenosine-induced cardiac pain in different body areas. In two of these patients, the distribution of anginal pain was similar to that experienced during one of the two adenosine infusions. In the remaining three patients, the distribution of anginal pain was similar to that experienced during adenosine infusion into the right coronary artery during some anginal episodes and to that experienced during adenosine infusion into the left coronary artery during other episodes.
  
  
  CONCLUSIONS
  During stimulation by adenosine of sensory receptors in different myocardial regions, the majority of patients experience cardiac pain in the same body area; only a few experience pain in different areas. These differences might be caused by different organizations of the ascending neural pathways to the cortex. Our results suggest that in the same patient different distributions of pain during anginal attacks are probably due to ischemia in different myocardial regions.
authors.affiliation: Cardiovascular Research Unit, Hammersmith Hospital, London, United Kingdom.
authors.forename: F
authors.initials: F
authors.lastname: Crea
authors.forename: A
authors.initials: A
authors.lastname: Gaspardone
authors.forename: J C
authors.initials: JC
authors.lastname: Kaski
authors.forename: G
authors.initials: G
authors.lastname: Davies
authors.forename: A
authors.initials: A
authors.lastname: Maseri
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000787:Angina Pectoris / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000294:innervation*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D009475:Neurons, Afferent / Q000187:drug effects*; D010147:Pain Measurement; D012720:Severity of Illness Index
chemical_list: D000241:Adenosine