Microvascular angina and the sensitive heart: historical perspective.
As our understanding of the etiology of chest pain of undetermined origin has evolved, the focus for studying this problem has switched from individual subspecialties to a multidisciplinary approach. In the subspecialties of gastroenterology and cardiology, the focus has shifted from organ-specific diagnoses to concepts of altered pain thresholds. Cardiologists began to look for functional causes of ischemia following the recognition that many patients with chest pain had normal coronary arteries. Abnormal responses of the coronary microcirculation to stress were identified in this population, and the concept of "microvascular angina" originated. Further evaluation, however, demonstrated that many of these patients did not have evidence of ischemia. In addition, a significant overlap with esophageal motility disorders was shown, and multiple sensitivities to otherwise nonirritating stimuli, whether in the heart or the esophagus, could be elicited in these patients. This finding led to the concept of abnormal visceral nociception, that is, the "sensitive heart" and the "tender esophagus," both the focus of ongoing clinical research.
Benjamin
S B
SB
Department of Gastroenterology, Georgetown University School of Medicine, Washington, D.C. 20007.
D000787:Angina Pectoris / Q000175:diagnosis* / Q000503:physiopathology; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003326:Coronary Circulation; D006801:Humans; D008833:Microcirculation