Psychophysiological mechanisms in silent myocardial ischaemia.
Six levels of coronary pain are defined and for each of them explanations for absence of pain in asymptomatic myocardial ischaemia are given: Level I: Myocardial ischaemia which can be less pronounced in amount during asymptomatic episodes. Level II: Adequate stimulus (chemical, mechanical) where biosynthesis of algogesic substances, degree of local mechanical involvement and spatial distribution may be different. Level III: For neuronal encoding the intensity theory is mainly for coronary pain, presupposing a central pain threshold which is higher in asymptomatic patients. Level IV: Conduction of painful information may be interrupted by destruction of afferent nerve ways. Level V: Spinal transmission: resting tone and ability to activate neural and humoral (endorphinergic) pain inhibition systems are stronger in asymptomatic patients. Level VI: Central processing: cognitive mechanisms (coping style) affect perception of coronary pain with differences in symptomatic and silent myocardial ischaemia.
Droste
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C
Rehabilitationszentrum für Herz-und Kreislaufkranke, Bad Krozingen, F.R.G.
Roskamm
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H
D003327:Coronary Disease / Q000523:psychology*; D006801:Humans; D009411:Nerve Endings / Q000503:physiopathology; D009431:Neural Conduction; D009619:Nociceptors / Q000503:physiopathology; D011603:Psychophysiology; D013131:Spine / Q000503:physiopathology