title: Microvascular angina in a patient with aortic stenosis.
abstract: A 39-year-old woman had exercise-induced ST segment depression associated with chest pain. Cardiac evaluation revealed moderate aortic stenosis (AS), related to the bicuspid valves, with an aortic mean pressure gradient of 22 mmHg, a calculated aortic valve area of 1.3 cm2 and normal left ventricular (LV) peak systolic and end-diastolic pressures, but no LV hypertrophy, resulting in normal LV wall stress. Although the coronary arteries were angiographically normal, rapid atrial pacing and an intracoronary papaverine injection revealed a significantly decreased coronary flow reserve (CFR), which may have played an important role in the pathogenesis of angina pectoris in this patient. Though the CFR is usually decreased in patients with AS, as well as in microvascular angina, in this particular case, it appeared to have decreased as a consequence of microvascular dysfunction rather than of AS-related mechanisms.
authors.affiliation: First Department of Internal Medicine, Miyazaki Medical College, Kiyotake, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Kawamoto
authors.forename: T
authors.initials: T
authors.lastname: Imamura
authors.forename: K
authors.initials: K
authors.lastname: Kawabata
authors.forename: H
authors.initials: H
authors.lastname: Date
authors.forename: T
authors.initials: T
authors.lastname: Ishikawa
authors.forename: M
authors.initials: M
authors.lastname: Maeno
authors.forename: T
authors.initials: T
authors.lastname: Nagoshi
authors.forename: Y
authors.initials: Y
authors.lastname: Fujiura
authors.forename: A
authors.initials: A
authors.lastname: Matsuyama
authors.forename: T
authors.initials: T
authors.lastname: Matsuo
authors.forename: Y
authors.initials: Y
authors.lastname: Koiwaya
authors.forename: T
authors.initials: T
authors.lastname: Eto
mesh_terms: D000328:Adult; D001024:Aortic Valve Stenosis / Q000473:pathology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology; D004562:Electrocardiography; D015444:Exercise; D005260:Female; D006801:Humans; D017566:Microvascular Angina / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D010208:Papaverine / Q000008:administration & dosage; D012039:Regional Blood Flow; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D010208:Papaverine