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August 22, 1980, Vol 244, No. 8 >
ARTICLE | August 22, 1980

The Anginal Syndrome With Normal Coronary Arteries: Title and subTitle BreakEtiologic and Prognostic Considerations FREE

Anthony N. DeMaria, MD; Garrett Lee, MD; Ezra A. Amsterdam, MD; Reginald Low, MD; Dean T. Mason, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to Section of Cardiovascular Medicine, University of California School of Medicine, Davis, CA 95616 (Dr DeMaria).


JAMA. 1980;244(8):826-828. doi:10.1001/jama.1980.03310080058032
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References

THE INCREASING application of coronary angiography to the evaluation of patients with angina pectoris has led to the identification of a group of patients who experience anginal-type chest pain despite the presence of normal coronary artery anatomy by arteriography. Indeed, such patients may constitute up to 20% of those who have undergone elective coronary arteriography for suspected coronary artery disease.1 Although initially believed to be primarily an affliction of women, the syndrome has been detected with increasing frequency in men and in some studies has been found to be equally prevalent in both sexes. Despite the presence of normal coronary arteries, persons with this syndrome may have major functional impairment. They may often require hospitalization for chest pain evaluation and management and may even present a condition of unstable angina.

Recently, coronary artery spasm has been demonstrated to be responsible for many chest pain syndromes, including variant angina pectoris,

REFERENCES

1 +
Kemp HG, Vokonas PS, Cohn PF, et al:  The anginal syndrome associated with normal coronary arteriograms . Am J Med 54:735-742, 1973;.
2 +
Maseri A, Severi S, DeNes M, et al:  Variant angina: One aspect of a continuous spectrum of vasospastic myocardial ischemia . Am J Cardiol 42:1019-1035, 1978;.
3 +
Boudoulas H, Cobb TC, Leighton RF, et al:  Myocardial lactate production in patients with angina-like chest pain and angiographically normal coronary arteries and left ventricle . Am J Cardiol 34:501-505, 1974;.
4 +
Arbogast R, Bourassa MG:  Myocardial function during atrial pacing in patients with angina pectoris and normal coronary arteriograms . Am J Cardiol 32:257-263, 1973;.
5 +
Berman DS, Salel AF, Mason DT:  Noninvasive detection of regional myocardial ischemia using rubidium-81 and the scintillation camera . Circulation 52:619-626, 1975;.
6 +
Zoneraich S:  Angina pectoris in diabetic patients with normal coronary arteries . JAMA 241:2311, 1979;.
7 +
Arnett EN, Roberts WC:  Acute myocardial infarction and angiographically normal coronary arteries . Circulation 53:395-400, 1976;.
8 +
Morrow AG, Roberts WC, Ross J Jr, et al:  Obstruction to left ventricular outflow . Ann Intern Med 69:1225, 1968;.
9 +
DeMaria AN, Lee G, Mason DT:  The mitral valve prolapse syndrome , in Mason DT (ed): Advances in Heart Disease . New York, Grune & Stratton Inc, 1977;, vol 1, pp 421-439.
10 +
James TN:  Pathology of small coronary arteries . Am J Cardiol 20:679-691, 1967;.
11 +
Richardson PJ, Jackson G, Olsen EGJ, et al:  Angina pectoris with normal coronary arteriograms , in Maseri A, Klasen G, Lesch M (eds): Primary and Secondary Angina Pectoris . New York, Grune & Stratton Inc, 1978;, p 297.
12 +
Eliot RS, Bratt GT:  Paradox of myocardial ischemia and necrosis in young women with normal coronary arteriograms: Relationship to anomalous hemoglobin oxygen dissociation , abstracted. Am J Cardiol 21:98, 1968;.
13 +
Harris P:  The myocardial factor in angina , in Maseri A, Klasen G, Lesch M (eds): Primary and Secondary Angina Pectoris . New York, Grune & Stratton Inc, 1978;, p 293.
14 +
Preston FE:  Platelet abnormalities and clinical syndromes of vascular insufficiency , in Maseri A, Klasen G, Lesch M (eds): Primary and Secondary Angina Pectoris . New York, Grune & Stratton Inc, 1978;, p 285.
15 +
Lary D, Goldschlager N:  Electrocardiographic changes during hyperventilation resembling myocardial ischemia in patients with normal coronary arteriograms . Am Heart J 87:383-390, 1974;.
16 +
Waxler EB, Kimbiris D, Dreifus LS:  The fate of women with normal coronary arteriograms and chest pain resembling angina pectoris . Am J Cardiol 28:25-32, 1971;.
17 +
Bemiller CR, Pepine CJ, Rogers AK:  Long-term observation in patients with angina and normal coronary arteriograms . Circulation 47:36-43, 1973;.

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1 +
Kemp HG, Vokonas PS, Cohn PF, et al:  The anginal syndrome associated with normal coronary arteriograms . Am J Med 54:735-742, 1973;.
2 +
Maseri A, Severi S, DeNes M, et al:  Variant angina: One aspect of a continuous spectrum of vasospastic myocardial ischemia . Am J Cardiol 42:1019-1035, 1978;.
3 +
Boudoulas H, Cobb TC, Leighton RF, et al:  Myocardial lactate production in patients with angina-like chest pain and angiographically normal coronary arteries and left ventricle . Am J Cardiol 34:501-505, 1974;.
4 +
Arbogast R, Bourassa MG:  Myocardial function during atrial pacing in patients with angina pectoris and normal coronary arteriograms . Am J Cardiol 32:257-263, 1973;.
5 +
Berman DS, Salel AF, Mason DT:  Noninvasive detection of regional myocardial ischemia using rubidium-81 and the scintillation camera . Circulation 52:619-626, 1975;.
6 +
Zoneraich S:  Angina pectoris in diabetic patients with normal coronary arteries . JAMA 241:2311, 1979;.
7 +
Arnett EN, Roberts WC:  Acute myocardial infarction and angiographically normal coronary arteries . Circulation 53:395-400, 1976;.
8 +
Morrow AG, Roberts WC, Ross J Jr, et al:  Obstruction to left ventricular outflow . Ann Intern Med 69:1225, 1968;.
9 +
DeMaria AN, Lee G, Mason DT:  The mitral valve prolapse syndrome , in Mason DT (ed): Advances in Heart Disease . New York, Grune & Stratton Inc, 1977;, vol 1, pp 421-439.
10 +
James TN:  Pathology of small coronary arteries . Am J Cardiol 20:679-691, 1967;.
11 +
Richardson PJ, Jackson G, Olsen EGJ, et al:  Angina pectoris with normal coronary arteriograms , in Maseri A, Klasen G, Lesch M (eds): Primary and Secondary Angina Pectoris . New York, Grune & Stratton Inc, 1978;, p 297.
12 +
Eliot RS, Bratt GT:  Paradox of myocardial ischemia and necrosis in young women with normal coronary arteriograms: Relationship to anomalous hemoglobin oxygen dissociation , abstracted. Am J Cardiol 21:98, 1968;.
13 +
Harris P:  The myocardial factor in angina , in Maseri A, Klasen G, Lesch M (eds): Primary and Secondary Angina Pectoris . New York, Grune & Stratton Inc, 1978;, p 293.
14 +
Preston FE:  Platelet abnormalities and clinical syndromes of vascular insufficiency , in Maseri A, Klasen G, Lesch M (eds): Primary and Secondary Angina Pectoris . New York, Grune & Stratton Inc, 1978;, p 285.
15 +
Lary D, Goldschlager N:  Electrocardiographic changes during hyperventilation resembling myocardial ischemia in patients with normal coronary arteriograms . Am Heart J 87:383-390, 1974;.
16 +
Waxler EB, Kimbiris D, Dreifus LS:  The fate of women with normal coronary arteriograms and chest pain resembling angina pectoris . Am J Cardiol 28:25-32, 1971;.
17 +
Bemiller CR, Pepine CJ, Rogers AK:  Long-term observation in patients with angina and normal coronary arteriograms . Circulation 47:36-43, 1973;.

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