Skip to main content
PMC home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1993;20(3):170–179.

Chest pain and angiographically normal coronary arteries. Implications for treatment.

V Mukerji 1, B D Beitman 1, M A Alpert 1
PMCID: PMC325089  PMID: 8219820

Abstract

Approximately 20% to 30% of patients who undergo coronary arteriography for the evaluation of chest pain are found to have normal coronary arteries. These patients have a survival rate comparable to that of the normal population, yet they continue to complain of symptoms on extended follow-up, and about half of this group are disabled on account of chest pain. Once other clinically obvious disorders have been ruled out, common diagnostic considerations include microvascular angina, esophageal dysfunction, and perhaps fibromyalgia. Panic disorder, however, is the most common condition affecting these patients and can be diagnosed in at least one third of the group, with or without the presence of the other conditions mentioned. Appropriate diagnosis and treatment can reduce the psychosocial morbidity so frequently seen in these patients.

Full text

PDF
170

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arbogast R., Bourassa M. G. Myocardial function during atrial pacing in patients with angina pectoris and normal coronary arteriograms. Comparison with patients having significant coronary artery disease. Am J Cardiol. 1973 Sep 7;32(3):257–263. doi: 10.1016/s0002-9149(73)80130-4. [DOI] [PubMed] [Google Scholar]
  2. Areskog M., Tibbling L. Oesophageal function and chest pain in male patients with recent acute myocardial infarction. Acta Med Scand. 1981;209(1-2):59–63. doi: 10.1111/j.0954-6820.1981.tb11552.x. [DOI] [PubMed] [Google Scholar]
  3. Arnett E. N., Isner J. M., Redwood D. R., Kent K. M., Baker W. P., Ackerstein H., Roberts W. C. Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. Ann Intern Med. 1979 Sep;91(3):350–356. doi: 10.7326/0003-4819-91-3-350. [DOI] [PubMed] [Google Scholar]
  4. Bates C. K. Medical risks of cocaine use. West J Med. 1988 Apr;148(4):440–444. [PMC free article] [PubMed] [Google Scholar]
  5. Beitman B. D., Kushner M., Lamberti J. W., Mukerji V. Panic disorder without fear in patients with angiographically normal coronary arteries. J Nerv Ment Dis. 1990 May;178(5):307–312. doi: 10.1097/00005053-199005000-00005. [DOI] [PubMed] [Google Scholar]
  6. Beitman B. D., Mukerji V., Kushner M., Thomas A. M., Russell J. L., Logue M. B. Validating studies for panic disorder in patients with angiographically normal coronary arteries. Med Clin North Am. 1991 Sep;75(5):1143–1155. doi: 10.1016/s0025-7125(16)30404-7. [DOI] [PubMed] [Google Scholar]
  7. Beitman B. D., Mukerji V., Lamberti J. W., Schmid L., DeRosear L., Kushner M., Flaker G., Basha I. Panic disorder in patients with chest pain and angiographically normal coronary arteries. Am J Cardiol. 1989 Jun 1;63(18):1399–1403. doi: 10.1016/0002-9149(89)91056-4. [DOI] [PubMed] [Google Scholar]
  8. Beitman B. D., Mukerji V., Lamberti J. W., Schmid L., Kushner M. Major depression and agoraphobia in patients with angiographically normal coronary arteries and panic disorder. Can J Psychiatry. 1990 May;35(4):298–304. doi: 10.1177/070674379003500403. [DOI] [PubMed] [Google Scholar]
  9. Berger H. J., Sands M. J., Davies R. A., Wackers F. J., Alexander J., Lachman A. S., Williams B. W., Zaret B. L. Exercise left ventricular performance in patients with chest pain, ischemic-appearing exercise electrocardiograms, and angiographically normal coronary arteries. Ann Intern Med. 1981 Feb;94(2):186–191. doi: 10.7326/0003-4819-94-2-186. [DOI] [PubMed] [Google Scholar]
  10. Berland J., Cribier A., Cazor J. L., Hecketsweiler B., Letac B. Angina pectoris with angiographically normal coronary arteries: a clinical, hemodynamic, and metabolic study. Clin Cardiol. 1984 Sep;7(9):485–492. doi: 10.1002/clc.4960070904. [DOI] [PubMed] [Google Scholar]
  11. Bertrand M. E., LaBlanche J. M., Tilmant P. Y., Thieuleux F. A., Delforge M. R., Carre A. G., Asseman P., Berzin B., Libersa C., Laurent J. M. Frequency of provoked coronary arterial spasm in 1089 consecutive patients undergoing coronary arteriography. Circulation. 1982 Jun;65(7):1299–1306. doi: 10.1161/01.cir.65.7.1299. [DOI] [PubMed] [Google Scholar]
  12. Bigger J. T., Giardina E. G., Perel J. M., Kantor S. J., Glassman A. H. Cardiac antiarrhythmic effect of imipramine hydrochloride. N Engl J Med. 1977 Jan 27;296(4):206–208. doi: 10.1056/NEJM197701272960407. [DOI] [PubMed] [Google Scholar]
  13. Boudoulas H., Cobb T. C., Leighton R. F., Wilt S. M. Myocardial lactate production in patients with angina-like chest pain and angiographically normal coronary arteries and left ventricle. Am J Cardiol. 1974 Oct 3;34(5):501–505. doi: 10.1016/0002-9149(74)90118-0. [DOI] [PubMed] [Google Scholar]
  14. Bugiardini R., Borghi A., Biagetti L., Puddu P. Comparison of verapamil versus propranolol therapy in syndrome X. Am J Cardiol. 1989 Feb 1;63(5):286–290. doi: 10.1016/0002-9149(89)90332-9. [DOI] [PubMed] [Google Scholar]
  15. Burckhardt D., Raeder E., Müller V., Imhof P., Neubauer H. Cardiovascular effects of tricyclic and tetracyclic antidepressants. JAMA. 1978 Jan 16;239(3):213–216. [PubMed] [Google Scholar]
  16. Cannon R. O., 3rd, Quyyumi A. A., Schenke W. H., Fananapazir L., Tucker E. E., Gaughan A. M., Gracely R. H., Cattau E. L., Jr, Epstein S. E. Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. J Am Coll Cardiol. 1990 Nov;16(6):1359–1366. doi: 10.1016/0735-1097(90)90377-2. [DOI] [PubMed] [Google Scholar]
  17. Cannon R. O., 3rd, Schenke W. H., Leon M. B., Rosing D. R., Urqhart J., Epstein S. E. Limited coronary flow reserve after dipyridamole in patients with ergonovine-induced coronary vasoconstriction. Circulation. 1987 Jan;75(1):163–174. doi: 10.1161/01.cir.75.1.163. [DOI] [PubMed] [Google Scholar]
  18. Cannon R. O., 3rd, Watson R. M., Rosing D. R., Epstein S. E. Angina caused by reduced vasodilator reserve of the small coronary arteries. J Am Coll Cardiol. 1983 Jun;1(6):1359–1373. doi: 10.1016/s0735-1097(83)80037-0. [DOI] [PubMed] [Google Scholar]
  19. Cannon R. O., 3rd, Watson R. M., Rosing D. R., Epstein S. E. Efficacy of calcium channel blocker therapy for angina pectoris resulting from small-vessel coronary artery disease and abnormal vasodilator reserve. Am J Cardiol. 1985 Aug 1;56(4):242–246. doi: 10.1016/0002-9149(85)90842-2. [DOI] [PubMed] [Google Scholar]
  20. Castillo-Ferrando J. R., Garcia M., Carmona J. Digoxin levels and diazepam. Lancet. 1980 Aug 16;2(8190):368–368. doi: 10.1016/s0140-6736(80)90364-5. [DOI] [PubMed] [Google Scholar]
  21. Clouse R. E., Lustman P. J. Psychiatric illness and contraction abnormalities of the esophagus. N Engl J Med. 1983 Dec 1;309(22):1337–1342. doi: 10.1056/NEJM198312013092201. [DOI] [PubMed] [Google Scholar]
  22. Coull D. C., Crooks J., Dingwall-Fordyce I., Scott A. M., Wier R. D. Amitriptyline and cardiac disease. Risk of sudden death identified by monitoring system. Lancet. 1970 Sep 19;2(7673):590–591. doi: 10.1016/s0140-6736(70)90169-8. [DOI] [PubMed] [Google Scholar]
  23. Curry R. C., Jr, Pepine C. J., Sabom M. B., Feldman R. L., Christie L. G., Varnell J. H., Conti C. R. Hemodynamic and myocardial metabolic effects of ergonovine in patients with chest pain. Circulation. 1978 Oct;58(4):648–654. doi: 10.1161/01.cir.58.4.648. [DOI] [PubMed] [Google Scholar]
  24. DeMeester T. R., O'Sullivan G. C., Bermudez G., Midell A. I., Cimochowski G. E., O'Drobinak J. Esophageal function in patients with angina-type chest pain and normal coronary angiograms. Ann Surg. 1982 Oct;196(4):488–498. doi: 10.1097/00000658-198210000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Derlet R. W., Albertson T. E. Emergency department presentation of cocaine intoxication. Ann Emerg Med. 1989 Feb;18(2):182–186. doi: 10.1016/s0196-0644(89)80111-8. [DOI] [PubMed] [Google Scholar]
  26. Eliot R. S., Bratt G. The paradox of myocardial ischemia and necrosis in young women with normal coronary anteriograms. Relation to abnormal hemoglobin-oxygen dissociation. Am J Cardiol. 1969 May;23(5):633–638. doi: 10.1016/0002-9149(69)90023-x. [DOI] [PubMed] [Google Scholar]
  27. Evans D. W., Lum L. C. Hyperventilation: An important cause of pseudoangina. Lancet. 1977 Jan 22;1(8004):155–157. doi: 10.1016/s0140-6736(77)91760-3. [DOI] [PubMed] [Google Scholar]
  28. Faxon D. P., McCabe C. H., Kreigel D. E., Ryan T. J. Therapeutic and economic value of a normal coronary angiogram. Am J Med. 1982 Oct;73(4):500–505. doi: 10.1016/0002-9343(82)90328-x. [DOI] [PubMed] [Google Scholar]
  29. Ferguson S. C., Hodges K., Hersh T., Jinich H. Esophageal Manometry in Patients with Chest Pain and Normal Coronary Arteriogram. Am J Gastroenterol. 1981 Feb;75(2):124–127. [PubMed] [Google Scholar]
  30. Frohlich E. D., Dustan H. P., Page I. H. Hyperdynamic beta-adrenergic circulatory state. Arch Intern Med. 1966 May;117(5):614–619. [PubMed] [Google Scholar]
  31. GORLIN R. The hyperkinetic heart syndrome. JAMA. 1962 Nov 24;182:823–829. doi: 10.1001/jama.1962.03050470001001. [DOI] [PubMed] [Google Scholar]
  32. Geltman E. M., Henes C. G., Senneff M. J., Sobel B. E., Bergmann S. R. Increased myocardial perfusion at rest and diminished perfusion reserve in patients with angina and angiographically normal coronary arteries. J Am Coll Cardiol. 1990 Sep;16(3):586–595. doi: 10.1016/0735-1097(90)90347-r. [DOI] [PubMed] [Google Scholar]
  33. Giardina E. G., Bigger J. T., Jr Antiarrhythmic effect of imipramine hydrochloride in patients with ventricular premature complexes without psychological depression. Am J Cardiol. 1982 Jul;50(1):172–179. doi: 10.1016/0002-9149(82)90025-x. [DOI] [PubMed] [Google Scholar]
  34. Giardina E. G., Bigger J. T., Jr, Glassman A. H., Perel J. M., Kantor S. J. The electrocardiographic and antiarrhythmic effects of imipramine hydrochloride at therapeutic plasma concentrations. Circulation. 1979 Nov;60(5):1045–1052. doi: 10.1161/01.cir.60.5.1045. [DOI] [PubMed] [Google Scholar]
  35. Gibbons R. J., Lee K. L., Cobb F., Jones R. H. Ejection fraction response to exercise in patients with chest pain and normal coronary arteriograms. Circulation. 1981 Nov;64(5):952–957. doi: 10.1161/01.cir.64.5.952. [DOI] [PubMed] [Google Scholar]
  36. Goldenberg D. L. Psychiatric and psychologic aspects of fibromyalgia syndrome. Rheum Dis Clin North Am. 1989 Feb;15(1):105–114. [PubMed] [Google Scholar]
  37. Green L. H., Cohn P. F., Holman B. L., Adams D. F., Markis J. E. Regional myocardial blood flow in patients with chest pain syndromes and normal coronary arteriograms. Br Heart J. 1978 Mar;40(3):242–249. doi: 10.1136/hrt.40.3.242. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Greenspan M., Iskandrian A. S., Catherwood E., Kimbiris D., Bemis C. E., Segal B. L. Myocardial bridging of the left anterior descending artery: evaluation using exercise thallium-201 myocardial scintigraphy. Cathet Cardiovasc Diagn. 1980;6(2):173–180. doi: 10.1002/ccd.1810060207. [DOI] [PubMed] [Google Scholar]
  39. Henderson R. D., Wigle E. D., Sample K., Marryatt G. Atypical chest pain of cardiac and esophageal origin. Chest. 1978 Jan;73(1):24–27. doi: 10.1378/chest.73.1.24. [DOI] [PubMed] [Google Scholar]
  40. Heupler F. A., Jr, Proudfit W. L., Razavi M., Shirey E. K., Greenstreet R., Sheldon W. C. Ergonovine maleate provocative test for coronary arterial spasm. Am J Cardiol. 1978 Apr;41(4):631–640. doi: 10.1016/0002-9149(78)90810-x. [DOI] [PubMed] [Google Scholar]
  41. Hewson E. G., Sinclair J. W., Dalton C. B., Richter J. E. Twenty-four-hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain. Am J Med. 1991 May;90(5):576–583. [PubMed] [Google Scholar]
  42. Hudson J. I., Pope H. G., Jr Fibromyalgia and psychopathology: is fibromyalgia a form of "affective spectrum disorder"? J Rheumatol Suppl. 1989 Nov;19:15–22. [PubMed] [Google Scholar]
  43. Isner J. M., Estes N. A., 3rd, Thompson P. D., Costanzo-Nordin M. R., Subramanian R., Miller G., Katsas G., Sweeney K., Sturner W. Q. Acute cardiac events temporally related to cocaine abuse. N Engl J Med. 1986 Dec 4;315(23):1438–1443. doi: 10.1056/NEJM198612043152302. [DOI] [PubMed] [Google Scholar]
  44. Isner J. M., Salem D. N., Banas J. S., Jr, Levine H. J. Long-term clinical course of patients with normal coronary arteriography: follow-up study of 121 patients with normal or nearly normal coronary arteriograms. Am Heart J. 1981 Oct;102(4):645–653. doi: 10.1016/0002-8703(81)90088-0. [DOI] [PubMed] [Google Scholar]
  45. Jackson G., Richardson P. J., Atkinson L., Armstrong P., Oram S. Angina with normal coronary arteriograms. Value of coronary sinus lactate estimation in diagnosis and treatment. Br Heart J. 1978 Sep;40(9):976–978. doi: 10.1136/hrt.40.9.976. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Jamieson W. R., Miyagishima R. T., Carr D. M., Stordy S. N., Sharp F. R. Surgical management of primary motor disorders of the esophagus. Am J Surg. 1984 Jul;148(1):36–42. doi: 10.1016/0002-9610(84)90286-1. [DOI] [PubMed] [Google Scholar]
  47. Jefferson J. W. A review of the cardiovascular effects and toxicity of tricyclic antidepressants. Psychosom Med. 1975 Mar-Apr;37(2):160–179. doi: 10.1097/00006842-197503000-00006. [DOI] [PubMed] [Google Scholar]
  48. Jenkins C. D. Behavioral risk factors in coronary artery disease. Annu Rev Med. 1978;29:543–562. doi: 10.1146/annurev.me.29.020178.002551. [DOI] [PubMed] [Google Scholar]
  49. Jones R. H., McEwan P., Newman G. E., Port S., Rerych S. K., Scholz P. M., Upton M. T., Peter C. A., Austin E. H., Leong K. H. Accuracy of diagnosis of coronary artery disease by radionuclide management of left ventricular function during rest and exercise. Circulation. 1981 Sep;64(3):586–601. doi: 10.1161/01.cir.64.3.586. [DOI] [PubMed] [Google Scholar]
  50. Karch S. B., Billingham M. E. The pathology and etiology of cocaine-induced heart disease. Arch Pathol Lab Med. 1988 Mar;112(3):225–230. [PubMed] [Google Scholar]
  51. Katz P. O., Dalton C. B., Richter J. E., Wu W. C., Castell D. O. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years' experience with 1161 patients. Ann Intern Med. 1987 Apr;106(4):593–597. doi: 10.7326/0003-4819-106-4-593. [DOI] [PubMed] [Google Scholar]
  52. Kemp H. G., Elliott W. C., Gorlin R. The anginal syndrome with normal coronary arteriography. Trans Assoc Am Physicians. 1967;80:59–70. [PubMed] [Google Scholar]
  53. Kemp H. G., Evans H., Elliott W. C., Gorlin R. Diagnostic accuracy of selective coronary cinearteriography. Circulation. 1967 Oct;36(4):526–533. doi: 10.1161/01.cir.36.4.526. [DOI] [PubMed] [Google Scholar]
  54. Kemp H. G., Jr Left ventricular function in patients with the anginal syndrome and normal coronary arteriograms. Am J Cardiol. 1973 Sep 7;32(3):375–376. doi: 10.1016/s0002-9149(73)80150-x. [DOI] [PubMed] [Google Scholar]
  55. Kemp H. G., Jr, Vokonas P. S., Cohn P. F., Gorlin R. The anginal syndrome associated with normal coronary arteriograms. Report of a six year experience. Am J Med. 1973 Jun;54(6):735–742. doi: 10.1016/0002-9343(73)90060-0. [DOI] [PubMed] [Google Scholar]
  56. Kemp H. G., Kronmal R. A., Vlietstra R. E., Frye R. L. Seven year survival of patients with normal or near normal coronary arteriograms: a CASS registry study. J Am Coll Cardiol. 1986 Mar;7(3):479–483. doi: 10.1016/s0735-1097(86)80456-9. [DOI] [PubMed] [Google Scholar]
  57. Kikendall J. W., Mellow M. H. Effect of sublingual nitroglycerin and long-acting nitrate preparations on esophageal motility. Gastroenterology. 1980 Oct;79(4):703–706. [PubMed] [Google Scholar]
  58. Kline M., Chesne R., Sturdevant R. A., McCallum R. W. Esophageal disease in patients with angina-like chest pain. Am J Gastroenterol. 1981 Feb;75(2):116–123. [PubMed] [Google Scholar]
  59. Koelz H. R. Treatment of reflux esophagitis with H2-blockers, antacids and prokinetic drugs. An analysis of randomized clinical trials. Scand J Gastroenterol Suppl. 1989;156:25–36. [PubMed] [Google Scholar]
  60. Kramer J. R., Kitazume H., Proudfit W. L., Sones F. M., Jr Clinical significance of isolated coronary bridges: benign and frequent condition involving the left anterior descending artery. Am Heart J. 1982 Feb;103(2):283–288. doi: 10.1016/0002-8703(82)90500-2. [DOI] [PubMed] [Google Scholar]
  61. Lange R. A., Cigarroa R. G., Yancy C. W., Jr, Willard J. E., Popma J. J., Sills M. N., McBride W., Kim A. S., Hillis L. D. Cocaine-induced coronary-artery vasoconstriction. N Engl J Med. 1989 Dec 7;321(23):1557–1562. doi: 10.1056/NEJM198912073212301. [DOI] [PubMed] [Google Scholar]
  62. Lavey E. B., Winkle R. A. Continuing disability of patients with chest pain and normal coronary arteriograms. J Chronic Dis. 1979;32(3):191–196. doi: 10.1016/0021-9681(79)90064-x. [DOI] [PubMed] [Google Scholar]
  63. Legrand V., Hodgson J. M., Bates E. R., Aueron F. M., Mancini G. B., Smith J. S., Gross M. D., Vogel R. A. Abnormal coronary flow reserve and abnormal radionuclide exercise test results in patients with normal coronary angiograms. J Am Coll Cardiol. 1985 Dec;6(6):1245–1253. doi: 10.1016/s0735-1097(85)80209-6. [DOI] [PubMed] [Google Scholar]
  64. Levine H. J. Difficult problems in the diagnosis of chest pain. Am Heart J. 1980 Jul;100(1):108–118. doi: 10.1016/0002-8703(80)90286-0. [DOI] [PubMed] [Google Scholar]
  65. Likoff W., Segal B. L., Kasparian H. Paradox of normal selective coronary arteriograms in patients considered to have unmistakable coronary heart disease. N Engl J Med. 1967 May 11;276(19):1063–1066. doi: 10.1056/NEJM196705112761904. [DOI] [PubMed] [Google Scholar]
  66. Magarian G. J. Hyperventilation syndromes: infrequently recognized common expressions of anxiety and stress. Medicine (Baltimore) 1982 Jul;61(4):219–236. [PubMed] [Google Scholar]
  67. Marchandise B., Bourassa M. G., Chaitman B. R., Lesperance J. Angiographic evaluation of the natural history of normal coronary arteries and mild coronary atherosclerosis. Am J Cardiol. 1978 Feb;41(2):216–220. doi: 10.1016/0002-9149(78)90159-5. [DOI] [PubMed] [Google Scholar]
  68. Moir D. C., Cornwell W. B., Dingwall-Fordyce I., Crooks J., O'Malley K., Turnbull M. J., Weir R. D. Cardiotoxicity of amitriptyline. Lancet. 1972 Sep 16;2(7777):561–564. doi: 10.1016/s0140-6736(72)91958-7. [DOI] [PubMed] [Google Scholar]
  69. Mosseri M., Yarom R., Gotsman M. S., Hasin Y. Histologic evidence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries. Circulation. 1986 Nov;74(5):964–972. doi: 10.1161/01.cir.74.5.964. [DOI] [PubMed] [Google Scholar]
  70. Mukerji V., Alpert M. A., Hewett J. E., Parker B. M. Can patients with chest pain and normal coronary arteries be discriminated from those with coronary artery disease prior to coronary angiography? Angiology. 1989 Apr;40(4 Pt 1):276–282. [PubMed] [Google Scholar]
  71. Mukerji V., Beitman B. D., Alpert M. A., Lamberti J. W., DeRosear L., Basha I. M. Panic disorder: a frequent occurrence in patients with chest pain and normal coronary arteries. Angiology. 1987 Mar;38(3):236–240. doi: 10.1177/000331978703800306. [DOI] [PubMed] [Google Scholar]
  72. Ochs H. R., Greenblatt D. J., Verburg-Ochs B. Effect of alprazolam on digoxin kinetics and creatinine clearance. Clin Pharmacol Ther. 1985 Nov;38(5):595–598. doi: 10.1038/clpt.1985.230. [DOI] [PubMed] [Google Scholar]
  73. Ockene I. S., Shay M. J., Alpert J. S., Weiner B. H., Dalen J. E. Unexplained chest pain in patients with normal coronary arteriograms: a follow-up study of functional status. N Engl J Med. 1980 Nov 27;303(22):1249–1252. doi: 10.1056/NEJM198011273032201. [DOI] [PubMed] [Google Scholar]
  74. Opherk D., Zebe H., Weihe E., Mall G., Dürr C., Gravert B., Mehmel H. C., Schwarz F., Kübler W. Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation. 1981 Apr;63(4):817–825. doi: 10.1161/01.cir.63.4.817. [DOI] [PubMed] [Google Scholar]
  75. Orlando R. C., Bozymski E. M. Clinical and manometric effects of nitroglycerin in diffuse esophageal spasm. N Engl J Med. 1973 Jul 5;289(1):23–25. doi: 10.1056/NEJM197307052890106. [DOI] [PubMed] [Google Scholar]
  76. Papanicolaou M. N., Califf R. M., Hlatky M. A., McKinnis R. A., Harrell F. E., Jr, Mark D. B., McCants B., Rosati R. A., Lee K. L., Pryor D. B. Prognostic implications of angiographically normal and insignificantly narrowed coronary arteries. Am J Cardiol. 1986 Dec 1;58(13):1181–1187. doi: 10.1016/0002-9149(86)90378-4. [DOI] [PubMed] [Google Scholar]
  77. Proudfit W. L., Bruschke V. G., Sones F. M., Jr Clinical course of patients with normal or slightly or moderately abnormal coronary arteriograms: 10-year follow-up of 521 patients. Circulation. 1980 Oct;62(4):712–717. doi: 10.1161/01.cir.62.4.712. [DOI] [PubMed] [Google Scholar]
  78. Proudfit W. L., Shirey E. K., Sones F. M., Jr Selective cine coronary arteriography. Correlation with clinical findings in 1,000 patients. Circulation. 1966 Jun;33(6):901–910. doi: 10.1161/01.cir.33.6.901. [DOI] [PubMed] [Google Scholar]
  79. Rao A. K., Mintz P. D., Lavine S. J., Bove A. A., McDonough M. T., Spann J. F., Walsh P. N. Coagulant activities of platelets in coronary artery disease. Circulation. 1984 Jan;69(1):15–21. doi: 10.1161/01.cir.69.1.15. [DOI] [PubMed] [Google Scholar]
  80. Richter J. E., Dalton C. B., Bradley L. A., Castell D. O. Oral nifedipine in the treatment of noncardiac chest pain in patients with the nutcracker esophagus. Gastroenterology. 1987 Jul;93(1):21–28. doi: 10.1016/0016-5085(87)90308-8. [DOI] [PubMed] [Google Scholar]
  81. Richter J. E., Spurling T. J., Cordova C. M., Castell D. O. Effects of oral calcium blocker, diltiazem, on esophageal contractions. Studies in volunteers and patients with nutcracker esophagus. Dig Dis Sci. 1984 Jul;29(7):649–656. doi: 10.1007/BF01347298. [DOI] [PubMed] [Google Scholar]
  82. Roberts R., Henderson R. D., Wigle E. D. Esophageal disease as a cause of severe retrosternal chest pain. Chest. 1975 May;67(5):523–526. doi: 10.1378/chest.67.5.523. [DOI] [PubMed] [Google Scholar]
  83. Robinson D. S., Barker E. Tricyclic antidepressant cardiotoxicity. JAMA. 1976 Nov 1;236(18):2089–2090. [PubMed] [Google Scholar]
  84. Schroeder J. S., Bolen J. L., Quint R. A., Clark D. A., Hayden W. G., Higgins C. B., Wexler L. Provocation of coronary spasm with ergonovine maleate. New test with results in 57 patients undergoing coronary arteriography. Am J Cardiol. 1977 Oct;40(4):487–491. doi: 10.1016/0002-9149(77)90060-1. [DOI] [PubMed] [Google Scholar]
  85. Shah K. A., Forman M. D., Friedman H. S. Munchausen's syndrome and cardiac catheterization. A case of a pernicious interaction. JAMA. 1982 Dec 10;248(22):3008–3009. [PubMed] [Google Scholar]
  86. Spandow O., Sökjer H., Tibbling L. Function of the lower oesophageal sphincter in a population selected at random. A manometric, radiological, and questionnaire study. Acta Otolaryngol. 1974 Sep-Oct;78(3-4):295–303. doi: 10.3109/00016487409126359. [DOI] [PubMed] [Google Scholar]
  87. Svensson O., Stenport G., Tibbling L., Wranne B. Oesophageal function and coronary angiogram in patients with disabling chest pain. Acta Med Scand. 1978;204(3):173–178. doi: 10.1111/j.0954-6820.1978.tb08420.x. [DOI] [PubMed] [Google Scholar]
  88. Tillman C. H., Mukerji V., Alpert M. A., Sanfelippo J. F. Isolated coronary ostial stenosis in men. Am Heart J. 1988 May;115(5):1127–1128. doi: 10.1016/0002-8703(88)90088-9. [DOI] [PubMed] [Google Scholar]
  89. Tollefson G., Lesar T., Grothe D., Garvey M. Alprazolam-related digoxin toxicity. Am J Psychiatry. 1984 Dec;141(12):1612–1613. doi: 10.1176/ajp.141.12.1612. [DOI] [PubMed] [Google Scholar]
  90. Vokonas P. S., Cohn P. F., Klein M. D., Laver M. B., Gorlin R. Hemoglobin affinity for oxygen in the anginal syndrome with normal coronary arteriograms. J Clin Invest. 1974 Aug;54(2):409–415. doi: 10.1172/JCI107776. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES