Skip to main content
Heart logoLink to Heart
. 1997 Jun;77(6):523–526. doi: 10.1136/hrt.77.6.523

Effect of oral aminophylline in patients with angina and normal coronary arteriograms (cardiac syndrome X).

P M Elliott 1, K Krzyzowska-Dickinson 1, R Calvino 1, C Hann 1, J C Kaski 1
PMCID: PMC484794  PMID: 9227295

Abstract

BACKGROUND: Patients with syndrome X (exertional angina, positive exercise test, normal coronary arteriogram) have an altered perception of cardiac pain. This symptom may arise from increased sensitivity to adenosine. Previous studies suggest that intravenous aminophylline (an adenosine receptor blocker) improves exercise tolerance in patients with this disorder. OBJECTIVE: To examine the efficacy of oral aminophylline in syndrome X. METHODS: 13 patients (11 women and two men, mean (SD) 54 (6) years) with syndrome X were studied. Patients were randomised in a double blind crossover study to receive either oral aminophylline or placebo for three weeks. All patients underwent symptom limited exercise testing and ambulatory electrocardiography at the end of each three week period. RESULTS: 10 patients completed the study. The time to angina during exercise testing in patients who were given aminophylline was longer than for the placebo group (mean (SD) 632 (202) seconds v 522 (264) seconds, P = 0.004). Peak exercise ST depression did not differ significantly between patients who received aminophylline and those administered placebo (mean (SD) -1.9 (0.7) mm v -1.5 (0.8) mm). Six patients taking aminophylline reported a reduction in the total number of episodes of chest pain during the three weeks, but the frequency and duration of ST segment depression during Holter monitoring was unchanged. CONCLUSION: Oral aminophylline has a favourable effect on exercise induced chest pain threshold in patients with syndrome X. The disparate effects on symptoms and ST segment changes are intriguing and further study is warranted.

Full text

PDF
523

Selected References

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

  1. Cannon R. O., 3rd, Epstein S. E. "Microvascular angina" as a cause of chest pain with angiographically normal coronary arteries. Am J Cardiol. 1988 Jun 1;61(15):1338–1343. doi: 10.1016/0002-9149(88)91180-0. [DOI] [PubMed] [Google Scholar]
  2. 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]
  3. Chauhan A., Mullins P. A., Thuraisingham S. I., Taylor G., Petch M. C., Schofield P. M. Abnormal cardiac pain perception in syndrome X. J Am Coll Cardiol. 1994 Aug;24(2):329–335. doi: 10.1016/0735-1097(94)90284-4. [DOI] [PubMed] [Google Scholar]
  4. Crea F., Pupita G., Galassi A. R., el-Tamimi H., Kaski J. C., Davies G. J., Maseri A. Comparative effects of theophylline and isosorbide dinitrate on exercise capacity in stable angina pectoris, and their mechanisms of action. Am J Cardiol. 1989 Nov 15;64(18):1098–1102. doi: 10.1016/0002-9149(89)90859-x. [DOI] [PubMed] [Google Scholar]
  5. Crea F., Pupita G., Galassi A. R., el-Tamimi H., Kaski J. C., Davies G., Maseri A. Role of adenosine in pathogenesis of anginal pain. Circulation. 1990 Jan;81(1):164–172. doi: 10.1161/01.cir.81.1.164. [DOI] [PubMed] [Google Scholar]
  6. Emdin M., Picano E., Lattanzi F., L'Abbate A. Improved exercise capacity with acute aminophylline administration in patients with syndrome X. J Am Coll Cardiol. 1989 Nov 15;14(6):1450–1453. doi: 10.1016/0735-1097(89)90380-x. [DOI] [PubMed] [Google Scholar]
  7. Heller G. V., Barbour M. M., Dweik R. B., Corning J. J., McClellan J. R., Garber C. E. Effects of intravenous theophylline on exercise-induced myocardial ischemia. I. Impact on the ischemic threshold. J Am Coll Cardiol. 1993 Apr;21(5):1075–1079. doi: 10.1016/0735-1097(93)90227-r. [DOI] [PubMed] [Google Scholar]
  8. Inobe Y., Kugiyama K., Morita E., Kawano H., Okumura K., Tomiguchi S., Tsuji A., Kojima A., Takahashi M., Yasue H. Role of adenosine in pathogenesis of syndrome X: assessment with coronary hemodynamic measurements and thallium-201 myocardial single-photon emission computed tomography. J Am Coll Cardiol. 1996 Oct;28(4):890–896. doi: 10.1016/s0735-1097(96)00271-9. [DOI] [PubMed] [Google Scholar]
  9. Kaski J. C., Crea F., Nihoyannopoulos P., Hackett D., Maseri A. Transient myocardial ischemia during daily life in patients with syndrome X. Am J Cardiol. 1986 Dec 1;58(13):1242–1247. doi: 10.1016/0002-9149(86)90390-5. [DOI] [PubMed] [Google Scholar]
  10. Kaski J. C., Rosano G. M., Collins P., Nihoyannopoulos P., Maseri A., Poole-Wilson P. A. Cardiac syndrome X: clinical characteristics and left ventricular function. Long-term follow-up study. J Am Coll Cardiol. 1995 Mar 15;25(4):807–814. doi: 10.1016/0735-1097(94)00507-M. [DOI] [PubMed] [Google Scholar]
  11. Lagerqvist B., Sylvén C., Beermann B., Helmius G., Waldenström A. Intracoronary adenosine causes angina pectoris like pain--an inquiry into the nature of visceral pain. Cardiovasc Res. 1990 Aug;24(8):609–613. doi: 10.1093/cvr/24.8.609. [DOI] [PubMed] [Google Scholar]
  12. Lagerqvist B., Sylvén C., Waldenström A. Lower threshold for adenosine-induced chest pain in patients with angina and normal coronary angiograms. Br Heart J. 1992 Sep;68(3):282–285. doi: 10.1136/hrt.68.9.282. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. 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]
  14. Maseri A., Crea F., Kaski J. C., Crake T. Mechanisms of angina pectoris in syndrome X. J Am Coll Cardiol. 1991 Feb;17(2):499–506. doi: 10.1016/s0735-1097(10)80122-6. [DOI] [PubMed] [Google Scholar]
  15. 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]
  16. Picano E., Pogliani M., Lattanzi F., Distante A., L'Abbate A. Exercise capacity after acute aminophylline administration in angina pectoris. Am J Cardiol. 1989 Jan 1;63(1):14–16. doi: 10.1016/0002-9149(89)91067-9. [DOI] [PubMed] [Google Scholar]
  17. Rosen S. D., Uren N. G., Kaski J. C., Tousoulis D., Davies G. J., Camici P. G. Coronary vasodilator reserve, pain perception, and sex in patients with syndrome X. Circulation. 1994 Jul;90(1):50–60. doi: 10.1161/01.cir.90.1.50. [DOI] [PubMed] [Google Scholar]
  18. Shapiro L. M., Crake T., Poole-Wilson P. A. Is altered cardiac sensation responsible for chest pain in patients with normal coronary arteries? Clinical observation during cardiac catheterisation. Br Med J (Clin Res Ed) 1988 Jan 16;296(6616):170–171. doi: 10.1136/bmj.296.6616.170-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Sylvén C., Beermann B., Jonzon B., Brandt R. Angina pectoris-like pain provoked by intravenous adenosine in healthy volunteers. Br Med J (Clin Res Ed) 1986 Jul 26;293(6541):227–230. doi: 10.1136/bmj.293.6541.227. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Sylvén C., Jonzon B., Brandt R., Beermann B. Adenosine-provoked angina pectoris-like pain--time characteristics, influence of autonomic blockade and naloxone. Eur Heart J. 1987 Jul;8(7):738–743. doi: 10.1093/eurheartj/8.7.738. [DOI] [PubMed] [Google Scholar]
  21. Sylvén C., Jonzon B., Edlund A. Angina pectoris-like pain provoked by i.v. bolus of adenosine: relationship to coronary sinus blood flow, heart rate and blood pressure in healthy volunteers. Eur Heart J. 1989 Jan;10(1):48–54. doi: 10.1093/oxfordjournals.eurheartj.a059380. [DOI] [PubMed] [Google Scholar]
  22. Sylvén C. Mechanisms of pain in angina pectoris--a critical review of the adenosine hypothesis. Cardiovasc Drugs Ther. 1993 Nov;7(5):745–759. doi: 10.1007/BF00878926. [DOI] [PubMed] [Google Scholar]
  23. Thames M. D., Kinugawa T., Dibner-Dunlap M. E. Reflex sympathoexcitation by cardiac sympathetic afferents during myocardial ischemia. Role of adenosine. Circulation. 1993 May;87(5):1698–1704. doi: 10.1161/01.cir.87.5.1698. [DOI] [PubMed] [Google Scholar]
  24. Turiel M., Galassi A. R., Glazier J. J., Kaski J. C., Maseri A. Pain threshold and tolerance in women with syndrome X and women with stable angina pectoris. Am J Cardiol. 1987 Sep 1;60(7):503–507. doi: 10.1016/0002-9149(87)90294-3. [DOI] [PubMed] [Google Scholar]
  25. Yoshio H., Shimizu M., Kita Y., Ino H., Kaku B., Taki J., Takeda R. Effects of short-term aminophylline administration on cardiac functional reserve in patients with syndrome X. J Am Coll Cardiol. 1995 Jun;25(7):1547–1551. doi: 10.1016/0735-1097(95)00097-n. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES