Review
Current concepts in medicine
Role of the vascular endothelium in patients with angina
pectoris or acute myocardial infarction with normal coronary arteries
Juan Sztajzel, François Mach, Alberto Righetti
Division of
Cardiology and Medical Policlinics, University Hospital, 24 rue
Micheli-du-Crest, 1211 Geneva 4, Switzerland
Submitted 20 February
1998;
Accepted 5 July 1999
Chest pain with normal coronary angiograms is a relatively
common syndrome. The mode of presentation of this syndrome includes patients with syndrome X and patients with an acute myocardial infarction and angiographically normal coronary arteries. Different mechanisms have been proposed to elucidate the exact cause and to
explain the various clinical presentations in these patients. Abnormalities of pain perception and the presence of oesophageal dysmotility have all been reported in patients with syndrome X. In situ
thrombosis or embolization with subsequent clot lysis and
recanalization, coronary artery spasm, cocaine abuse, and viral
myocarditis have been described as potential mechanisms responsible for
an acute myocardial infarction in patients with angiographically normal
coronary arteries. Recent data suggest that both microvascular and
epicardial endothelial dysfunction may play an important role in the
pathophysiological mechanism of the syndrome of stable angina or acute
myocardial infarction with normal coronary arteries.
Keywords: chest pain; coronary arteries; vascular endothelium; myocardial infarction; angina pectoris; syndrome X
© 2000 by The Fellowship of Postgraduate Medicine
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