Central neural contribution to the perception of chest pain in cardiac syndrome X. Issue 6 (1st June 2002)

• Record Type: Journal Article
• Authors: Rosen, S D; Paulesu, E; Wise, R J S; Camici, P G
• Is Part Of: Heart. Volume 87:Issue 6(2002)
• Page Start: 513
• Page End: 519
• Publication Date: 2002-06-01
• Subjects: syndrome X -- chest pain -- regional cerebral blood flow; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heart.87.6.513
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: To investigate the central neural contribution to chest pain perception in cardiac syndrome X (angina-like pain, ECG changes during stress, angiographically normal coronary arteriogram). Subjects: Eight syndrome X patients and eight healthy volunteers. Methods: Dobutamine stress using echocardiography to assess myocardial function, and positron emission tomography to measure changes in regional cerebral blood flow, as an index of neuronal activity. Results: During similar doses of dobutamine, syndrome X patients and controls showed comparable regional cerebral blood flow changes in the hypothalamus, thalami, right orbito-frontal cortex, and anterior temporal poles, associated with the sensation of a fast or powerful heart beat. In patients, but not controls, the stress also generated severe chest pain associated with increased activity in the right anterior insula/frontal operculum junction. There were ischaemia-like ECG changes in the syndrome X patients, but no left ventricular dysfunction on echocardiography. Activation of the right insula during chest pain clearly distinguished the syndrome X patients from a group of patients with known coronary disease. Conclusions: Chest pain and ECG changes were not accompanied by demonstrable myocardial dysfunction in syndrome X patients, but altered central neural handling of afferent signals may contribute to the abnormal pain perception in these patients.