Central neural contribution to the perception of chest pain in cardiac syndrome X

Heart. 2002 Jun;87(6):513-9. doi: 10.1136/heart.87.6.513.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angina Pectoris / physiopathology*
  • Brain / physiology
  • Cardiotonic Agents
  • Cerebrovascular Circulation / physiology
  • Coronary Disease / complications
  • Coronary Disease / physiopathology
  • Dobutamine
  • Echocardiography, Stress / methods
  • Female
  • Humans
  • Male
  • Microvascular Angina / physiopathology*
  • Middle Aged
  • Neural Conduction / physiology*
  • Perception / physiology
  • Tomography, Emission-Computed / methods

Substances

  • Cardiotonic Agents
  • Dobutamine