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Mechanisms of angina
  1. M J Quinn
  1. Dr M J Quinn, 38 Harwood Road, Fulham, London SW6 4PH, UK; mjquinn001{at}btinternet.com

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To the editor: Angina is traditionally thought to be “ischaemic” in origin with increasing demands for blood in the myocardium giving rise to visceral pain. Prolonged ischaemia leads to myocardial infarction. The prognosis for each condition may depend on their varying aetiologies.1 Recent studies demonstrate aberrant myocardial reinnervation in ventricular arrhythmias, cardiomyopathies and after myocardial infarction; in some circumstances periarteriolar reinnervation takes place.2

Concentric layers of periarteriolar nerves occur in uterine smooth muscle causing sustained, visceral pain in the week before menstruation.3 These lesions often accompany widespread aberrant reinnervation in specific areas of uterine muscle, specifically the uterine isthmus where primary neurovascular bundles enter the viscus. Sources of injury include persistent straining during defecation and traumatic injuries sustained in childbirth.3 4

Few gynaecologists are familiar with the morphology of the inferior hypogastric and uterovaginal plexi.5 Widespread use of formalin to preserve cadavers for medical education in the post-war years, selectively destroys fine, autonomic nerves.5 However, both uterine and cardiac ganglia were familiar to 19th century anatomists dissecting fresh cadaveric material.6 Does periarteriolar reinnervation, or, aberrant myocardial reinnervation, account for some forms of angina or acute myocardial infarction, and their varying prognoses?

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