By Juan Carlos Kaski (auth.), Juan Carlos Kaski (eds.)
Angina pectoris with basic coronary arteriograms is a standard entity which has questioned cardiologists virtually because the creation of coronary arteriography. regardless of significant advances within the figuring out of the pathophysiology of angina lately and a large number of experiences at the topic, the reason and mechanisms underlying the syndrome of angina with common coronary arteries stay unknown. certainly, result of investigations are arguable and hypothesis nonetheless prevails concerning the nature of the so known as `Syndrome X'.
virtually each vital point of Syndrome X has been tackled within the e-book and the reader is uncovered not just to the cardiologists' opinion, but in addition to the authoritative perspectives of the gastroenterologists, gynaecologists and psychiatrists, tremendous good represented during this monograph. The booklet bargains with `cardiologists' Syndrome X' and never the metabolic entity termed `Syndrome X'. the potential connection among the 2, despite the fact that, is mentioned.
Angina with general Coronary Arteries: Syndrome X contributes to the certainty of Syndrome X and is helping clinicians deal with their Syndrome X-patients larger and investigators to open new avenues for examine.
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Many afferent nerve fibre terminals in the oesophagus, as in other parts of the gut, appear to be in the form of arborising free nerve endings l2 . Such free nerve endings in the skin are polymodal 33 receptors, responding to several different stimuli. PolymodaI receptors are common in the viscera13, although the anatomical substrate of such electrophysiologically characterised receptors has not been directly demonstrated. Some more specific structures have been put forward as potential sensory receptors in the oesophagus, such as the "intra-ganglionic laminar endings" of Rodrigo 14, laminar nerve endings surrounding small submucosal blood vessels 15 and the parafascicular ganglia of Christensen and Robison l6 .
A number of mechanisms are of potential interest in the context of chest pain of undetermined origin. Firstly, sensitisation of polymodal nociceptors by, for instance, noxious heat has long been recognised in the skin 28 -30 . These receptors then respond to lower intensity mechanical stimuli (ie they have been sensitised). Recent evidence has indicated a similar potential among visceral polymodal receptors, specifically in the testicle31 , colon32 and ureter33 . Although neurophysiological studies are lacking, clinical evidence suggests a similar potential in the human oesophagus 34 .
An important reason for performing oesophageal tests in patients with chest pain of undetermined origin is to attempt to reassure them by positively diagnosing a condition other than heart disease 142. Three recent studies have reported a favourable outcome in patients with non-cardiac chest pain in whom an oesophageal abnormality was demonstrated 112,122,143. However, in all three, the benefit was confined to selected groups of patients. Thus, in one study, it was only possible to demonstrate such a beneficial effect in those who recalled being told of an oesophageal source for their pain 143 .
Angina Pectoris with Normal Coronary Arteries: Syndrome X by Juan Carlos Kaski (auth.), Juan Carlos Kaski (eds.)