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KMID : 0371620020170010027
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Journal of Wonkwang Medical Science
2002 Volume.17 No. 1 p.27 ~ p.45
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Etiology and Clinical Presentation in Patients with Angina-like Chest Pain and Normal Coronary Angiograms
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Yun Kyeong-Ho
Oh Seok-Kyu
Yoo Nam-Jin
Kim Nam-Ho
Jeong Jin-Won
Kim Tae-Hyeon
Lee Myeung-Su
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Abstract
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Background : The obvious clinical differentiation of the histories between vasospastic angina and esophageal disorder is not still clear. The aim of this study is to describe clinical characteristics and incidence of patient with angina-like chest pain and nonspecific findings in coronary angiogram.
Methods : From March 1998 to March 2000, 76 consecutive patient with normal or insignificant coronary arteriographic findings were included. Ergonovine provocation test was performed in all the patients, and for the patients that coronary spasm was not induced, esophago-gastro-duodenoscopy, esophageal manometry, Bernstein test, 24 hour esophageal pH monitor, measurement of esophageal pressure, esophageal pH monitoring under treadmill test were done. To evaluate of clinical features, one physician ascertained history by administered questionnaire.
Results : 1. Of 237 patients that coronary angiography was performed, 76 cases(32%) showed normal or insignificant angiographic findings. Of this patients, 32 cases(42%) revealed vasospastic angina, 22 cases(29%) gastroesophageal reflux, 8 cases(11%) Nutcracker esophagus, and 3 cases(4%) nonspecific esophageal motility disorder. 2. Risk factors of vasospastic angina were male sex and smoking. Vasospastic angina were induced by moderate physical activity rather than exercise and alcohol, especially morning next to alcohol drinking. The chest pain presented early in the morning and in evening, and at night made frequent awakening due to pain. Belching occurred in 38% of patients, and thereafter soon the pain subside. In addition, cold sweat(in 88% of the patients), syncope(19%), nausea(38%), vomiting(22%), and general weakness(38%) were accompanied. 3. Gastroesophageal reflux was more complained in female. It referred to the back in 23% of the patients. The symptom was exacerbated during exercise and improved after taking water or antacid. 72% of the patients had a chronic duration of more than a year, and the pain usually presented in the afternoon. Gastrointestinal symptom revealed in 50% of the patients, but that was not related with chest pain. 4. The incidence of esophageal motility disorder was nearly same in male and female. The pain was radiated to the back in 36% of the patients. The prevalence period was short, and the symptom duration was more than 1 hour in 45% of the patients.
Conclusion : There were some distinguishable characteristics between vasospastic angina and esophageal disorder. Full medical history taking may provide important clues to make diagnosis. We noticed that, belching or liquor is very important history to suggest vasospastic angina. Even though the mechanism was not fully determined, we expect that there would be the specific findings, which different aspects of the medical history, of vasospastic angina and esophageal disorders, respectively.
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KEYWORD
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clinical features, history, vasospastic angina, esophageal disorder
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