Wv. Harford, THE SYNDROME OF ANGINA-PECTORIS - ROLE OF VISCERAL PAIN PERCEPTION, The American journal of the medical sciences, 307(4), 1994, pp. 305-315
Angina pectoris is a pain syndrome caused by coronary arteriosclerosis
but also by a number of other disorders, including microvascular angi
na, gastroesophageal reflux (GER), and esophageal dysmotility. The rel
ationship between abnormal physiology and pain in these conditions is
complex. Simultaneous ambulatory monitoring of esophageal pH and motil
ity has demonstrated that patients may have identical episodes of ches
t pain with acid reflux, dysmotility, both types of events, or neither
. Patients may have anginal chest pain with inflation of an esophageal
balloon, and patients with microvascular angina may have pain with ca
theter manipulation in the right atrium. Recent evidence suggests that
disorders of visceral pain perception may play a role in both chest p
ain of esophageal origin and microvascular angina. The physiology of v
isceral pain is reviewed, including concepts of convergence of somatic
and visceral afferent input, descending modulation of pain perception
, and sensitization of visceral pain afferents. An approach to evaluat
ion and treatment of chest pain in patients with angiographically norm
al coronary arteries is outlined.