ESOPHAGEAL DYSFUNCTION AS A CAUSE OF ANGINA-PECTORIS (LINKED ANGINA) - DOES IT EXIST

Purpose: The differentiation between cardiac and esophageal causes of retrosternal chest pain is notoriously difficult. Theoretically, cardi ac and esophageal causes may coexist. It has also been reported that g astroesophageal reflux and esophageal motor abnormalities may elicit m yocardial ischemia and chest pain, a phenomenon called linked angina p ectoris. The aim of this study was to assess the incidence of esophage al abnormalities as a cause of retrosternal chest pain in patients wit h previously documented coronary artery disease. Patients and methods: Thirty consecutive patients were studied, all of whom had undergone c oronary arteriography. The patients were studied after they were admit ted to the coronary care unit with an attack of typical chest pain. On electrocardiograms (ECGs) taken during pain, 15 patients (group I) ha d new signs of ischemia; the other 15 patients (group II) did not. In none of the patients were cardiac enzymes elevated. As soon as possibl e, but within 2 hours after admission, combined 24-hour recording of e sophageal pressure and pH was performed. During chest pain, 12-lead EC G recording was carried out. In group I, all 15 patients experienced o ne or more pain episodes during admission, 25 of which were associated with ischemic electrocardiographic changes. The other two episodes we re reflux-related. Only one of the 25 ischemia-associated pain episode s was also reflux-related, ie, it was preceded by a reflux episode. In group II, 19 chest pain episodes occurred in 11 patients. None of the se was associated with electrocardiographic changes, but 8 were associ ated with reflux (42%) and 8 with abnormal esophageal motility (42%). Conclusion: Linked angina is a rare phenomenon.