Musculo-skeletal pathology in patients with angina pectoris and normal coronary angiograms

Purpose. To evaluate the role of the musculo-skeletal apparatus in patients with angina pectoris despite normal coronary angiograms. Design. A survey of patients and controls investigated by blinded observers . Setting. A tertiary cardiologic referral centre. Subjects, Thirty women and 18 men (mean age 52.9 years) with chest pain of an average duration of 3 years and 11 months were investigated. All had nor mal resting electrocardiograms. No patients showed evidence of left ventric ular hypertrophy or valvular heart disease on echocardiography and all had a normal coronary angiogram. All had left ventricular ejection fraction >50 %, and none had signs of coronary vasospasm, Eighteen healthy persons (10 w omen and eight men, mean age 51.2 years) served as controls. Main outcome measures. The group frequency of chest wall complaints, spinal radiograph and physical examination findings; pressure pain thresholds. Results, The patients had significantly more complaints of pain from the ne ck, chest, and thoracic spine, and sensations and pain radiating to the arm s than the controls. The patients had more degenerative findings on radiogr aph than the controls, mainly at levels C4-C7. Physical examination showed that abnormal findings were significantly more frequent in patients than in the control group in the anterior and posterior chest wall, in the spine a t levels Th1-Th6 and in the muscles of the neck and shoulder girdle. There were no statistically significant differences in pain thresholds or in neur ological examination. Conclusion, The musculo-skeletal abnormalities observed in the patients cou ld include reflex mechanisms. Whether the abnormal findings are mainly resp onsible for the angina pectoris symptoms or merely epiphenomena warrants fu rther study.