Possible causes of symptoms in suspected coronary heart disease but normalangiograms

Background: In patients with suspected coronary heart disease and normal an giogaphy, the causes of cardiac symptoms frequently remain undetermined. A correct diagnosis is desirable, however, since some of the underlying disor ders may be curable, treatable, influence prognosis, or induce screening of the relatives. Hypothesis: In such patients, the prevalence of arterial hypertension, hemo chromatosis, hypothyroidism, hypoparathyroidism, tachycardiomyopathy amyloi dosis, and neuromuscular disorders as a possible cause for their symptoms a nd the seroprevalence of micro-organisms, known to cause myocardial damage, were assessed. Methods: Consecutive patients with normal coronary angiograms were invited for two visits comprising clinical history and investigation, electrocardio grams, blood tests, and echocardiography. Patients were investigated neurol ogically if unexplained anginal chest pain or creatine kinase elevation per sisted or if echocardiography showed isolated left ventricular abnormal tra beculations. Results: In 71 patients (31 women, 40 men, mean age 60 years), the most com mon cause for cardiac symptoms was hypertension (66%), followed by neuromus cular disorders (13%), tachycardiomyopathy (9%), hypothyroidism (4%), and h emochromatosis (3%). The seroprevalence for Chlamydia species was 90%, Heli cobacter pylori 70%, Chlamydia pneumoniae 63%, Borrelia bulgdorferi sensu l ato 15%, and Rickettsia conorii 10%. No possible cause was found in 24% of the patients. Conclusions: In patients with suspected coronary heart disease and normal a ngiograms, hypertension, neuromuscular disorders, tachycardiomyopathy, hypo thyroidism, and hemochromatosis should be considered as possible causes.