Frequency of symptoms suggestive of dynamic coronary artery disease in patients referred for coronary angiography

Abstract

The diagnosis of angina pectoris is based on Heberden's original description, which defines angina as chest pain elicited by exertion and relieved by rest. 1 If this definition is used strictly, the diagnosis of angina cannot be assigned to patients having chest pain primarily at rest or not reliably reproduced by exertion. This simplistic view of “classic” exertional angina was based on the belief that myocardial ischemia could only be caused by excessive myocardial oxygen demand in the presence of a hemodynamically significant fixed coronary artery stenosis. Recent data 2 have shown that angina pectoris can result from dynamic processes involving coronary vasoconstriction or transient thrombosis, which may reduce myocardial blood flow and result in ischemia at submaximal levels of cardiac oxygen demand. The term “mixed” angina was proposed for patients who experienced ischemia at variable levels of exertion. 3 Although it has been suggested that mixed angina represents the most common form of angina, no substantiated estimates of its prevalence have been described. We administered a comprehensive questionnaire designed to characterize angina pectoris and, specifically, to quantify the frequency of symptoms suggestive of a vasoactive component (variable threshold angina) in a group of angina patients referred for elective coronary angiography.