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Musculo-skeletal pathology in patients with angina pectoris and normal coronary angiograms
O Frøbert1, J Fossgreen, J Søndergaard-Petersen
1Department of Cardiology, Skejby Hospital, University Hospital Aarhus, Denmark. frobert@inet.uni2.dk
Insights
Patients with angina despite normal coronary angiograms showed more musculoskeletal issues. These findings suggest a potential link between chest pain and the musculoskeletal system, warranting further investigation.
Area of Science:
- Cardiology
- Musculoskeletal Medicine
- Pain Management
Background:
- Angina pectoris with normal coronary angiograms (INOCA) affects a significant patient population.
- The etiology of INOCA remains incompletely understood, with various contributing factors proposed.
- Musculoskeletal factors are increasingly recognized as potential contributors to chest pain syndromes.
Purpose of the Study:
- To investigate the role of the musculoskeletal apparatus in patients experiencing angina pectoris with normal coronary angiograms.
- To compare musculoskeletal findings between patients with INOCA and healthy controls.
- To identify specific musculoskeletal abnormalities associated with INOCA.
Main Methods:
- A survey and blinded physical examination of patients with INOCA and healthy controls.
- Assessment included chest wall complaints, spinal radiography, and physical examination findings.
- Pressure pain thresholds and neurological examinations were also conducted.
Main Results:
- Patients with INOCA reported significantly more neck, chest, and thoracic spine pain, with radiation to the arms, compared to controls.
- Radiographic examination revealed more degenerative spinal findings in patients, primarily at cervical levels C4-C7.
- Physical examination identified significantly more abnormalities in the chest wall, thoracic spine (Th1-Th6), and neck/shoulder girdle muscles in the INOCA group.
Conclusions:
- Musculoskeletal abnormalities are prevalent in patients with angina pectoris and normal coronary angiograms.
- These findings may involve reflex mechanisms contributing to chest pain.
- Further research is needed to determine if these musculoskeletal abnormalities are a primary cause or secondary epiphenomena of INOCA symptoms.
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 normal resting electrocardiograms. No patients showed evidence of left ventricular 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 women 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 neck, chest, and thoracic spine, and sensations and pain radiating to the arms than the controls. The patients had more degenerative findings on radiograph 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 at levels Th1-Th6 and in the muscles of the neck and shoulder girdle. There were no statistically significant differences in pain thresholds or in neurological examination.
Conclusion:
The musculo-skeletal abnormalities observed in the patients could include reflex mechanisms. Whether the abnormal findings are mainly responsible for the angina pectoris symptoms or merely epiphenomena warrants further study.