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Possible causes of symptoms in suspected coronary heart disease but normal angiograms
G Mölzer1, J Finsterer, W Krugluger
1Second Medical Department of Rudolfstiftung Hospital, Vienna, Austria.
Insights
In patients with normal coronary angiograms, hypertension and neuromuscular disorders are common causes of cardiac symptoms. Other conditions like tachycardiomyopathy and hypothyroidism also warrant consideration for accurate diagnosis.
Area of Science:
- Cardiology
- Internal Medicine
- Neurology
Background:
- Undiagnosed cardiac symptoms in patients with normal coronary angiograms present a diagnostic challenge.
- Identifying underlying causes is crucial for curable conditions, prognosis, and family screening.
Purpose of the Study:
- To determine the prevalence of specific conditions causing cardiac symptoms in patients with normal coronary angiograms.
- To assess the seroprevalence of microorganisms potentially causing myocardial damage.
Main Methods:
- Consecutive patients with normal coronary angiograms underwent clinical evaluation, ECG, blood tests, and echocardiography.
- Neurological investigations were performed for persistent symptoms or specific echocardiographic findings.
Main Results:
- Hypertension was the most common cause (66%), followed by neuromuscular disorders (13%) and tachycardiomyopathy (9%).
- High seroprevalence of Chlamydia species (90%), Helicobacter pylori (70%), and Chlamydia pneumoniae (63%) was observed.
- A cause remained undetermined in 24% of patients.
Conclusions:
- Hypertension, neuromuscular disorders, tachycardiomyopathy, hypothyroidism, and hemochromatosis are key considerations in patients with cardiac symptoms and normal coronary angiograms.
- Further investigation into these conditions can lead to improved patient outcomes.
Background:
In patients with suspected coronary heart disease and normal angiography, the causes of cardiac symptoms frequently remain undetermined. A correct diagnosis is desirable, however, since some of the underlying disorders may be curable, treatable, influence prognosis, or induce screening of the relatives.
Hypothesis:
In such patients, the prevalence of arterial hypertension, hemochromatosis, hypothyroidism, hypoparathyroidism, tachycardiomyopathy, amyloidosis, and neuromuscular disorders as a possible cause for their symptoms and 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, electrocardiograms, blood tests, and echocardiography. Patients were investigated neurologically if unexplained anginal chest pain or creatine kinase elevation persisted or if echocardiography showed isolated left ventricular abnormal trabeculations.
Results:
In 71 patients (31 women, 40 men, mean age 60 years), the most common cause for cardiac symptoms was hypertension (66%), followed by neuromuscular disorders (13%), tachycardiomyopathy (9%), hypothyroidism (4%), and hemochromatosis (3%). The seroprevalence for Chlamydia species was 90%, Helicobacter pylori 70%, Chlamydia pneumoniae 63%, Borrelia burgdorferi sensu lato 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 angiograms, hypertension, neuromuscular disorders, tachycardiomyopathy, hypothyroidism, and hemochromatosis should be considered as possible causes.