Related Experiment Video
Updated: Sep 12, 2026
Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
Lower threshold for adenosine-induced chest pain in patients with angina and normal coronary angiograms
B Lagerqvist1, C Sylvén, A Waldenström
1Department of Internal Medicine, University Hospital, Uppsala, Sweden.
Insights
Patients with angina-like chest pain and normal coronary arteries are more sensitive to adenosine-induced chest pain. They experience pain at lower doses and have less tolerance, indicating a heightened pain response.
Area of Science:
- Cardiology
- Pain Research
Background:
- Angina-like chest pain with normal coronary angiograms is a common clinical problem.
- The underlying mechanisms for this condition are not fully understood.
Purpose of the Study:
- To determine if patients with angina-like chest pain and normal coronary arteries exhibit increased sensitivity to adenosine-induced chest pain compared to patients with coronary stenoses and healthy controls.
Main Methods:
- A single-blind study involving intravenous bolus injections of increasing adenosine doses.
- Chest pain and electrocardiographic changes were monitored in three groups: patients with normal coronaries (group A), patients with coronary stenoses (group B), and healthy volunteers (group C).
Main Results:
- Adenosine provoked angina-like pain in all patients in groups A and B, indistinguishable from their usual angina.
- Group A patients reported chest pain at significantly lower adenosine doses (0.9 mg) than group B (3.1 mg) and group C (6.2 mg).
- Maximum tolerable adenosine doses were also significantly lower in group A (4.7 mg) compared to group B (9.2 mg) and group C (12.0 mg).
Conclusions:
- Patients experiencing angina-like chest pain despite normal coronary angiograms demonstrate a heightened sensitivity and reduced tolerance to adenosine-induced pain.
- This suggests a potential hypersensitivity to adenosine or related pathways in this patient population.
Objective:
To investigate whether patients with angina-like chest pain and normal coronary angiograms are more sensitive to adenosine as an inducer of chest pain.
Design:
Increasing doses of adenosine were given in a single blind study as intravenous bolus injections. Chest pain and the electrocardiographic findings were noted.
Patients:
Eight patients with angina-like chest pain but no coronary stenoses (group A), nine patients with angina and coronary stenoses (group B), and 16 healthy volunteers (group C).
Results:
In the absence of ischaemic signs on the electrocardiogram adenosine provoked angina-like pain in all patients in groups A and B. The pain was located in the chest, and its quality and location were described as being no different from the patient's habitual angina. In group C, 14 of 16 subjects reported chest pain. The lowest dose resulting in chest pain was lower in group A (0.9 (0.6) mg) than in group B (3.1 (1.5)mg) (p < 0.005) and in group C (6.2 (3.7) mg) (p < 0.005). The maximum tolerable dose was lower in group A (4.7 (2.1) mg) than in group B (9.2 (3.8) mg) (p < 0.05) and in group C (12.0 (4.1) mg) (p < 0.005).
Conclusions:
Patients with angina-like chest pain and normal coronary angiograms have a low pain threshold and low tolerance to pain induced by adenosine.
Related Concept Videos
01:16Antianginal Drugs: Nitrates and β-Blockers
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow. Administered...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Angina I: Introduction
01:27Angina II: Classification
01:29Angina III: Clinical Manifestations and Assessment
01:20Angina V: Nursing Management