Microvascular angina and the sensitive heart: historical perspective

Area of Science:

• Cardiology
• Gastroenterology
• Pain Research

Background:

• Chest pain of undetermined origin (CPUO) research has evolved from subspecialty-focused to a multidisciplinary approach.
• Initial focus in cardiology and gastroenterology shifted from organ-specific diagnoses to altered pain thresholds.
• Recognition of normal coronary arteries in many CPUO patients prompted investigation into functional causes.

Purpose of the Study:

• To explore the shift in understanding CPUO etiology.
• To investigate the concept of microvascular angina and its limitations.
• To examine the role of abnormal visceral nociception in CPUO.

Main Methods:

• Review of evolving diagnostic concepts in cardiology and gastroenterology for CPUO.
• Identification of abnormal coronary microcirculation responses to stress.
• Evaluation of overlap between cardiac and esophageal motility disorders.

Main Results:

• The concept of "microvascular angina" emerged from studying coronary microcirculation abnormalities.
• Many patients with suspected microvascular angina showed no evidence of ischemia.
• Significant overlap was found with esophageal motility disorders, suggesting broader visceral hypersensitivity.

Conclusions:

• CPUO is increasingly understood through the lens of abnormal visceral nociception.
• The "sensitive heart" and "tender esophagus" concepts represent a paradigm shift in CPUO research.
• Ongoing research focuses on these altered pain perception mechanisms in CPUO.