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Angiology
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Syndrome of Diminished Vasodilator Reserve of the Coronary Microcirculation (Microvascular Angina or Syndrome X): Diagnosis by Combined Atrial Pacing and Thallium 201 Imaging—A Case Report

Gregory J. Magarian

General Medicine and Cardiology Services, Veterans Administration Medical Center and Oregon Health Sciences University School of Medicine, Portland, Oregon

Robert Palac

General Medicine and Cardiology Services, Veterans Administration Medical Center and Oregon Health Sciences University School of Medicine, Portland, Oregon

Steven Reinhart

General Medicine and Cardiology Services, Veterans Administration Medical Center and Oregon Health Sciences University School of Medicine, Portland, Oregon

Patients with angina-like chest pain without evidence of epicardial coronary artery disease or coronary arterial vasospasm are becoming increasingly recognized. These are often related to noncardiac causes including esophageal, musculoskeletal, and hyperventilatory or panic states. However, recently a subgroup of such patients are being recognized as having true myocardial ischemia and chest pain on the basis of diminished coronary microvascular vasodilatory reserve (microvascular ischemia or Syndrome X). The authors describe such a patient who was found to have replication of anginal pain associated with a reversible ischemic defect on thallium 201 imaging during atrial pacing, suggesting ischemia in this myocardial segment. Resolution of angina and ST segment electrocardiographic changes of ischemia occurred with cessation of pacing. We believe this is the first report of a patient with this form of myocardial ischemia diagnosed by this method and should be considered in patients with anginal chest pain after significant coronary artery disease and coronary vasospasm have been excluded.

Angiology, Vol. 41, No. 8, 667-672 (1990)
DOI: 10.1177/000331979004100813
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This article has been cited by other articles:


Home page
 ANGIOLOGYHome page
J. Schwartz, A. Leibovitz, and B. Habot
Profuse Diaphoresis as the Presenting Symptom of Myocardial Ischemia with Normal Appearance of Coronary Arteriogram A Case Report
Angiology, May 1, 1992; 43(5): 432 - 435.
[Abstract] [PDF]


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