Angina with normal coronary angiograms

Cardiologists have struggled for 40 years with patients with angina-like chest pain whose coronary angiograms show no evidence of obstructive coronary artery disease. This is an enigmatic condition that keeps cardiologists awake at night. Patients are usually women, aged 40 to 50 years of age, with typical descriptions of chest pain consistent with angina pectoris. Abnormal non-invasive testing leads to coronary arteriography that shows no signs of coronary artery stenosis - unsettling for both doctor and patient.

Clearly there may be a variety of aetiologies. Persistent and sustained stress may cause such clinical presentations and are benign if the stressors are recognised and removed. A second pattern has resonance in the myometrium. Many women present with premenstrual pain associated with perivascular nerve fibre proliferation. This lesion is caused by injuries during childbirth and, more purely, through persistent physical efforts during defaecation (Fig 1). There are similar lesions in all pelvic organs. Similar patterns have been described in the myocardium by the UCLA group (Chen, et al, many papers). Women have markedly more problems with "constipation" compared to men particularly in their post-reproductive years resulting in a wide range of disorders and diseases, at different ages.

The cardiac plexus sits among the pulmonary veins on the posterior surface of the left atrium. It is rarely seen by cardiologists, the coeliac plexus is rarely seen by diabetologists and the hypogastric plexus almost never seen by gynaecologists. These autonomic plexi may be the source of many Western diseases.

http://www.ncbi.nlm.nih.gov/pubmed/19712795?ordinalpos=4&itool=Email.EmailReport.Pubmed_ReportSelector.Pubmed_RVDocSum