Harford W V
Department of Veterans Affairs Medical Center, Dallas, Texas 75216.
Am J Med Sci. 1994 Apr;307(4):305-15. doi: 10.1097/00000441-199404000-00011.
Angina pectoris is a pain syndrome caused by coronary arteriosclerosis but also by a number of other disorders, including microvascular angina, gastroesophageal reflux (GER), and esophageal dysmotility. The relationship between abnormal physiology and pain in these conditions is complex. Simultaneous ambulatory monitoring of esophageal pH and motility has demonstrated that patients may have identical episodes of chest pain with acid reflux, dysmotility, both types of events, or neither. Patients may have anginal chest pain with inflation of an esophageal balloon, and patients with microvascular angina may have pain with catheter manipulation in the right atrium. Recent evidence suggests that disorders of visceral pain perception may play a role in both chest pain of esophageal origin and microvascular angina. The physiology of visceral pain is reviewed, including concepts of convergence of somatic and visceral afferent input, descending modulation of pain perception, and sensitization of visceral pain afferents. An approach to evaluation and treatment of chest pain in patients with angiographically normal coronary arteries is outlined.
心绞痛是一种疼痛综合征，其病因不仅包括冠状动脉粥样硬化，还包括许多其他病症，如微血管性心绞痛、胃食管反流（GER）和食管运动障碍。在这些情况下，异常生理与疼痛之间的关系很复杂。同时进行食管pH值和运动的动态监测表明，患者可能出现与胃酸反流、运动障碍、两种情况都有或两者都没有的相同胸痛发作。食管气囊充气时患者可能出现心绞痛样胸痛，而微血管性心绞痛患者在右心房进行导管操作时可能出现疼痛。最近的证据表明，内脏痛觉障碍可能在食管源性胸痛和微血管性心绞痛中都起作用。本文综述了内脏痛的生理学，包括躯体和内脏传入输入的汇聚概念、痛觉的下行调节以及内脏痛传入神经的敏化。概述了对冠状动脉造影正常的胸痛患者的评估和治疗方法。
