{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T06:41:24Z","timestamp":1773643284346,"version":"3.50.1"},"reference-count":47,"publisher":"BMJ","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"published-print":{"date-parts":[[1996,5]]},"abstract":"<jats:p>OBJECTIVE: To evaluate the role of nociception in patients with angina despite normal coronary angiograms and to investigate whether any abnormality is confined to visceral or somatosensory perception. METHODS: Perception, pain threshold, and brain evoked potentials to nociceptive electrical stimuli of the oesophageal mucosa and the sternal skin were investigated in 10 patients who had angina but normal coronary angiograms, no other signs of cardiac disease, and normal upper endoscopy. Controls were 10 healthy volunteers. The peaks of the evoked potential signal were designated N for negative deflections and P for positive. Numbers were given to the peaks in order of appearance after the stimulus. The peak to peak amplitudes (P1\/N1, N1\/P2) were measured in microV. RESULTS: (1) Angina pectoris was provoked in seven patients following continuous oesophageal stimulation. (2) Distant projection of pain occurred after continuous electrical stimulation of the oesophagus in four patients and in no controls. (3) Patients had higher oesophageal pain thresholds (median 16.3 mA v 7.3 mA, P = 0.02) to repeated stimuli than controls, whereas the values did not differ with respect to the skin. There were no intergroup differences in thresholds to single stimuli. (4) Patients had substantially reduced brain evoked potential amplitudes after both single oesophageal (P1\/N1, median values: 7.2 microV, controls: 29.0 microV; N1\/P2: 16.5 microV, controls: 66.0 microV; P &lt; 0.001 for both) and skin (N1\/P2: 13.5 microV; controls: 76.0 microV; P &lt; 0.001) stimuli despite the similar pain thresholds. CONCLUSION: Central nervous system responses to visceral and somatosensory nociceptive input are altered in patients who have angina despite normal coronary angiograms.<\/jats:p>","DOI":"10.1136\/hrt.75.5.436","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:46:00Z","timestamp":1190137560000},"page":"436-441","source":"Crossref","is-referenced-by-count":36,"title":["Pain perception and brain evoked potentials in patients with angina despite normal coronary angiograms."],"prefix":"10.1136","volume":"75","author":[{"given":"O.","family":"Fr\u00f8bert","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Arendt-Nielsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Bak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Funch-Jensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Peder Bagger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1996,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/0735-1097(90)90377-2","article-title":"Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries","volume":"16","author":"Cannon, R.O.; Quyyumni, A.A.; Schenke, W.H.","year":"1990","unstructured":"Cannon RO, Quyyumni AA, Schenke WH, et al. Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. JAm Coil Cardiol 1990;16:1359-66.","journal-title":"JAm Coil Cardiol"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1136\/bmj.296.6616.170-a","article-title":"Is altered cardiac sensation responsible for chest pain in patients with normal coronary arteries? Clinical observation during cardiac catheterisation","volume":"296","author":"Shapiro, L.M.; Crake, T.; Poole Wilson, P.A.","year":"1988","unstructured":"Shapiro LM, Crake T, Poole Wilson PA. Is altered cardiac sensation responsible for chest pain in patients with normal coronary arteries? Clinical observation during cardiac catheterisation. Br Med Y Clin Res Ed 1988;296: 170-1.","journal-title":"Br Med Y Clin Res Ed"},{"key":"ref_3","first-page":"282","article-title":"Lower threshold for adenosine-induced chest pain in patients with angina and normal coronary angiograms","volume-title":"Br Heart _J","volume":"68","author":"Lagerqvist, B.; Sylven, C.; Waldenstrom, A.","year":"1992","unstructured":"Lagerqvist B, Sylven C, Waldenstrom A. Lower threshold for adenosine-induced chest pain in patients with angina and normal coronary angiograms. Br Heart _J 1992;68: 282-5."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1161\/01.CIR.63.4.817","article-title":"Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms","volume":"63","author":"Opherk, D.; Zebe, H.; Weihe, E.","year":"1981","unstructured":"Opherk D, Zebe H, Weihe E, et al. Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation 1981;63:817-25.","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1016\/0002-9149(94)90177-5","article-title":"Abnormal autonomic control of the cardiovascular system in syndrome X","volume":"73","author":"Rosano, G.M.; Ponikowski, P.; Adamopoulos, S.","year":"1994","unstructured":"Rosano GM, Ponikowski P, Adamopoulos S, et al. Abnormal autonomic control of the cardiovascular system in syndrome X. Am _J Cardiol 1994;73:1174-9.","journal-title":"Am _J Cardiol"},{"issue":"41","key":"ref_6","first-page":"143","article-title":"Differentiation of oesophageal pain from angina pectoris: role of the oesophageal acid perfusion test","volume":"1962","author":"Bernstein, L.M.; Fruin, R.C.; Pacini, R.","unstructured":"Bernstein LM, Fruin RC, Pacini R. Differentiation of oesophageal pain from angina pectoris: role of the oesophageal acid perfusion test. Medicine 1962;41: 143-62.","journal-title":"Medicine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1007\/BF01072186","article-title":"Oesophageal manometrics in patients with angina-like chest pain","volume":"22","author":"Brand, D.L.; Martin, D.; Pope, C.E.","year":"1977","unstructured":"Brand DL, Martin D, Pope CE. Oesophageal manometrics in patients with angina-like chest pain. Dig Dis 1977;22: 300-4.","journal-title":"Dig Dis"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/0002-9343(90)90145-4","article-title":"Coronary flow reserve, oesophageal motility, and chest pain in patients with angiographically normal coronary arteries","volume":"88","author":"Cannon, R.O.; Cattau, E.L.; Yakshe, P.N.","year":"1990","unstructured":"Cannon RO, Cattau EL, Yakshe PN, et al. Coronary flow reserve, oesophageal motility, and chest pain in patients with angiographically normal coronary arteries. Am _J Med 1990;88:217-22.","journal-title":"Am _J Med"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/0022-3999(87)90078-X","article-title":"Acute chest pain without obvious organic cause before age 40-personality and recent life events","volume":"31","author":"Roll, M.; Theorell, T.","year":"1987","unstructured":"Roll M, Theorell T. Acute chest pain without obvious organic cause before age 40-personality and recent life events. _J Psychosom Res 1987;31:215-21.","journal-title":"_J Psychosom Res"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1136\/pgmj.64.756.743","article-title":"Angina-like chest pain: a joint medical and psychiatric investigation","volume":"64","author":"Colgan, S.M.; Schofield, P.M.; Whorwell, P.J.; Bennett, D.H.; Brooks, N.H.; Jones, P.E.","year":"1988","unstructured":"Colgan SM, Schofield PM, Whorwell PJ, Bennett DH, Brooks NH, Jones PE. Angina-like chest pain: a joint medical and psychiatric investigation. Postgrad Med _J 1988;64:743-6.","journal-title":"Postgrad Med _J"},{"key":"ref_11","first-page":"\"33","article-title":"Panic disorder in patients with angiographically normnal coronary arteries","volume":"92","author":"Beitman, B.D.","year":"1992","unstructured":"Beitman BD. Panic disorder in patients with angiographically normnal coronary arteries. Am Jf Med 1992;92: 33-40S. 14 Nachlas IW. Pseudo-angina pectoris originating in the cervical spine. JAMA 1934;103:323-5.","journal-title":"Am Jf Med; Nachlas IW. Pseudo-angina pectoris originating in the cervical spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1136\/bmj.1.4649.332","article-title":"Pain in the chest wall simulating heart disease","volume":"i:","author":"Allison, DR","year":"1950","unstructured":"Allison DR. Pain in the chest wall simulating heart disease. BMJ 1950;i:332-6.","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1056\/NEJM194806172382501","article-title":"Osteoarthritis of the cervicodorsal spine (radiculitis) simulating coronary-artery disease. Clinical and roentgenologic findings","volume":"238","author":"Davis, D.; Ritvo, M.","year":"1948","unstructured":"Davis D, Ritvo M. Osteoarthritis of the cervicodorsal spine (radiculitis) simulating coronary-artery disease. Clinical and roentgenologic findings. N Engl Jf Med 1948;238: 857-66.","journal-title":"N Engl Jf Med"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/BF01307534","article-title":"Chest pain as a consequence of abnormal visceral nociception","volume":"38","author":"Cannon, R.O.; Benjamin, S.B.","year":"1993","unstructured":"Cannon RO, Benjamin SB. Chest pain as a consequence of abnormal visceral nociception. Dig Dis Sci 1993;38: 193-6.","journal-title":"Dig Dis Sci"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1056\/NEJM199405193302003","article-title":"Imipramine in patients with chest pain despite normal coronary angiograms","volume":"330","author":"Cannon, R.O.; Quyyumi, A.A.; Mincemoyer, R.","year":"1994","unstructured":"Cannon RO, Quyyumi AA, Mincemoyer R, et al. Imipramine in patients with chest pain despite normal coronary angiograms. N EnglJfMed 1994;330:1411-7.","journal-title":"N EnglJfMed"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1093\/oxfordjournals.eurheartj.a061668","article-title":"Prevalence of vasospastic ischaemia induced by the cold pressor test or hyperventilation in patients with severe angina","volume":"5","author":"Rasmussen, K.; Bagger, J.P.; Bottzauw, J.; Henningsen, P.","year":"1984","unstructured":"Rasmussen K, Bagger JP, Bottzauw J, Henningsen P. Prevalence of vasospastic ischaemia induced by the cold pressor test or hyperventilation in patients with severe angina. EurHeartJ 1984;5:354-61.","journal-title":"EurHeartJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/j.1475-097X.1985.tb00756.x","article-title":"Reproducibility of coronary haemodynamics and cardiac metabolism during pacing-induced angina pectoris","volume":"5","author":"Bagger, J.P.; Nielsen, T.T.; Thomassen, A.","year":"1985","unstructured":"Bagger JP, Nielsen TT, Thomassen A. Reproducibility of coronary haemodynamics and cardiac metabolism during pacing-induced angina pectoris. Clin Physiol 1985;5: 359-70.","journal-title":"Clin Physiol"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1136\/jnnp.53.5.398","article-title":"First pain event related potentials to argon laser stimuli: recording and quantification","volume":"53","author":"Arendt-Nielsen, L.","year":"1990","unstructured":"Arendt-Nielsen L. First pain event related potentials to argon laser stimuli: recording and quantification. JfNeurol Neurosurg Psychiatry 1990;53:398-404.","journal-title":"JfNeurol Neurosurg Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/0165-0270(88)90054-4","article-title":"Selective averaging of argon laser induced pre-pain and pain related cortical responses","volume":"24","author":"Arendt-Nielsen, L.; Bjerring, P.","year":"1988","unstructured":"Arendt-Nielsen L, Bjerring P. Selective averaging of argon laser induced pre-pain and pain related cortical responses. Neurosci Methods 1988;24:117-23.","journal-title":"Neurosci Methods"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/0304-3959(91)90202-9","article-title":"Cerebral eventrelated responses induced by CO2 laser stimulation in subjects suffering from cervico-brachial syndrome","volume":"47","author":"Gibson, S.J.; Le Vasseur, S.A.; Helme, R.D.","year":"1991","unstructured":"Gibson SJ, Le Vasseur SA, Helme RD. Cerebral eventrelated responses induced by CO2 laser stimulation in subjects suffering from cervico-brachial syndrome. Pain 1991;47:173-82.","journal-title":"Pain"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1136\/gut.33.3.298","article-title":"Cerebral potentials evoked by oesophageal distension in patients with non-cardiac chest pain","volume":"33","author":"Smout, A.J.; DeVore, M.S.; Dalton, C.B.; Castell, D.O.","year":"1992","unstructured":"Smout AJ, DeVore MS, Dalton CB, Castell DO. Cerebral potentials evoked by oesophageal distension in patients with non-cardiac chest pain. Gut 1992;33:298-302.","journal-title":"Gut"},{"key":"ref_22","first-page":"70","article-title":"Response of BMS (burning mouth syndrome) patients to brief nociceptive heat and mechanical stimuli","volume":"7","author":"Svensson, P.; Bak, P.; Arendt-Nielsen, L.; Kaaber, S.; Bjerring, P.","year":"1993","unstructured":"Svensson P, Bak P, Arendt-Nielsen L, Kaaber S, Bjerring P. Response of BMS (burning mouth syndrome) patients to brief nociceptive heat and mechanical stimuli. _J Orofacial Pain 1993;7:70-6.","journal-title":"_J Orofacial Pain"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/S0140-6736(94)92755-3","article-title":"Central nervous pathways mediating angina pectoris","volume":"344","author":"Rosen, S.D.; Paulesu, E.; Frith, C.D.","year":"1994","unstructured":"Rosen SD, Paulesu E, Frith CD, et al. Central nervous pathways mediating angina pectoris. Lancet 1994;344: 147-50.","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/0304-3959(83)90111-2","article-title":"The assessment of pain by cerebral evoked potentials","volume":"16","author":"Chudler, E.H.; Dong, W.K.","year":"1983","unstructured":"Chudler EH, Dong WK. The assessment of pain by cerebral evoked potentials. Pain 1983;16:221-44.","journal-title":"Pain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/0013-4694(70)90062-3","article-title":"The effects of aging on the wave form of the somatosensory cortical evoked potential","volume":"29","author":"Luders, H.","year":"1970","unstructured":"Luders H. The effects of aging on the wave form of the somatosensory cortical evoked potential. Electroencephalogr Clin Neurophysiol 1970;29:450-60.","journal-title":"Electroencephalogr Clin Neurophysiol"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.2337\/diacare.14.11.1086","article-title":"Visceral afferent neuropathy in diabetic gastroparesis","volume":"14","author":"Rathmann, W.; Enck, P.; Frieling, T.; Gries, F.A.","year":"1991","unstructured":"Rathmann W, Enck P, Frieling T, Gries FA. Visceral afferent neuropathy in diabetic gastroparesis. Diabetes Care 1991;14:1086-9.","journal-title":"Diabetes Care"},{"issue":"101","key":"ref_27","article-title":"and modulation of laser-evoked potentials","volume":"38","author":"Characteristics, Arendt-Nielsen L.; detection","year":"1994","unstructured":"Arendt-Nielsen L. Characteristics, detection, and modulation of laser-evoked potentials. Acta Anaesth Scand 1994;38:suppl 101.","journal-title":"Acta Anaesth Scand"},{"issue":"27-32","key":"ref_28","first-page":"\"34\" # \"75","article-title":"Irritable oesophagus","volume":"92","author":"Janssens, J.P.; Vantrappen, G.","year":"1992","unstructured":"Janssens JP, Vantrappen G. Irritable oesophagus. Am Jf Med 1992;92:27-32S. 34 Brennum J, Arendt-Nielsen L, Horn A, Secher NH, Jensen TS. Quantitative sensory examination during epidural anaesthesia and analgesia in man: effects of morphine. Pain 1993;52:75-83.","journal-title":"Am Jf Med; Quantitative sensory examination during epidural anaesthesia and analgesia in man: effects of morphine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/0304-3959(81)90098-1","article-title":"Opiate pharmacology and individual differences. II. Somatosensory evoked potentials","volume":"10","author":"Buchsbaum, M.S.; Davis, G.C.; Coppola, R.; Naber, D.","year":"1981","unstructured":"Buchsbaum MS, Davis GC, Coppola R, Naber D. Opiate pharmacology and individual differences. II. Somatosensory evoked potentials. Pain 1981;10:367-77.","journal-title":"Pain"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1159\/000387427","article-title":"Effect of opiates and opiate antagonists on somatosensory evoked potentials in patients with schizophrenia and normal adults","volume":"4","author":"Davis, G.C.; Buchsbaum, M.S.; Naber, D.; Van Kanmmen, D.P.","year":"1980","unstructured":"Davis GC, Buchsbaum MS, Naber D, Van Kanmmen DP. Effect of opiates and opiate antagonists on somatosensory evoked potentials in patients with schizophrenia and normal adults. Adv Biol Psychiatry 1980;4:73-80.","journal-title":"Adv Biol Psychiatry"},{"key":"ref_31","first-page":"713","article-title":"Comparison of experimental oesophageal pain with clinical pain of angina pectoris and oesophageal disease","volume":"29","author":"Kramer, P.; Hollander, W.","year":"1955","unstructured":"Kramer P, Hollander W. Comparison of experimental oesophageal pain with clinical pain of angina pectoris and oesophageal disease. Gastroenterology 1955;29:713-43.","journal-title":"Gastroenterology"},{"key":"ref_32","first-page":"217","article-title":"Role of the gastrointestinal tract in production of cardiac symptoms","volume":"114","author":"Morrison, L.M.; Swaim, W.A.","year":"1940","unstructured":"Morrison LM, Swaim WA. Role of the gastrointestinal tract in production of cardiac symptoms. Am Coll Cardiol 1940;114:217-23.","journal-title":"Am Coll Cardiol"},{"key":"ref_33","article-title":"Visceral pain. Plethysmographic 'pain reactions\". Dilatation of the oesophagus","author":"Sturup, G.K.","year":"1940","unstructured":"Sturup GK. Visceral pain. Plethysmographic 'pain reactions\". Dilatation of the oesophagus. London: HK Lewis, 1940."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1097\/00005344-199105000-00009","article-title":"An alpha-adrenergic coronary constriction during oesophageal distention in the dog","volume":"17","author":"Gayheart, P.A.; Gwirtz, P.A.; Bravenec, J.S.; Longlet, N.; Jones, C.E.","year":"1991","unstructured":"Gayheart PA, Gwirtz PA, Bravenec JS, Longlet N, Jones CE. An alpha-adrenergic coronary constriction during oesophageal distention in the dog. Cardiovasc Pharmacol 1991;17:747-53.","journal-title":"Cardiovasc Pharmacol"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/0140-6736(93)90817-Z","article-title":"Effect of oesophageal acid instillation on coronary blood flow","volume":"341","author":"Chauhan, A.; Petch, M.C.; Schofield, P.M.","year":"1993","unstructured":"Chauhan A, Petch MC, Schofield PM. Effect of oesophageal acid instillation on coronary blood flow. Lancet 1993;341: 1309-10.","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/0304-3959(89)90019-5","article-title":"Angina pectoris. Clinical characteristics, neurophysiological and molecular mechanisms","volume":"36","author":"Sylven, C.","year":"1989","unstructured":"Sylven C. Angina pectoris. Clinical characteristics, neurophysiological and molecular mechanisms. Pain 1989;36: 145-67.","journal-title":"Pain"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0304-3959(92)90245-7","article-title":"Viscerosomatic convergence onto feline spinal neurons from oesophagus, heart and somatic fields: effects of inflammation","volume":"49","author":"Garrison, D.W.; Chandler, M.J.; Foreman, R.D.","year":"1992","unstructured":"Garrison DW, Chandler MJ, Foreman RD. Viscerosomatic convergence onto feline spinal neurons from oesophagus, heart and somatic fields: effects of inflammation. Pain 1992;49:373-82.","journal-title":"Pain"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/0304-3959(90)90021-5","article-title":"Visceral pain: a review of experimental studies","volume":"41","author":"Ness, T.J.; Gebhart, G.F.","year":"1990","unstructured":"Ness TJ, Gebhart GF. Visceral pain: a review of experimental studies. Pain 1990;41:167-234.","journal-title":"Pain"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1007\/BF00376776","article-title":"Electrophysiological and psychophysical quantification of temporal summation in the human nociceptive system","volume":"68","author":"Arendt-Nielsen, L.; Brennum, J.; Sindrup, S.; Bak, P.","year":"1994","unstructured":"Arendt-Nielsen L, Brennum J, Sindrup S, Bak P. Electrophysiological and psychophysical quantification of temporal summation in the human nociceptive system. EurJ Appl Physiol 1994;68:266-73.","journal-title":"EurJ Appl Physiol"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/0304-3959(91)90087-E","article-title":"Pain and hyperalgesia following tissue injury: new mechanisms and new treatments","volume":"44","author":"Dubner, R.","year":"1991","unstructured":"Dubner R. Pain and hyperalgesia following tissue injury: new mechanisms and new treatments. Pain 1991;44: 213-4.","journal-title":"Pain"},{"key":"ref_41","first-page":"1366","article-title":"Impaired forearm vasodilator reserve in patients with microvascular angina. Evidence of a generalized disorder of vascular function? NEnglJ7Med","volume":"317","author":"Sax, F.L.; Cannon, R.O.; Hanson, C.; Epstein, S.E.","year":"1987","unstructured":"Sax FL, Cannon RO, Hanson C, Epstein SE. Impaired forearm vasodilator reserve in patients with microvascular angina. Evidence of a generalized disorder of vascular function? NEnglJ7Med 1987;317:1366-70."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1016\/0002-9149(88)91180-0","article-title":"\"Microvascular angina\" as a cause of chest pain with angiographically normal coronary arteries","volume":"61","author":"Cannon, R.O.; Epstein, S.E.","year":"1988","unstructured":"Cannon RO, Epstein SE. \"Microvascular angina\" as a cause of chest pain with angiographically normal coronary arteries. Am Cardiol 1988;61:1338-43.","journal-title":"Am Cardiol"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1161\/01.CIR.86.1.179","article-title":"Coronary reserve and exercise ECG in patients with chest pain and normal coronary angiograms","volume":"86","author":"Camici, P.G.; Gistri, R.; Lorenzoni, R.","year":"1992","unstructured":"Camici PG, Gistri R, Lorenzoni R, et al. Coronary reserve and exercise ECG in patients with chest pain and normal coronary angiograms. Circulation 1992;86: 179-86.","journal-title":"Circulation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1161\/01.CIR.90.1.50","article-title":"Coronary vasodilator reserve, pain perception, and sex in patients with syndrome X","volume":"90","author":"Rosen, S.D.; Uren, N.G.; Kaski, J.C.; Tousoulis, D.; Davies, G.J.; Camici, P.G.","year":"1994","unstructured":"Rosen SD, Uren NG, Kaski JC, Tousoulis D, Davies GJ, Camici PG. Coronary vasodilator reserve, pain perception, and sex in patients with syndrome X. Circulation 1994;90:50-60.","journal-title":"Circulation"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/0735-1097(94)90284-4","article-title":"Abnormal cardiac pain perception in syndrome X","volume":"24","author":"Chauhan, A.; Mullins, P.A.; Thuraisingham, S.I.; Taylor, G.; Petch, M.C.; Schofield, P.M.","year":"1994","unstructured":"Chauhan A, Mullins PA, Thuraisingham SI, Taylor G, Petch MC, Schofield PM. Abnormal cardiac pain perception in syndrome X. Am Coll Cardiol 1994;24: 329-35.","journal-title":"Am Coll Cardiol"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1007\/BF01537406","article-title":"Comparison of oesophageal manometry, provocative testing, and ambulatory monitoring in patients with unexplained chest pain","volume":"35","author":"Hewson, E.G.; Dalton, C.B.; Richter, J.E.","year":"1990","unstructured":"Hewson EG, Dalton CB, Richter JE. Comparison of oesophageal manometry, provocative testing, and ambulatory monitoring in patients with unexplained chest pain. Dig Dis Sci 1990;35:302-9.","journal-title":"Dig Dis Sci"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1016\/S0140-6736(87)92686-9","article-title":"The irritable oesophagus-a frequent cause of angina-like pain","volume":"i:","author":"Vantrappen, G.; Janssens, J.; Ghillebert, G.","year":"1987","unstructured":"Vantrappen G, Janssens J, Ghillebert G. The irritable oesophagus-a frequent cause of angina-like pain. Lancet 1987;i: 1232-4.","journal-title":"Lancet"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/hrt.75.5.436","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T21:48:33Z","timestamp":1758404913000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/hrt.75.5.436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,5]]},"references-count":47,"journal-issue":{"issue":"5","published-online":{"date-parts":[[1996,5,1]]},"published-print":{"date-parts":[[1996,5]]}},"alternative-id":["10.1136\/hrt.75.5.436"],"URL":"https:\/\/doi.org\/10.1136\/hrt.75.5.436","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[1996,5]]}}}