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To the Editor: In their Clinical Review of angina with normal coronary arteries,¹ Drs Bugiardini and Bairey Merz discussed patients admitted to emergency departments complaining of chest pain without significant coronary heart disease (CHD) that could justify their clinical symptoms. In considering women with positive myocardial perfusion scans and electrocardiographic changes but normal coronary arteries, they emphasize that endothelial function may play a key role in the pathophysiology.

However, another theory hypothesizes that high left ventricular end-diastolic pressure (LVEDP) can produce abnormal perfusion stress tests in the absence of significant CHD.^2-5 Elhabyan et al⁵ found that female sex and elevated LVEDP are predictors of a positive stress test. Moreover, elevated LVEDP is an important factor that determines oxygen supply to the myocardium. Coronary blood flow can be influenced by the perfusion pressure that occurs during diastole. The amount of flow entering the coronary tree during diastole is the result of . . . [Full Text of this Article]

Bernardo J. Reyes, MD
bernardo.reyes@camc.org

Omar Hallak, MD; Abdul Karim Elhabyan, MD; B. Daniel Lucas, Jr, PharmD; Hoda Kasem, MD
CAMC Health Education and Research Institute
Charleston, W Va

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