Leon-Sotomayor, Luis A.
March 1974
Angiology;Mar1974, Vol. 25 Issue 3, p161
Academic Journal
This study is concerned with twelve patients presenting a triad of symptoms characterized by migraine headaches, anginoid chest pain and symptoms suggestive of functional hypoglycemia. A positive family history for migraine headache, hypertension and myocardial infarction was found in over two-thirds of the cases. Baseline electrocardiographic abnormalities, positive exorcise electrocardiogram, positive Valsalva-EKG test and a functional hypoglycemic glucose curve was obtained in all cases. In five patients, electroencephalographic abnormalities were noted but were not consistent in repeated studies. In six patients a selective coronary arteriography with left ventriculogram was performed. In all the cases with exception of one, normal coronary arteriogram and normal left ventricular hemodynamics were found. An exaggerated sympathetic overactivity was noted during the study. In four out of the six cases this was characterized by segmental coronary spasm which was more pronounced on the right than on the left coronary arterial system. This was associated with the onset of anginoid chest pain which promptly subsided with the use of sublingual nitroglycerin. It is inferred from this study that the underlying pathophysiology causing both the migraine headache and chest pain is probably due to arterial vasoconstriction most likely resulting from an exaggerated sympathetic overactivity (cardiac migraine). The beneficial effect obtained by the use of propranolol and the use of other therapeutic modalities directed in curtailing exaggerated sympathetic influence in the cardiovascular system, support this proposed contention.


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