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European Heart Journal 1996 17(3):407-413;
Copyright © 1996 by the European Society of Cardiology.
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© 1996 The European Society of Cardiology

Cardio-oesophageal reflex in humans as a mechanism for ‘linked angina’

A. Chauhan, M. C. Petch and P. M. Schofield

Regional Cardiac Unit, Papworth Hospital Papworth Everard, Cambridge, U.K.

Received 7 June 1995; accepted 11 July 1995.

Correspondence:Dr A. Chauhan, Senior Interventional Fellow, Laurel Cardiology, 865 West 10th Avenue, Vancouver, British Columbia V5Z 1L7

Abstract

The aim of this study was to investigate the hypothesis that oesophageal acid stimulation reduces coronary blood flow in humans as a result of the presence of a cardiooesophageal reflex which may provide a mechanism for ‘linked angina’. We studied the effect of oesophageal acid stimulation on coronary blood flow in 35 syndrome X patients and 24 heart transplant patients. A line tube was positioned into the patient's distal oesophagus. An intracoronary Doppler catheter was positioned in the proximal left anterior descending coronary artery for coronary blood flow measurements. Oesophageal instillation of 0·1 M hydrochloric acid was performed (60 ml over 5 min) and the measurements were repeated. The coronary blood flow was significantly reduced by acid oesophageal stimulation in the syndrome X group [pre-acid 78·9 ± 36· ml . min–1, post-acid 50·8 ± 32·9 ml . min–1 (P=0·0001)]. However, coronary blood flow in the heart transplant group, in whom the heart is denervated, was unaffected by acid infusion. We conclude that oesophageal acid stimulation can produce angina and significantly reduce coronary blood flow in humans. The lack of any significant effect in the heart transplant group, in whom the heart is denervated, suggests a neural reflex.

(Eur Heart J 1996; 17: 407–413)

Key Words: Coronary blood flow • cardio-oesophageal reflex


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