From Heart to Brain: The Genesis and Processing of Cardiac Pain

摘要: Angina pectoris is important because of its association with heart disease and risk death. Historically after Heberden's account angina in 1772, the pain coronary artery quickly followed. Within a few years, Burns suggested an etiological role for ischemia. Subsequently, theories differential myocardial stretch dominated thinking until Lewis' chemical hypothesis 1932, which local release substances during ischemia was seen as cause pain. This review considers how at tissue level triggers activation afferent nociceptive fibres. The projections sympathetic vagal fibres are described, number methodologies cited (eg, injection pseudorabies virus into mapping retrograde viral transport pathways; elevation neuronal c-fos synthesis brain regions activated by capsaicin application to heart). Our own functional neuroimaging studies also reviewed. There 2 intriguing features angina. first poor correlation between symptoms extent disease. spectrum ranges from entirely silent that syndrome--the 'sensitive heart'--of cardiac syndrome X. An even more difficult aspect wide variability experienced individual patient. A new paradigm presented which, besides considering oxygen supply/demand imbalance, draws insights broader field research. Neuromodulation applies multiple levels neuraxis--peripheral nerves, spinal cord, brain--and it invites exploitation, whether pharmacological or electrical, benefit patient