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September 1974

Thrombocythemia and Myocardial Ischemia With Normal Coronary Angiogram

Author Affiliations

From the Department of Nutrition, Harvard School of Public Health (Drs. Barr, Cohen, and Lown); the Department of Medicine, Peter Bent Brigham Hospital (Drs. Cohen and Lown), Boston; and Mid Island Hospital (Dr. Berken), Bethpage, NY. Dr. Barr is now with Central Emek Hospital, Afula, Israel.

Arch Intern Med. 1974;134(3):528-533. doi:10.1001/archinte.1974.00320210138021

Until development of coronary angiography, angina pectoris was regarded almost exclusively as the result of atherosclerosis of the large coronary arteries. This supposition is no longer tenable. Chest pain indistinguishable from classical angina pectoris has been described in patients having normal coronary vessels.1-3 Further, typical angina was described in a woman who, during attacks of chest pain, had monophasic current of injury with accompanying life-threatening arrhythmia, yet had normal coronary angiograms.4 Acute myocardial infarction was verified in two young men in whom subsequent arteriography showed normal coronary vasculature.5,6 Ischemic signs and symptoms with normal coronary angiograms have been ascribed to deranged oxyhemoglobin dissociation,7 as well as to small-vessel disease.2,8 The purpose of this case report is to add thrombocythemia to this dossier.

Patient Summary  A 40-year-old white woman, the mother of two, was referred for evaluation of disabling chest pain of recent onset. She had