Dr Shirely Smith from charring cross hospital London wrote this masterpiece in BMJ in the year 1962 . He was doing a research about the origin of angina like pain in patients who had upper GI disease or disorders of cervical spine .He found a hidden invisible neural link between heart and it’s neighboring viscera. What he referred it as linked angina . It links the pain from ,Esophagus, gall bladder , duodenum , cervical spine to the heart .
This article I consider as one of the all time classics in clinical cardiology . Here is the link for linked angina (Courtesy of BMJ)
High lights ( Inferred ) from the article
We know angina typically occurs on exertion .If it occurs at rest we call it as unstable angina .
Can it occur at rest other than unstable angina ?
Yes it can . ( Post prandial ,Nocturnal, emotional etc)
Can the heart be the referral site for visceral pain ?
Yes .It seems so .
Can visceral pain be trigger for developing true angina ?
Again possible . A Patient with documented CAD develop a true esophageal pain it is likely to induce a sensation of angina rather than abdominal pain .Similarly , cervical pain may represent a masked angina in a patient with active cervical spondylitis .(Homing in of angina to the nearest non cardiac culprit )
Those were the times when the brain worked more than hands . Common sense prevailed over machine sense .This article argues for a big debate about the origin of so called atypical angina in a patient with multiple common visceral conditions.Even 50 years later we have little clue about alimentary -cardiac neural spill over !
Today we live in a complex and confusing and commercial medical world .We have atleast a dozen chest pain triaging protocols in ER . Still errors are rampant. Errors are acceptable . . . but this one was an absolute shocker . . . “I know a patient with vague chest/epigastric pain , non specific T inversion , documented gall stones , landed in cath lab not by accident but by meticulous planning !”