Angina with normal coronary arteriograms. Value of coronary sinus lactate estimation in diagnosis and treatment.

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Abstract
Patients (35) with chest pain of sufficient severity to warrant coronary arteriography had normal coronary arteriograms. In each of them coronary sinus lactate was measured before and during atrial pacing. In 16 the lactate metabolism was normal as shown by a change between resting and peak pacing arteriovenous lactate difference of less than 0.09 mmol/l (0.8 mg/100 ml). Patients (19) had abnormal lactate metabolism, the change being greater than 0.09 mmol/l (0.8 mg/100 ml). Of the group 16 (84%) with abnormal lactate metabolism responded symptomatically to oral .beta.-blockade in contrast to only 1 patient in the normal group (P < 0.001). After 1 yr all 16 patients with abnormal lactate metabolism who had responded to .beta.-blockade worsened when placebo was substituted. Of the 16 patients with normal lactate metabolism, 15 had become free of symptoms on no specific drug therapy; it is unlikely that their original pain was of cardiac origin. By estimating the coronary sinus lactate it is possible to divide patients with chest pain and normal coronary arteriograms into 2 groups. Those with pain of non-cardiac origin have normal lactate metabolism, are unlikely to respond to .beta.-blockade and improve spontaneously. The group with abnormal lactate metabolism have genuine angina, usually respond to .beta.-blockade and deteriorate when treatment is discontinued. Further observation is required to determine the prognosis of the 2 groups and to estimate frequency of development of coronary artery disease.