Headache and heart disease

NEW YORK, September 19 (Praxis Press). The pain caused by myocardial ischemia may be referred to the neck, jaw, epigastrium and arms; when referred cardiac pain is perceived as a headache, it is usually accompanied by typical angina. In this week's issue of the Lancet, Lanza and colleagues reported an unusual pattern of cardiac pain in a 68-year-old man. The patient presented with a three-year history of brief occipital headaches that occurred at rest; his medical history was significant for two cardiovascular risk factors (smoking and hypercholesterolemia). During a typical headache, laboratory tests revealed elevated levels of creatine kinase, creatine kinase-MB and troponin I, although the results of an electrocardiogram and electrocardiography were normal. An exercise test precipitated the headache and T-wave peaking, which resolved with sublingual nitrates. Angiography revealed 90% occlusion of the left anterior descending coronary artery, 90% occlusion of the left circumflex coronary artery...