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[Leading symptom of angina pectoris. Psychophysiologic mechanisms of pain perception in chest pain complaints].

Anginal chest pain represents an important cardiac symptom which proved to have a high pretest probability for the existence of potential heart disease. The occurrence of clinically unapparent or atypically exposed myocardial ischemia, as well as discrepancies in effort angina, provide evidence that the release of a nociceptive stimulus does not guarantee pain perception of the same proportion. The connections between sequential nociceptive nerve impulses at different central nervous regions and particularly at non-specified thalamic nuclei allow learning processes in the development of pain perception. The intensity of pain may be altered to a great extent by the anxiety level. The patient might develop habits of vigilance for low threshold abnormal signals generated from the interior of the body; he might, however, also reach a stage of complete pain suppression by centrifugal control of the nociceptive input. Heart pain is probably one of the moderators in a more complex warning system.