Acute coronary hemodynamic response to cigarette smoking in patients with coronary artery disease

Abstract

The acute changes in coronary blood flow and coronary resistance that occur in response to cigarette smoking have not been accurately determined. To define the factors that affect this response, coronary sinus blood flow was measured in 16 patients (group I) with coronary artery disease and in 6 patients (group II) without angiographically detectable coronary disease. Seven patients (group IA) had severe (greater than or equal to 75%) proximal left coronary lesions and nine patients (group IB) had significant distal lesions with 50% or less proximal stenoses. Group I had a smaller overall increase (increases 1.6 +/- 5.3%) in coronary sinus blood flow than did group II (increases 7.7 +/- 6.1%) (p less than 0.05). Coronary resistance increased overall (increases 2.7 +/- 5.3%) in group I but decreased (decreases 2.4 +/- 3.4%) in group II (p less than 0.05). Patients in group IA had a highly significant increase in coronary resistance as compared with group IB (increases 7.0 +/- 4.2% versus decreases 0.9 +/- 2.6%) (p less than 0.001). Coronary sinus flow tended to decrease (decreases 1.2 +/- 4.6%) in group IA but to increase (increases 3.8 +/- 5.1%) in group IB (p = 0.06). It is concluded that smoking increases coronary resistance in patients with coronary artery disease. A greater impact is observed in patients with a severe proximal stenosis than in those with a distal stenosis. It is proposed that smoking increases coronary artery tone at the site of the stenosis, limiting the coronary flow response proportionally to the size of the affected vascular bed.

Cigarette Smoking and the Risk of Supraventricular and Ventricular Tachyarrhythmias in High‐Risk Cardiac Patients with Implantable Cardioverter Defibrillators

“…The constituents of inhaled tobacco damage the cardiovascular system by numerous mechanisms, including endothelial dysfunction, platelet dysfunction, increased coagulation, increased heart rate, blood pressure, increased myocardial oxygen demand, and vasoconstriction 18–21 . Therefore, smoking may be expected to have multiple adverse effects in patients with heart failure.…”

Smoking-induced coronary vasoconstriction in patients with atherosclerotic coronary artery disease: evidence for adrenergically mediated alterations in coronary artery tone.

“…Thus, coronary artery tone appears to be sensitive and responsive to alterations in az-,8-adrenergic "balance" in some patients with atherosclerotic coronary artery disease. Cryer et al 1 have shown that the plasma concentrations of norepinephrine and epinephrine rise during cigarette smoking and that the peripheral hemodynamic effects of smoking are abolished with combinedca-and /3-adrenergic blockade. Others have shown that nonselective ,e-adrenergic blockade with propranolol augments the smoking-induced increase in peripheral vascular tone.'…”

Nicotine and sympathetic neurotransmission

“…This can be attributed to (1) a beta-adrenoceptormediated increase in heart rate and left ventricular contractility and (2) an alpha-adrenoceptor-mediated increase in coronary vasomotor tone [25,55]. By preventing the compensatory local metabolic increase in coronary blood flow, nicotine offsets the physiological adaptation of coronary flow to an increased myocardial oxygen demand [29].…”