Comparative sensitivity of exercise, cold pressor and ergonovine testing in provoking attacks of variant angina in patients with active disease.

Abstract

SUMMARY Exercise, ergonovine and the cold pressor test have been used to provoke variant angina attacks. The sensitivity of these three tests was compared in 34 hospitalized patients with well documented, active variant angina who had recently undergone coronary arteriography. The three tests were usually perfornmed on three consecutive days, and 28 of the 34 Methods Patient PopulationThe following criteria were required for the diagnosis of variant angina: burning or squeezing retrosternal chest pain at rest; relief of pain by sublingual nitroglycerin in less than 5 minutes; ST-segment elevation of at least 0.2 mV not present on the baseline ECG but documented during pain and disappearing after relief of pain; and no evidence of myocardial infarction.The 34 study patients met these criteria, had recently undergone coronary arteriography (table 1) and were hospitalized in the coronary care unit with continuous electrocardiographic monitoring. Except for sublingual nitroglycerin given to relieve angina, the patients were receiving no cardiovascular drugs. Their mean age was 50.5 years (range 32-70 years); 30 were men and four were women. Three had multivessel disease, 16 had a one-vessel stenosis >70% and 15 had no lesions -70%, including three whose coronary arteries appeared normal. Left ventriculography was normal in 29 cases; a hypokinetic or akinetic zone was present in patients 6, 14, 28, 32 and 33. The baseline ECG was normal in 25 cases; patient 1 had minimal ST depression in leads V4 to V6, and eight patients had abnormally negative T waves (patients 5, 8, 11, 15, 25, 28, 32 and 33).The site of ST elevation was the anterior ECG leads in 19 and the inferior leads in 15. The frequency of anginal attacks for each patient during the study period is listed in table 1. Asymptomatic episodes of transient ST elevation occurred in eight patients, all of whom were also experiencing frequent symptomatic attacks. In addition, nearly all patients had brief angina episodes that disappeared spontaneously or with nitroglycerin before electrocardiographic abnormalities could be detected. Both types of attacks were counted.

alpha-Adrenergic receptors and coronary spasm: an elusive link.

“…The first observation is consistent with the findings of a recent report, showing only a 10% incidence of positive results of the cold pressor test in a group of 34 patients with variant angina, 32 of whom (94%) responded to ergonovine. 26 We certainly cannot exclude that in our patients a-stimulation could have produced minor degrees of coronary vasoconstriction, insufficient to cause ST segment changes, as described in two patients by Raizner et all However, this possibility appears rather unlikely, at least in the eight patients with coronary lesions equal or greater than 90% in whom even minimal changes in coronary cross-sectional area should be critical enough to produce acute myocardial ischemia. Although coronary spasm can be undoubtedly precipitated in some patients with very active disease by various sympathetic maneuvers, the reproducibility and specificity of this response have not yet been assessed and its actual relevance to the pathophysiologic mechanism of coronary spasm has not been demonstrated.…”

Early postoperative myocardial morbidity in patients with coronary artery disease undergoing major non-cardiac surgery: correlation with perioperative ischaemia

“…45 For patients with coronary artery spasm, this may be elicited by stressing with intravenous ergonovine maleate. 44 The design of this study did not include preoperative Holter monitoring. We cannot say whether these ST changes were totally new in relation to the preoperative stress, or whether they were a progression of preoperative events.…”

Overview of the Non-Invasive Examinations in Patients with Coronary Spastic Angina

“…In patients with variant angina or CSA, 37.8% to 67.5% of patients had positive ischemic findings as shown in Table 1. Organic stenosis was found in 14.7% to 74.6% of these patients [15,[20][21][22]. Table 2a showed that more than a third patient with CSA and without organic stenosis had ischemic findings on exercise tests, while more than two thirds patients with CSA with organic stenosis had ischemic findings on exercise testing as shown in Table 2b.…”

“…Positive rate by cold pressor test was 14% to 15% of patients with variant angina, as shown in Table 1 [3,21]. Some cardiologists performed the combined cold pressor and hyperventilation test in patients with variant angina.…”