Coronary artery spasm: An important mechanism in the pathophysiology of ischemic heart disease

Conti, C. Richard; Pepine, Carl J.; Curry, R. Charles

doi:10.1016/0146-2806(79)90004-5

Cited by 33 publications

(2 citation statements)

References 130 publications

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“…However, since much of these data are from uncon trolled trials, one must interpret them with caution. In particular, patients with variant angina are notorious for spontaneous remis sion [ 19], This problem was suggested in early trials with the calcium blocker perhexiline [20]. We treated 21 variant angina pa tients using an uncontrolled approach.…”

Section: Rationale For Use Of Calcium Antagonists In Patients With CLmentioning

confidence: 99%

Calcium Antagonists

et al. 1985

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At present nitrates remain the initial treatment for relief or prevention of angina in patients with coronary artery disease. In cases where nitrates and beta blockers have been used and are ineffective for managing effort angina, calcium antagonists may be substituted or added to the beta-blocking treatment. When the predominant symptom is rest angina, and there is evidence suggesting coronary artery spasm, nitrates and a calcium antagonist can be effective therapy. In patients with heart block, bradyarrhythmias, heart failure, or hypertension nifedipine may be the drug of choice. In contrast verapamil merits choice when supra-ventricular tachycardia is present. Diltiazem appears intermediate between nifedipine and verapamil and may be particularly useful when hypotension or other side effects must be avoided.

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Section: Rationale For Use Of Calcium Antagonists In Patients With CLmentioning

confidence: 99%

Calcium Antagonists

et al. 1985

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“…Despite this seemingly favourable situation, the results of surgery for patients with variant angina are less favourable than for those with effort angina associated with ST depression, fixed coronary obstructions and no evidence of coronary spasm. Perioperative mortality and infarction rates have been higher and the postoperative recurrence of angina more common following bypass surgery in patients with variant angina (Conti et al 1979).This might be the result of recurrent spasm in the grafted native artery extending below the site of graft insertion. With this possibility in mind, Grondin & Limet (1977) successfully combined local arterial denervation with coronary bypass, but the number of patients treated in this way is too small for any conclusions to be drawn.…”

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confidence: 99%

Coronary Artery Spasm: A Review

Richmond

1980

J R Soc Med

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Recommendations for use of ergonovine to provoke coronary artery spasm

Pepine¹,

Feldman²,

Conti³

et al. 1980

Cathet. Cardiovasc. Diagn.

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TO THE EDITORErgonovine is in widespread use as a test to evoke coronary artery spasm. In patients without variant angina undergoing catheterization, ergonovine produced minimal (approximately 18%) generalized decrease in coronary artery diameter 111. This decrease in diameter is usually not associated with reduction in coronary flow or with abnormal lactate metabolism [2,3]. In patients with variant angina the response to ergonovine is much more pronounced and often results in either total, or near-total, focal or diffuse narrowing of one or more epicardial vessels. This response is associated with reduction in regional coronary flow [3], usually (but not always) followed by ST segment elevation and chest pain. Ventricular arrhythmias andor heart block are not uncommon. These responses occur with low doses of ergonovine-ingeneral, I 0.1 mg--and support the concept that variant anginapatients have altered coronary artery sensitivity to certain vasoconstrictor stimuli [4]. Often, responses to ergonovine appear remarkably similar to spontaneous episodes of coronary artery spasm [4,5]. These observations have generated numerous questions relative to the clinical use of ergonovine to test for coronary spasm. Some of the more important and frequently asked questions follow: 1) Which patients should be tested for spasm? 2) Is the test safe? 3) What protocol should be used?Results from the initial 130patients tested in our laboratories are summarized, according to their clinical presentation, in Figure 1. We have now tested over 350 patients with ergonovine, and our experience has been similar. Ergonovine evokes spasm in almost all patients with clinical findings of variant angina if they are tested during an active phase of their disease. Testing patients with other chest pain syndromes appears to have a relatively low yield (approximately 2%), implying that coronary artery spasm, at least the type evoked by ergonovine, does not play a role in the genesis of chest pain in the large majority of these patients [61. Therefore, ergonovine seems to be more useful to confirm the presence of spasm in patients with findings suggesting variant angina when, for some reason, spontaneous pain with ST segment shifts andor reversible coronary artery narrowing have not been documented. Additionally, ergonovine may be useful in determining the location and extent (vessels involved, diffuse or focal) of spasm, since some preliminary information suggests that these could be important relative to either prognosis or patency of planned aortocoronary bypass grafts. Information is not available relative to the possible usefulness of ergonovine in the evaluation of other patient subsets such as those with evolving myocardial infarction or ST elevation without chest pain.In our experience, and in approximately 1 ,OOO total cases in the literature, the test has been safe. Recently, however, five cases of "refractory" ergonovine-induced coronary artery spasm have been reported 173. These patients, collected from multiple centers, did not respon...

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Coronary artery spasm: An important mechanism in the pathophysiology of ischemic heart disease

Cited by 33 publications

References 130 publications

Calcium Antagonists

Calcium Antagonists

Coronary Artery Spasm: A Review

Recommendations for use of ergonovine to provoke coronary artery spasm

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