Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina.

Abstract

It has been shown in different groups of patients with variant angina that coronary spasm can be reproduced by physiologic maneuvers Received Feb. 4, 1986; revision accepted Aug. 14, 1986. Presented in part at the 58th Scientific Sessions of the American Heart Association, November 11-14, 1985, Washington, D.C.Vol. 74, No. 6, December 1986 In patients with variant angina focal coronary spasm can be reproduced by ergonovine"922 and, less frequently, also by hyperventilation.2"25 Isolated reports suggest that coronary spasm can also be provoked by a number of physiologic maneuvers2"29 and pharmacologic agents such as histamine,9 epinephrine,3 metacholine,5 and dopamine.30 It has therefore become apparent in patients with variant angina that particular segments of their epicardial coronary arteries exhibit an abnormal reactivity to stimuli that produce only minor degrees of coronary constriction, if any, in normal individuals or in patients with other forms of angina.3'The aim of our study was to investigate whether the abnormal coronary reactivity exhibited by patients with vasospastic angina results from specific abnormal agonist-receptor interactions or from a local, nonspecific supersensitivity to different stimuli. To this end, we studied the responses of patients with vasospastic angina to a series of provocative tests known to induce coronary spasm through different mechanisms.

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

“…Positive rate by hyperventilation testing was 53.6% to 100%, as shown in Table 1 [2,3,[16][17][18]. In patients with high disease activity who had more than 5 times spontaneous attacks per week, 84% was positive frequency, whereas moderate (less than 5 times spontaneous attacks per week) or low (less than one spontaneous attack per week) disease activity had positive results in 39% or 29%.…”

Evaluation of Coronary Artery Status by Coronary Angiography after First Survival of Acute Myocardial Infarction

“…This phenomenon may form irreversible red thrombus formation which leads to persistent coronary occlusion and AMI. Younger patients without conventional CAD risk factors except smoking and early thrombolysis has fair chance of recanalization of infarct related coronary artery [13][14][15][16].…”

Biphasic response of coronary arterial diameter to intracoronary ergonovine

“…It can be administered safely via an intravenous or an intracoronary route to provoke coronary artery spasm. [2][3][4][5] We report an unusual case, in whom intracoronary administration of ergonovine produced a biphasic response: an initial dilation with low dose and a subsequent constriction with high dose, of the large epicardial coronary artery.…”