Variant angina associated with angiographically demonstrated coronary artery spasm and REM sleep

King, Michael; Zir, Leonard M.; Kaltman, Alfred J.; Fox, Arthur C.

doi:10.1097/00000441-197305000-00009

Cited by 91 publications

(24 citation statements)

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“…So far as we know no systematic study has been reported on the treatment of spontaneous angina pectoris by beta blockers. Unsatisfactory results have been reported in single cases (Whiting et al, 1970;MacAlpin, Kattus, and Alvaro, 1973;King et al, 1973;Bodenheimer et al, 1974;Hernandez-Casas, Dear, and Leachman, 1974). It is noteworthy that in the present investigation betablocking agents were not given in uniform, predetermined doses, but the dosage was increased until the optimal effect was achieved.…”

Section: Discussionmentioning

confidence: 97%

“…Subsequently several cases have been reported, some with normal coronary arteriograms, in which coronary spasm was detected during attacks of acute ischaemia (Ross and Gorlin, 1968;Dhurandhar et al, 1972;King et al, 1973;McAlpin et al, 1973;MacAlpin, 1973;Oliva, Potts, and Pluss, 1973;Linhart, 1974). Severe coronary spasm in association with anginal attacks has been found in some patients with classical angina pectoris (Gensini et al, 1962;Demany, Tambe, and Zimmerman, 1968).…”

Section: Discussionmentioning

confidence: 99%

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Treatment of spontaneous angina pectoris with beta blocking agents. A clinical, electrocardiographic, and haemodynamic appraisal.

Guazzi¹,

Fiorentini²,

Polese³

et al. 1975

Heart

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The study also showed that: (a) the effects on angina are strictly dose-dependent, and optimal results are achieved at individualized doses; (b) within the same subject the response may be preferential to one betablocker as opposed to the other; (c) propranolol is more effective in type II angina; (d) the occurrence of heart failure is uncommon even with high doses of beta blockers; (e) the relief of angina is due to prevention of ischaemia and not to a placebo or anaesthetic effect; (f) the prevention of ischaemia is not adequately explained by reduction of the mechanical effort and the oxygen need of the myocardium; (g) the antianginal effect is possibly dissociated from the beta blockade of the heart.The hypothesis that beta-blocking agents influence the coronary vasomotion is discussed.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Treatment of spontaneous angina pectoris with beta blocking agents. A clinical, electrocardiographic, and haemodynamic appraisal.

Guazzi¹,

Fiorentini²,

Polese³

et al. 1975

Heart

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show abstract

“…25 Similarly, ischemic events can occur during sleep, especially REM sleep, in patients with severe coronary artery disease and vasospastic angina. 26, 27 Somers et al also reported that REM sleep is most manifest toward the end of sleep prior to arousal, and that hemodynamic and sympathetic changes during REM sleep may play a role in triggering ischemic events in patients with vascular disease. 23 In the present study it appears that in 14 patients in the event group an slp(+)V-trough was indicative of imbalance of autonomic activity and altered hemodynamics, and triggered a cardiac event.…”

Section: Main Results and Comparison With Previous Studiesmentioning

confidence: 99%

V-Shaped Trough in Autonomic Activity Is a Possible Precursor of Life-Threatening Cardiac Events

Osaka

Watanabe

Murata

et al. 2010

Circ J

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Background:No reliable precursor of sudden cardiac death is known. Methods and Results:Holter electrocardiograms of 34 patients experiencing a cardiac event (event group, 20 deaths) were compared with 191 controls (no event group). The event group included 25 patients with ventricular fibrillation or acute myocardial infarction (AMI), and 9 with cardiac arrest due to complete atrioventricular block. The logarithms were calculated of the moving average of 5 successive values for the low-frequency component (LF), the high-frequency component (HF), and the ratio LF/HF of heart rate variability: ln(LF), ln(HF) and ln(LF/HF). A V-shaped trough appeared in the curve of ln(LF/HF) [sV-trough] or ln(HF) [pV-trough] before such an event in 31 patients in the event group. The V-trough was marked by a small variation lasting 2 h, an abrupt descent lasting 30 min, and a sharp ascent for 40 min. An sV-trough was observed in 22 patients before the onset of ventricular fibrillation or AMI. A pV-trough was observed in all 9 patients before the onset of complete atrioventricular block. In the no event group, an sV-trough and a pV-trough were observed in 10 subjects (5%) and 20 subjects (10%), respectively. The positive predictive accuracy of an sV-trough for ventricular fibrillation or AMI and that of a pV-trough for complete atrioventricular block was 88% and 100%, respectively. Conclusions:A previously unidentified V-trough of autonomic activity is a potential precursor of lethal events. (Circ J 2010; 74: 1906 - 1915

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“…However, it has been shown that spontaneous ischemic episodes of CAS are often preceded by a reduction, rather than by an increase, of vagal activity 67, and followed by an increase in coronary levels of catecholamines 68. Studies have also shown that CAS at night more frequently occurs during the rapid eye movement phases of sleep, when a reduction in vagal activity is associated with an increase in adrenergic activity 29,69, suggesting that CAS is not necessarily induced by vagal activity.…”

Section: Pathogenesismentioning

confidence: 99%

Coronary Artery Spasm: Review and Update

Hung¹,

Hu²,

Hung³

2014

Int. J. Med. Sci.

166

145

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Coronary artery spasm (CAS), an intense vasoconstriction of coronary arteries that causes total or subtotal vessel occlusion, plays an important role in myocardial ischemic syndromes including stable and unstable angina, acute myocardial infarction, and sudden cardiac death. Coronary angiography and provocative testing usually is required to establish a definitive diagnosis. While the mechanisms underlying the development of CAS are still poorly understood, CAS appears to be a multifactorial disease but is not associated with the traditional risk factors for coronary artery disease. The diagnosis of CAS has important therapeutic implications, as calcium antagonists, not β-blockers, are the cornerstone of medical treatment. The prognosis is generally considered benign; however, recurrent episodes of angina are frequently observed. We provide a review of the literature and summarize the current state of knowledge regarding the pathogenesis of CAS.

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Variant angina associated with angiographically demonstrated coronary artery spasm and REM sleep

Cited by 91 publications

References 0 publications

Treatment of spontaneous angina pectoris with beta blocking agents. A clinical, electrocardiographic, and haemodynamic appraisal.

Treatment of spontaneous angina pectoris with beta blocking agents. A clinical, electrocardiographic, and haemodynamic appraisal.

V-Shaped Trough in Autonomic Activity Is a Possible Precursor of Life-Threatening Cardiac Events

Coronary Artery Spasm: Review and Update

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