Skip to main content
SpringerLink
Log in
Book cover

Chest Pain with Normal Coronary Arteries pp 101–117Cite as

The Coronary Slow Flow Phenomenon

  • Chapter
  • First Online:

Abstract

The coronary slow flow phenomenon (CSFP) is a microvascular coronary disorder, ­characterised angiographically by delayed contrast opacification of the distal vasculature in the absence of obstructive coronary artery disease. Its prevalence has been reported as 1–3 % of coronary angiograms performed. It often presents initially as an acute coronary syndrome with 8 % of patients having positive cardiac markers for myocardial infarction. Although transient T wave changes are frequently observed during the acute episode, only a third of patients have clinical evidence of inducible myocardial ischaemia. Both structural and functional studies have demonstrated the presence of microvascular coronary dysfunction however the underlying cause remains elusive. Possible pathogenetic mechanisms include a defective endothelial nitric oxide pathway, excessive endothelin mediated vasoconstriction, autonomic dysfunction, platelet dysfunction, metabolic derangements (associated with the metabolic syndrome and hyperhomocystinaemia), and vascular inflammation. The risk of future cardiac events following the initial presentation appears low however many patients continue to experience recurrent chest pain. Further well-controlled therapeutic studies are required to identify effective therapies for this disabling condition.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries: a new angiographic finding. Am Heart J. 1972;84:66–71.

    CAS  PubMed  Google Scholar 

  2. Arbogast R, Bourassa MG. Myocardial function during atrial pacing in patients with angina and normal arteriograms. Am J Cardiol. 1973;32:257–63.

    CAS  PubMed  Google Scholar 

  3. Wilson RF, Lesser JR, Laxson DD, White CW. Intense microvascular constriction after angioplasty of acute thrombotic coronary arterial lesions. Lancet. 1989;1:807–11.

    CAS  PubMed  Google Scholar 

  4. Beltrame JF, Limaye SB, Horowitz JD. The coronary slow flow phenomenon – a new coronary microvascular disorder. Cardiology. 2002;97:197–202.

    PubMed  Google Scholar 

  5. Chesebro JH, Knatterud GL, Roberts R, et al. Thrombolysis in Myocardial Infarction (TIMI) trial, Phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation. 1987;76:142–54.

    CAS  PubMed  Google Scholar 

  6. Sharman JE, Moir S, Kostner KM, Haluska B, Marwick TH. Patients with coronary slow flow phenomenon demonstrate normal myocardial blood flow and arterial wave reflection between acute episodes. Int J Cardiol. 2009;131:321–5.

    PubMed  Google Scholar 

  7. Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93:879–88.

    CAS  PubMed  Google Scholar 

  8. Yilmaz MB, Erdem A, Yontar OC, et al. Relationship between HbA1c and coronary flow rate in patients with type 2 diabetes mellitus and angiographically normal coronary arteries. Turk Kardiyol Dern Ars. 2010;38:405–10.

    PubMed  Google Scholar 

  9. Yaymaci B, Dagdelen S, Bozbuga N, et al. The response of the myocardial metabolism to atrial pacing in patients with coronary slow flow. Int J Cardiol. 2001;78:151–6.

    CAS  PubMed  Google Scholar 

  10. Yigit F, Sezgin AT, Demircan S, Tekin G, Erol T, Muderrisoglu H. Slow coronary flow is associated with carotid artery dilatation. Tohoku J Exp Med. 2006;209:41–8.

    PubMed  Google Scholar 

  11. Faile BA, Guzzo JA, Tate DA, Nichols TC, Smith SC, Dehmer GJ. Effect of sex, hemodynamics, body size, and other clinical variables on the corrected thrombolysis in myocardial infarction frame count used as an assessment of coronary blood flow. Am Heart J. 2000;140:308–14.

    CAS  PubMed  Google Scholar 

  12. Beltrame JF, Limaye SB, Wuttke R, Horowitz JD. Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am Heart J. 2003;146:84–90.

    PubMed  Google Scholar 

  13. Jesuthasan LSB, Beltrame JF, Marwick TH. Prevalence of Coronary Slow Flow in Patients Undergoing Coronary Angiogram in a Large Teaching Hospital. Heart, Lung and Circulation 2009;18:S121.

    Google Scholar 

  14. Mangieri E, Macchiarelli G, Ciavolella M, et al. Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diagn. 1996;37:375–81.

    CAS  PubMed  Google Scholar 

  15. Cin VG, Pekdemir H, Camsar A, et al. Diffuse intimal thickening of coronary arteries in slow coronary flow. Jpn Heart J. 2003;44:907–19.

    PubMed  Google Scholar 

  16. Oz O, Bayram NA, Durmaz T, Keles T, Akcay M, Bozkurt E. The relationship between coronary slow flow phenomenon and coronary calcium score. Perfusion. 2010;25:97–102.

    PubMed  Google Scholar 

  17. Beltrame JF, Turner SP, Horowitz JD. Persistence of the coronary slow flow phenomenon. Am J Cardiol. 2001;88:938.

    CAS  PubMed  Google Scholar 

  18. Beltrame JF, Turner SP, Leslie SL, Solomon P, Freedman SB, Horowitz JD. The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon. J Am Coll Cardiol. 2004;44:57–62.

    CAS  PubMed  Google Scholar 

  19. Kurtoglu N, Akcay A, Dindar I. Usefulness of oral dipyridamole therapy for angiographic slow coronary artery flow. Am J Cardiol. 2001;87:777–9.

    CAS  PubMed  Google Scholar 

  20. Lanza GA, Crea F. Primary coronary microvascular dysfunction: clinical presentation, pathophysiology, and management. Circu­lation. 2010;121:2317–25.

    PubMed  Google Scholar 

  21. Li JJ, Wu YJ, Qin XW. Should slow coronary flow be considered as a coronary syndrome? Med Hypotheses. 2006;66:953–6.

    PubMed  Google Scholar 

  22. Vurus Kan E, Alpman A. Slow coronary flow: a distinct angiographic subgroup in syndrome X. Kardi Yoloji Dergi si 2003.

    Google Scholar 

  23. Leone MC, Gori T, Fineschi M. The coronary slow flow phenomenon: a new cardiac “Y” syndrome? Clin Hemorheol Microcirc. 2008;39:185–90.

    PubMed  Google Scholar 

  24. Nava Lopez G, Monteverde C, Jauregui R, et al. X syndrome. Angiographic findings. Arch Inst Cardiol Mex. 1989;59:257–65.

    CAS  PubMed  Google Scholar 

  25. Bencze J, Kiss RG, Toth-Zsamboki E, et al. Characterisation of coronary X syndrome subtypes identified by coronary blood flow velocity. Eur Heart J. 2006;27:349.

    Google Scholar 

  26. Danenberg HD, Hasin Y, Gilon D. A 42-year-old man with recurrent myocardial infarction and normal appearing coronary arteries. Int J Cardiol. 1999;69:225–6.

    CAS  PubMed  Google Scholar 

  27. Kapoor A, Goel PK, Gupta S. Slow coronary flow – a cause for angina with ST segment elevation and normal coronary arteries. A case report. Int J Cardiol. 1998;67:257–61.

    CAS  PubMed  Google Scholar 

  28. Przybojewski J, Becker P. Angina pectoris and acute myocardial infarction due to “slow-flow phenomenon” in non-atherosclerotic coronary arteries: a case report. Angiology. 1986;37:751–61.

    CAS  PubMed  Google Scholar 

  29. Diver DJ, Bier JD, Ferreira PE, et al. Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA trial). Am J Cardiol. 1994;74:531–7.

    CAS  PubMed  Google Scholar 

  30. Kaski JC, Rosano GM, Collins P, Nihoyannopoulos P, Maseri A, Poole-Wilson PA. Cardiac syndrome X: clinical characteristics and left ventricular function. Long-term follow-up study. J Am Coll Cardiol. 1995;25:807–14.

    CAS  PubMed  Google Scholar 

  31. Fineschi M, Gori T. Coronary slow flow: description of a new “cardiac Y” syndrome. Int J Cardiol. 2009;137:308–10.

    PubMed  Google Scholar 

  32. Paul LC, Jani D, Menete A, Mocumbi AO, Ferreira B. Coronary slow-flow phenomenon. Cardiovasc J Afr. 2007;18:385–6.

    PubMed  Google Scholar 

  33. Goel PK, Gupta SK, Agarwal A, Kapoor A. Slow coronary flow: a distinct angiographic subgroup in syndrome X. Angiology. 2001;52:507–14.

    CAS  PubMed  Google Scholar 

  34. Celik T, Iyisoy A, Kursaklioglu H, Yuksel C, Turhan H, Isik E. ST elevation during treadmill exercise test in a young patient with slow coronary flow: a case report and review of literature. Int J Cardiol. 2006;112:e1–4.

    PubMed  Google Scholar 

  35. Murakami H, Urabe K, Nishimura M. Inappropriate microvascular constriction produced transient ST-segment elevation in patients with syndrome X. J Am Coll Cardiol. 1998;32:1287–94.

    CAS  PubMed  Google Scholar 

  36. Wozakowska-Kaplon B, Niedziela J, Krzyzak P, Stec S. Clinical manifestations of slow coronary flow from acute coronary syndrome to serious arrhythmias. Cardiol J. 2009;16:462–8.

    PubMed  Google Scholar 

  37. Yamagishi H, Itagane H, Hato K, et al. A case of rest angina due to microvascular spasm. Jpn Circ J. 1997;61:87–9.

    CAS  PubMed  Google Scholar 

  38. Horimoto M, Igarashi K, Takenaka T, Inoue H, Yamazaki K, Sakuragi H. Acetylcholine- and ergonovine-induced coronary microvascular spasm reflected by increased coronary vascular resistance and myocardial lactate production. Clin Cardiol. 2000;23:221–5.

    CAS  PubMed  Google Scholar 

  39. Yilmaz H, Demir I, Uyar Z. Clinical and coronary angiographic characteristics of patients with coronary slow flow. Acta Cardiol. 2008;63:579–84.

    PubMed  Google Scholar 

  40. Binak E, Gunduz H, Sahin M, Kurtoglu N, Dindar I. The relation between impaired glucose tolerance and slow coronary flow. Int J Cardiol. 2006;111:142–6.

    PubMed  Google Scholar 

  41. Gibson CM, Ryan KA, Murphy SA, et al. Impaired coronary blood flow in nonculprit arteries in the setting of acute myocardial infarction. The TIMI Study Group. Thrombolysis in myocardial infarction. J Am Coll Cardiol. 1999;34:974–82.

    CAS  PubMed  Google Scholar 

  42. Yetkin E, Turhan H, Erbay AR, Aksoy Y, Senen K. Increased thrombolysis in myocardial infarction frame count in patients with myocardial infarction and normal coronary arteriogram: a possible link between slow coronary flow and myocardial infarction. Atherosclerosis. 2005;181:193–9.

    CAS  PubMed  Google Scholar 

  43. Amasyali B, Turhan H, Kose S, et al. Aborted sudden cardiac death in a 20-year-old man with slow coronary flow. Int J Cardiol. 2006;109:427–9.

    PubMed  Google Scholar 

  44. Saya S, Hennebry TA, Lozano P, Lazzara R, Schechter E. Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: a case report and review of literature. Clin Cardiol. 2008;31:352–5.

    PubMed  Google Scholar 

  45. Sezgin AT, Barutcu I, Ozdemir R, et al. Effect of slow coronary flow on electrocardiographic parameters reflecting ventricular heterogeneity. Angiology. 2007;58:289–94.

    PubMed  Google Scholar 

  46. Atak R, Turhan H, Sezgin AT, et al. Effects of slow coronary artery flow on QT interval duration and dispersion. Ann Noninvasive Electrocardiol. 2003;8:107–11.

    PubMed  Google Scholar 

  47. Voelker W, Euchner U, Dittmann H, Karsch KR. Long-term clinical course of patients with angina and angiographically normal coronary arteries. Clin Cardiol. 1991;14:307–11.

    CAS  PubMed  Google Scholar 

  48. Vural M, Satiroglu O, Akbas B, Goksel I, Karabay O. Coronary artery disease in association with depression or anxiety among patients undergoing angiography to investigate chest pain. Tex Heart Inst J. 2009;36:17–23.

    PubMed  Google Scholar 

  49. Ciavolella M, Avella A, Bellagamba S, Mangieri E, Nigri A, Reale A. Angina and normal epicardial coronary arteries: radionuclide features and pathophysiological implications at long-term follow-up. Coron Artery Dis. 1994;5:493–9.

    CAS  PubMed  Google Scholar 

  50. Turkmen M, Barutcu I, Esen AM, Karakaya O, Esen O, Basaran Y. Comparison of exercise QRS amplitude changes in patients with slow coronary flow versus significant coronary stenosis. Jpn Heart J. 2004;45:419–28.

    PubMed  Google Scholar 

  51. Cutri N, Zeitz C, Kucia AM, Beltrame JF. ST/T wave changes during acute coronary syndrome presentation in patients with the coronary slow flow phenomenon. Int J Cardiol. 2011;146:457–8.

    PubMed  Google Scholar 

  52. Demirkol MO, Yaymaci B, Mutlu B. Dipyridamole myocardial perfusion single photon emission computed tomography in patients with slow coronary flow. Coron Artery Dis. 2002;13:223–9.

    PubMed  Google Scholar 

  53. Baykan M, Baykan EC, Turan S, et al. Assessment of left ventricular function and Tei index by tissue Doppler imaging in patients with slow coronary flow. Echocardiography. 2009;26:1167–72.

    PubMed  Google Scholar 

  54. Sevimli S, Buyukkaya E, Gundogdu F, et al. Left ventricular functions in patients with coronary slow flow: a tissue Doppler study. Eur Heart J. 2006;27:560.

    Google Scholar 

  55. Sezgin AT, Topal E, Barutcu I, et al. Impaired left ventricle filling in slow coronary flow phenomenon: an echo-Doppler study. Angiology. 2005;56:397–401.

    PubMed  Google Scholar 

  56. Aksakal E, Islamoglu Y, Simsek Z, et al. The association of coronary slow flow with time to peak systolic strain. Turk Kardiyol Dern Ars. 2011;39:29–34.

    PubMed  Google Scholar 

  57. Nurkalem Z, Gorgulu S, Uslu N, et al. Longitudinal left ventricular systolic function is impaired in patients with coronary slow flow. Int J Cardiovasc Imaging. 2009;25:25–32.

    PubMed  Google Scholar 

  58. Mosseri M, Yarom R, Gotsman MS, Hasin Y. Histologic evidence for small-vessel coronary artery disease in patients with angina and patent large coronary arteries. Circulation. 1986;74:964–72.

    CAS  PubMed  Google Scholar 

  59. Fragasso G, Chierchia SL, Arioli F, et al. Coronary slow-flow causing transient myocardial hypoperfusion in patients with cardiac syndrome X: long-term clinical and functional prognosis. Int J Cardiol. 2009;137:137–44.

    PubMed  Google Scholar 

  60. Beltrame JF. Chest pain and normal angiography. In: Braunwald E, editor. Braunwald’s Heart disease edition. Philadelphia: Elsevier; 2006.

    Google Scholar 

  61. Erdogan D, Caliskan M, Gullu H, Sezgin AT, Yildirir A, Muderrisoglu H. Coronary flow reserve is impaired in patients with slow coronary flow. Atherosclerosis. 2007;191:168–74.

    CAS  PubMed  Google Scholar 

  62. Van Lierde J, Vrolix M, Sionis D, De Geest H, Piessens J. Lack of evidence for small vessel disease in a patient with “slow dye progression” in the coronary arteries. Cathet Cardiovasc Diagn. 1991;23:117–20.

    PubMed  Google Scholar 

  63. Sezgin N, Barutcu I, Sezgin AT, et al. Plasma nitric oxide level and its role in slow coronary flow phenomenon. Int Heart J. 2005;46:373–82.

    CAS  PubMed  Google Scholar 

  64. Ari H, Ari S, Erdogan E, et al. The effects of endothelial dysfunction and inflammation on slow coronary flow. Turk Kardiyol Dern Ars. 2010;38:327–33.

    PubMed  Google Scholar 

  65. Camsari A, Pekdemir H, Cicek D, et al. Endothelin-1 and nitric oxide concentrations and their response to exercise in patients with slow coronary flow. Circ J. 2003;67:1022–8.

    CAS  Google Scholar 

  66. Selcuk MT, Selcuk H, Temizhan A, et al. Asymmetric dimethylarginine plasma concentrations and L-arginine/asymmetric dimethylarginine ratio in patients with slow coronary flow. Coron Artery Dis. 2007;18:545–51.

    PubMed  Google Scholar 

  67. Muxel S, Fineschi M, Hauser ER, Gori T. Coronary slow flow or syndrome Y: dysfunction at rest, preserved reactivity of the peripheral endothelium. Int J Cardiol. 2011;147:151–3.

    PubMed  Google Scholar 

  68. Shirani S, Darabian S, Jozaghi S, Hamidian R. Correlation between endothelial dysfunction in normal coronary patients with slow flow and aortic ectasia: the first report. Cardiol J. 2009;16:146–50.

    PubMed  Google Scholar 

  69. Pekdemir H, Polat G, Cin VG, et al. Elevated plasma endothelin-1 levels in coronary sinus during rapid right atrial pacing in patients with slow coronary flow. Int J Cardiol. 2004;97:35–41.

    PubMed  Google Scholar 

  70. Hirata K, Matsuda Y, Akita H, Yokoyama M, Fukuzaki H. Myocardial ischaemia induced by endothelin in the intact rabbit: angiographic analysis. Cardiovasc Res. 1990;24:879–83.

    CAS  PubMed  Google Scholar 

  71. Kaski JC, Tousoulis D, Rosano GMC, Clarke J, Davies GJ. Role of neuropeptide Y in the pathogenesis of syndrome X. Eur Heart J. 1992;13:103.

    Google Scholar 

  72. Di Donato M, Fantini F, Maioli M, Prisco D, Rogasi PG, Neri Serneri GG. Blood velocity in the coronary artery circulation: Relation to thromboxane A2 levels in coronary sinus in patients with angiographically normal coronary arteries. Cathet Cardiovasc Diagn. 1987;13:162–6.

    PubMed  Google Scholar 

  73. Yalcin AA, Kalay N, Caglayan AO, et al. The relationship between slow coronary flow and angiotensin converting enzyme and ATIIR1 gene polymorphisms. J Natl Med Assoc. 2009;101:40–5.

    PubMed  Google Scholar 

  74. Nurkalem Z, Tangurek B, Zencirci E, et al. Endothelial nitric oxide synthase gene (T-786C) polymorphism in patients with slow coronary flow. Coron Artery Dis. 2008;19:85–8.

    PubMed  Google Scholar 

  75. Caglayan AO, Kalay N, Saatci C, Yalcyn A, Akalyn H, Dundar M. Lack of association between the Glu298Asp polymorphism of endothelial nitric oxide synthase and slow coronary flow in the Turkish population. Can J Cardiol. 2009;25:e69–72.

    CAS  PubMed  Google Scholar 

  76. Kosus A, Sagkan O, Dursun I, et al. Heart rate variability in patients with coronary slow flow. J Am Coll Cardiol. 2002;39:235B.

    Google Scholar 

  77. Pekdemir H, Cicek D, Camsari A, et al. The relationship between plasma endothelin-1, nitric oxide levels, and heart rate variability in patients with coronary slow flow. Ann Noninvasive Electrocardiol. 2004;9:24–33.

    PubMed  Google Scholar 

  78. Yazici M, Demircan S, Durna K, Sahin M. The role of adrenergic activity in slow coronary flow and its relationship to TIMI frame count. Angiology. 2007;58:393–400.

    CAS  PubMed  Google Scholar 

  79. Xia S, Deng SB, Wang Y, et al. Clinical analysis of the risk factors of slow coronary flow. Heart Vessels. 2011;26:480–6.

    PubMed  Google Scholar 

  80. Celik T, Yuksel UC, Bugan B, et al. Increased platelet activation in patients with slow coronary flow. J Thromb Thrombolysis. 2010;29:310–15.

    PubMed  Google Scholar 

  81. Sen N, Basar N, Maden O, et al. Increased mean platelet volume in patients with slow coronary flow. Platelets. 2009;20:23–8.

    CAS  PubMed  Google Scholar 

  82. Gokce M, Kaplan S, Tekelioglu Y, Erdogan T, Kucukosmanoglu M. Platelet function disorder in patients with coronary slow flow. Clin Cardiol. 2005;28:145–8.

    PubMed  Google Scholar 

  83. Nurkalem Z, Orhan AL, Alper AT, et al. The relation between insulin resistance determined by homeostatic [corrected from haemostatic] modelling and slow coronary flow. Ann Acad Med Singapore. 2008;37:188–91.

    PubMed  Google Scholar 

  84. Sezgin AT, Barutcu I, Sezgin N, et al. Contribution of plasma lipid disturbances to vascular endothelial function in patients with slow coronary flow. Angiology. 2006;57:694–701.

    PubMed  Google Scholar 

  85. Yildiz A, Yilmaz R, Demirbag R, Gur M, Bas MM, Erel O. Association of serum uric acid level and coronary blood flow. Coron Artery Dis. 2007;18:607–13.

    PubMed  Google Scholar 

  86. Yazici M, Demircan S, Aksakal E, et al. Plasma insulin, glucose and lipid levels, and their relations with corrected TIMI frame count in patients with slow coronary flow. Anadolu Kardiyol Derg. 2003;3:222–6.

    PubMed  Google Scholar 

  87. Barutcu I, Sezgin AT, Sezgin N, et al. Elevated plasma homocysteine level in slow coronary flow. Int J Cardiol. 2005;101:143–5.

    PubMed  Google Scholar 

  88. Evrengul H, Tanriverdi H, Kuru O, et al. Elevated homocysteine levels in patients with slow coronary flow: relationship with helicobacter pylori infection. Helicobacter. 2007;12:298–305.

    CAS  PubMed  Google Scholar 

  89. Riza Erbay A, Turhan H, Yasar AS, et al. Elevated level of plasma homocysteine in patients with slow coronary flow. Int J Cardiol. 2005;102:419–23.

    PubMed  Google Scholar 

  90. Tanriverdi H, Evrengul H, Enli Y, et al. Effect of homocysteine-induced oxidative stress on endothelial function in coronary slow-flow. Cardiology. 2007;107:313–20.

    CAS  PubMed  Google Scholar 

  91. Enli Y, Turk M, Akbay R, et al. Oxidative stress parameters in patients with slow coronary flow. Adv Ther. 2008;25:37–44.

    CAS  PubMed  Google Scholar 

  92. Yildiz A, Gur M, Yilmaz R, et al. Association of paraoxonase activity and coronary blood flow. Atherosclerosis. 2008;197:257–63.

    CAS  PubMed  Google Scholar 

  93. Barutcu I, Sezgin AT, Sezgin N, et al. Increased high sensitive CRP level and its significance in pathogenesis of slow coronary flow. Angiology. 2007;58(4):401–7.

    CAS  PubMed  Google Scholar 

  94. Madak N, Nazli Y, Mergen H, et al. Acute phase reactants in patients with coronary slow flow phenomenon. Anadolu Kardiyol Derg. 2010;10:416–20.

    PubMed  Google Scholar 

  95. Ozcan T, Gen R, Akbay E, et al. The correlation of thrombolysis in myocardial infarction frame count with insulin resistance in patients with slow coronary flow. Coron Artery Dis. 2008;19:591–5.

    PubMed  Google Scholar 

  96. Turhan H, Saydam GS, Erbay AR, et al. Increased plasma soluble adhesion molecules; ICAM-1, VCAM-1, and E-selectin levels in patients with slow coronary flow. Int J Cardiol. 2006;108:224–30.

    PubMed  Google Scholar 

  97. Yazici M, Aksakal E, Demircan S, Sahin M, Sagkan O. Is slow coronary flow related with inflammation and procoagulant state? Anadolu Kardiyol Derg. 2005;5:3–7.

    PubMed  Google Scholar 

  98. Albayrak S, Ordu S, Yuksel H, Ozhan H, Yazgan O, Yazici M. Efficacy of nebivolol on flow-mediated dilation in patients with slow coronary flow. Int Heart J. 2009;50:545–53.

    CAS  PubMed  Google Scholar 

  99. Tiryakioglu S, Tiryakioglu O, Ari H, Basel MC, Bozat T. Effects of nebivolol on endothelial function and exercise parameters in patients with slow coronary flow. Clin Med Cardiol. 2009;3:115–19.

    CAS  PubMed  Google Scholar 

  100. Akcay A, Acar G, Kurutas E, et al. Beneficial effects of nebivolol treatment on oxidative stress parameters in patients with slow coronary flow. Turk Kardiyol Dern Ars. 2010;38:244–9.

    PubMed  Google Scholar 

  101. Gunes Y, Tuncer M, Guntekin U, Ceylan Y, Sahin M, Simsek H. Regional functions of the left ventricle in patients with coronary slow flow and the effects of nebivolol. Ther Adv Cardiovasc Dis. 2009;3:441–6.

    PubMed  Google Scholar 

  102. Chang SF, Ma JY, Qian JY, Shu XH, Ge JB. Effects of intracoronary administration of nitroglycerin and verapamil for treatment of coronary slow flow phenomenon. Zhonghua Xin Xue Guan Bing Za Zhi. 2010;38:27–30.

    CAS  PubMed  Google Scholar 

  103. Sadamatsu K, Tashiro H, Yoshida K, et al. Acute effects of isosorbide dinitrate and nicorandil on the coronary slow flow phenomenon. Am J Cardiovasc Drugs. 2010;10:203–8.

    CAS  PubMed  Google Scholar 

  104. Topal E, Ozdemir R, Barutcu I, et al. The effects of trimetazidine on heart rate variability in patients with slow coronary artery flow. J Electrocardiol. 2006;39:211–18.

    PubMed  Google Scholar 

  105. Guntekin U, Gumrukcuoglu HA, Gunes Y, et al. The effects of perindopril on QT duration and dispersion in patients with coronary slow flow. Heart Vessels. 2011;26:357–62.

    PubMed  Google Scholar 

  106. Cakmak M, Tanriverdi H, Cakmak N, Evrengul H, Cetemen S, Kuru O. Simvastatin may improve myocardial perfusion abnormality in slow coronary flow. Cardiology. 2008;110:39–44.

    CAS  PubMed  Google Scholar 

  107. Caliskan M, Erdogan D, Gullu H, et al. Effects of atorvastatin on coronary flow reserve in patients with slow coronary flow. Clin Cardiol. 2007;30:475–9.

    PubMed  Google Scholar 

  108. Fan Y, Yang SS, Yu JB, et al. Atrovastatin use and coronary flow reserve in patients with coronary slow flow. Zhonghua Xin Xue Guan Bing Za Zhi. 2010;38:143–6.

    CAS  PubMed  Google Scholar 

  109. Gunes Y, Tuncer M, Guntekin U, Ceylan Y. The effects of nebivolol on P wave duration and dispersion in patients with coronary slow flow. Anadolu Kardiyol Derg. 2009;9:290–5.

    PubMed  Google Scholar 

  110. Ball CJ, Wilson DP, Turner SP, Saint DA, Beltrame JF. Heterogeneity of L- and T-channels in the vasculature: rationale for the efficacy of combined L- and T-blockade. Hypertension. 2009;53:654–60.

    CAS  PubMed  Google Scholar 

  111. Sadamatsu K, Inoue S, Tashiro H. Coronary slow flow phenomenon caused by contrast-induced microvascular spasm. Intern Med. 2007;46:1991–3.

    PubMed  Google Scholar 

  112. Ghaffari N, Ball C, Kennedy JA, Stafford I, Beltrame JF. Acute modulation of vasoconstrictor responses by pravastatin in small vessels. Circ J. 2011;75:1506–14.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, The Queen Elizabeth Hospital, University of Adelaide, 28 Woodville Road, Woodville, Adelaide, SA, 5011, Australia

    John Beltrame MBBS, PhD

  2. Division of Cardiology, San Francisco General Hospital, SFGH NH 5th Floor, 0846, San Francisco, CA, 94143-0846, USA

    Peter Ganz MD

  3. Center of Excellence in Vascular Research, University of California – San Francisco, San Francisco, CA, USA

    Peter Ganz MD

Authors
  1. John Beltrame MBBS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Ganz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John Beltrame MBBS, PhD .

Editor information

Editors and Affiliations

  1. Medical School, Coronary Artery Disease, Research Group, St George's Hospital, Cranmer Terrace, London, SW17 0RE, United Kingdom

    Juan Carlos Kaski

  2. University of Sydney, Discipline of Surgery, The Whiteley-Martin Research Centre, Parker Street, Sydney, 2747, New South Wales, Australia

    Guy D. Eslick

  3. , Women's Heart Center, Cedars-Sinai Heart Institute, S. San Vicente Blvd 444, Los Angeles, 90048, USA

    C. Noel Bairey Merz

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Beltrame, J., Ganz, P. (2013). The Coronary Slow Flow Phenomenon. In: Kaski, J., Eslick, G., Bairey Merz, C. (eds) Chest Pain with Normal Coronary Arteries. Springer, London. https://doi.org/10.1007/978-1-4471-4838-8_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4838-8_10

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4837-1

  • Online ISBN: 978-1-4471-4838-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation