Advertisement

Clinical Aspects of Atherosclerosis. Role of Coronary Artery Spasm

  • M. E. Bertrand
Conference paper

Abstract

Over the past several years, pathological and pathophysiological studies suggested that fixed coronary artery stenosis due to atherosclerosis were responsible for myocardial ischemia and infarction. Most physicians had been taught in medical school that the coronary narrowing was the cause of angina and that pain occured as a result of an imbalance of myocardial oxygen supply and demand. However in the 18’s many authors have postulated that spasm was the likely cause of angina. In fact, like many concepts in medicine the idea of spasm, once popular, was subsequently rejected and is now being rediscovered. In 1959 Prinzmetal (1) revived interest in coronary artery spasm when he described a group of patients with “variant angina” and postulated that this clinical syndrome could be related to an increased vascular tonus superimposed on fixed proximal atherosclerotic narrowing. In 1962 Gensini (2) was able to document the appearance of spontaneous coronary artery spasm. Subsequent developments including coronary arteriography, hemodynamic and electrocardiographic monitoring, isotope studies provided important evidence concerning the existence of coronary artery spasm in man. Maseri and colleagues (3) have provided very elegant physiopathologic investigations in patients with angina at rest These developments have implicated coronary artery spasm in the pathophysiology of many other ischemic syndromes in addition to Prinzmetal’s variant angina, More recently provocative testing (4–7) provided some more lights on the possible role of coronary spasm in heart disease in general.

Keywords

Angina Pectoris Coronary Arteriography Coronary Spasm Provocative Testing Coronary Artery Spasm 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Prinzmetal M, Kenamer R, Merliss R, Wada T, Bor N (1959) Angina pectoris I — A variant from of angina pectoris. Preliminary report. Am. J. Med. 27: 375–388Google Scholar
  2. 2.
    Gensini GG, Di Giorgi S, Murao Netto S (1962) Arteriography demonstration of coronary artery spasm and its release after the use of a vasodilatator in a case of angina pectoris and in the experimental animal. Angiology 13: 550–553PubMedCrossRefGoogle Scholar
  3. 3.
    Maseri A, Nimmo R, Chierchia S, Marchesi C, Pesole A, l’Abbate A (1975) The ergoCoronary artery spasm as a cause of acute myocardial ischemia in man. Chest 68 625CrossRefGoogle Scholar
  4. 4.
    Heupler F, Proutfit W, Siegel W, Shirey E, Razavi M, Sones M (1975) The ergo- novine maleate for the diagnostic of coronary spasm. Circulation 51, suppl. 2, 11Google Scholar
  5. 5.
    Bertrand ME, Rousseau MF, Lablanche JM, Warembourg Jr H, Carre AG, Lekieffre J, (1979) La detection du spasme des artères coronaires par le test à la méthylergométrine. Technique, Résultats. Indications. Arch. Mai. Coeur 72: 123Google Scholar
  6. 6.
    Bertrand ME, Lablanche JM, Tilmant PY (1980) Use of provocative testing in aftgina pectoris. Herz 5: 65PubMedGoogle Scholar
  7. 7.
    Bertrand ME, Lablanche JM, Tilmant FY, Thieuleux FA, Delforge MR, Carre AG, Asseman Ph, Berzin B, Libersa C, Laurent JM (1982). Frequency of provoked coronary arterial spasm en 1 089 consecutive patients undergoing coronary arteriography. Circulation 42: 605Google Scholar
  8. 8.
    Chahine RA, Raizner AE, Ishimori T, Luchi RJ, Mc Intosh MD (1975) The incidence and clinical implications of coronary artery spasm. Circulation 52: 972.PubMedGoogle Scholar
  9. 9.
    Curry JR, Pepine CJ, Sábomi MB, Conti CR (1979). Similarities of ergonovine induced and spontaneous attacks of variant angina. Circulation 59: 307PubMedGoogle Scholar
  10. 10.
    Meller J, Pichard A, Dack S (1976) Coronary arterial spasm in Prinzmetal’s angina. A proved hypothesis. Am. J. Cardiol. 37: 938CrossRefGoogle Scholar
  11. 11.
    Maseri A, Severi S, De Nes M, L’Abbate A, Chierchia S, Marzilli M, Ballestra AM, Parodi O, Biagini A, Distante A (1978) “Variant” angina: One aspect of a continuous spectrum of vasospastic myocardial ischemia. Pathogenetic mechanisms. Estimated incidence and clinical and coronary arteriographic findings in 138 patients. Am. J. Cardiol. 42: 1019.PubMedCrossRefGoogle Scholar
  12. 12.
    Angoli L, Marinoni GP, Palcone C, Bramucci E, De Servi S, Specchia G, Montemartini C (1977) Spasme coronaire à l’effort. Démonstration coronarographique d’un cas. Arch. Mai. Coeur 71: 823.Google Scholar
  13. 13.
    Yasue H, Ornote S, Takizana A, Nagao M, Miwa K, Tanaka S (1979) Exertional angina pectoris caused by coronary arterial spasm: effects of various drugs. Am. J. Cardiol. 43: 647.PubMedCrossRefGoogle Scholar
  14. 14.
    Maseri A, L’Abbate A, Baroldi G, Chierchia S, Marzilli M, Ballestra AM, Severi S, Parodi O, Biagini A, Distante A, Pesola A (1978) Coronary vasospasm as a possible cause of myocardial infarction: a conclusion derived from the study of pre-infarction angina. N. Engl. J. Med. 299: 1271–77.PubMedCrossRefGoogle Scholar
  15. 15.
    Oliva PB, Breckinridge JC (1977) Arteriographic evidence of coronary arterial spasm in acute rryocardial infarction. Circulation 56: 366–74000.PubMedGoogle Scholar
  16. 16.
    Dewood MA, Sporess J, Notske R, Mouser MT, Burroughs R, Galden M, Lang HT (1980). Prevalence of total coronary occlusion during the early hours of transmural rryocardial infarction. N. Engl. J. Med. 303: 897–903.PubMedCrossRefGoogle Scholar
  17. 17.
    Rentrop P, Blanke H, Karsch KR, Kaiser H, Kostering H, Leitz K (1981) Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris. Circulation 63: 307–17.PubMedCrossRefGoogle Scholar
  18. 18.
    Mathey DE, Kuck KH, Tilsner V, Krebber HJ, Bleifeld W (1981). Non surgical coronary artery recanalization after acute transmural myocardial infarction. Circulation 63: 489–97.PubMedCrossRefGoogle Scholar
  19. 19.
    Folts JD, Crowell EB, Rowe GG (1976). Platelet aggregation in partially obstructed vessels and its elimination with aspirin. Circulation 54: 365–70.PubMedGoogle Scholar
  20. 20.
    Gertz SD, Vretsky G, Wainberg S, Navot N, Gotsman MS (1981). Endothelial cell damage and thrombus formation after partial constriction: relevance to the role of coronary artery spasm in the pathogenesis of myocardial infarction. Circulation 63: 476–86.PubMedCrossRefGoogle Scholar
  21. 21.
    Curry RC Jr, Pepine CJ, Feldman RL, Whittle JL, Conti CR (1980). Frequency of rryocardial infarction and sudden death in 44 variant angina patients. A high risk ischemic heart disease subset. Proc. of VII European Congress of Cardiol. Paris p. 6.Google Scholar
  22. 22.
    Arciniegas J, Little WC, Coghlan HC, Russell RO, Rackley CE, Mantle JA (1981). Coronary artery spasm: an isolated phenomenon or one manifestation of a more diffuse hyperreactivity (abst.). Am. J. Cardiol. 47: 450.CrossRefGoogle Scholar
  23. 23.
    Bauer TW, Moore GW, Hutchins GM (1982). Morphologic evidence for coronary artery spasm in eclampsia. Circulation 65: 255.PubMedCrossRefGoogle Scholar
  24. 24.
    Lange R, Reid M, Tresch D, Keelan M, Bemhard V, Coolidge G (1972). Non atheromatous ischemic heart disease following withdrawal from chronic industrial nitroglycerin exposure. Circulation 46: 666.PubMedGoogle Scholar
  25. 25.
    Mc Alpin R (1980). Coronary arterial spasm to sites of organic narrowing. Am. J. Cardiol. 46: 143.CrossRefGoogle Scholar
  26. 26.
    Maseri A, Severi S, Chierchia S, Parodi 0, Biagini A (1978). Characteristics and pathogenetic mechanism of “primary” angina at rest. In “primary and secondary angina pectoris”. (Maseri A, Klassen GA, Lesch M edit.) Grune et Stratton, New York, p. 265.Google Scholar
  27. 27.
    Marzilli M, Goldstein S, Trivella M, Palumbo C, Maseri A (1980). Some clinical considerations regarding the relation of coronary vasospasm to coronary atherosclerosis. A hypothetical pathogenesis. Am. J. Cardiol. 45: 882PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1983

Authors and Affiliations

  • M. E. Bertrand

There are no affiliations available

Personalised recommendations