Clinical Aspects of Atherosclerosis. Role of Coronary Artery Spasm
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.
KeywordsAngina Pectoris Coronary Arteriography Coronary Spasm Provocative Testing Coronary Artery Spasm
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- 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
- 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.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
- 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
- 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.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
- 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
- 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
- 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