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Update 1989 pp 505-510 | Cite as

The Role of Coronary Vasomotor Tone in Chronic and Acute Ischemic Syndromes

  • J. C. Kaski
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 8)

Abstract

Our understanding of the mechanisms underlying chronic stable angina, unstable angina, myocardial infarction and sudden cardiac death has increased in recent years. There are indications that common mechanisms may initiate these ischemic entities, particularly the acute syndromes [1–3]. It is now generally accepted that an episodic increase of the vasomotor tone of epicardial coronary arteries is not only the cause of variant angina but may also represent a pathogenic component in other more common anginal syndromes [4, 5].

Keywords

Acute Myocardial Infarction Unstable Angina Stable Angina Coronary Blood Flow Coronary Occlusion 
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.

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References

  1. 1.
    Epstein SE, Palmen ST (1984) Mechanisms contributing to precipitation of unstable angina and acute myocardial infarction: implications regarding therapy. Am J Cardiol 54:1245–1252PubMedCrossRefGoogle Scholar
  2. 2.
    Fuster V, Badimon L, Cohen M, Ambrose JA, Badimon JJ, Chesebro J (1988) Insights into the pathogenesis of acute ischemic syndromes. Circulation 77:1213–1220PubMedCrossRefGoogle Scholar
  3. 3.
    Davies M, Thomas A (1985) Plaque fissuring — the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina. Br Heart J 53:363–373PubMedCrossRefGoogle Scholar
  4. 4.
    Epstein SE, Talbot TL (1981) Dynamic coronary tone in precipitation, exacerbation and relief of angina pectoris. Am J Cardiol 48:797–803PubMedCrossRefGoogle Scholar
  5. 5.
    Willerson JT, Hillis LD, Winniford M, Buja LM (1986) Speculation regarding mechanisms responsible for acute ischemic heart disease syndromes. J Am Coll Cardiol 8:245–250PubMedCrossRefGoogle Scholar
  6. 6.
    Maseri A, Chierchia S, Kaski JC (1985) Mixed forms of angina. Am J Cardiol 56:30–33CrossRefGoogle Scholar
  7. 7.
    Crea F, Margonato A, Kaski JC, et al (1986) Variability of results during repeat exercise stress testing in patients with stable angina pectoris: Role of dynamic coronary flow reserve. Am Heart J 112:249–254PubMedCrossRefGoogle Scholar
  8. 8.
    Kaski JC, Crea F (1987) Practical assessment of the role of dynamic coronary stenoses in patients with stable exertional angina. In: Maseri A, Sobel BE, Chierchia S (eds) Hammersmith cardiology workshop series. Raven Press, New York, p 117Google Scholar
  9. 9.
    Deanfield JE, Maseri A, Selwyn AP, et al (1983) Myocardial ischaemia during daily life in patients with stable angina: its relation to symptoms and heart rate changes. Lancet 753–758Google Scholar
  10. 10.
    Schang SJ, Pepine C (1977) Transient asymptomatic ST segment depression during daily activity. Am J Cardiol 39:396–402PubMedCrossRefGoogle Scholar
  11. 11.
    Chierchia S, Gallino A, Smith G, et al (1984) The role of heart rate in the pathophysiology of chronic stable angina. Lancet 2:1353–1357PubMedCrossRefGoogle Scholar
  12. 12.
    Chierchia S, Balasubramanian V, Muiesan L, et al (1984) Transient impairment of coronary flow: a frequent cause of ischemia in chronic stable angina during normal daily life. JACC 3:579Google Scholar
  13. 13.
    Crea F, Davies G, Romeo F, et al (1984) Myocardial ischemia during ergonovine testing: different susceptibility to coronary vasoconstriction in patients with exertional and variant angina. Circulation 69:690–695PubMedCrossRefGoogle Scholar
  14. 14.
    Gage JE, Hess OM, Murakami T, et al (1986) Vasoconstriction of stenotic coronary arteries during dynamic exercise in patients with classic angina pectoris: reversibility by nitroglycerin. Circulation 75:865–876CrossRefGoogle Scholar
  15. 15.
    Brown BG, Lee AB, Bolson EL, Dodge HT (1984) Reflex constriction of significant coronary stenosis as a mechanism contributing to ischemic left ventricular dysfunction during isometric exercise. Circulation 70:18–24PubMedCrossRefGoogle Scholar
  16. 16.
    Brown BG, Bolson E, Petersen RB, Pierce CD, Dodge HT (1981) The mechanisms of nitroglycerin action: stenosis vasodilatation as a major component of the drug response. Circulation 64:1089–1097PubMedCrossRefGoogle Scholar
  17. 17.
    Vlodaver Z, Edwards JE (1971) Pathology of coronary atherosclerosis. Prog Cardiovasc Dis 14:256–259PubMedCrossRefGoogle Scholar
  18. 18.
    MacAlpin RN (1980) Contribution of dynamic vascular wall thickening to luminal narrowing during coronary arterial constriction. Circulation 61:296–301PubMedGoogle Scholar
  19. 19.
    Kaski JC, Rodriguez-Plaza L, Meran DO, Araujo L, Chierchia S, Maseri A (1985) Improved coronary supply: prevailing mechanism of action of nitrates in chronic stable angina. Am Heart J 110:238–245PubMedCrossRefGoogle Scholar
  20. 20.
    Feldman RL (1987) Coronary thrombosis, coronary spasm and coronary atherosclerosis and speculation on the link between unstable angina and acute myocardial infarction. Am J Cardiol 59:1187–1190PubMedCrossRefGoogle Scholar
  21. 21.
    Maseri A (1984) Spasm and dynamic coronary stenosis. J Cardiovasc Pharmacol 6:683–690CrossRefGoogle Scholar
  22. 22.
    Maseri A, Severi S, De Nes M, et al (1978) “Variant” angina: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Am J Cardiol 42:1019–1035PubMedCrossRefGoogle Scholar
  23. 23.
    Kaski JC, Crea F, Meran D, et al (1986) Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina. Circulation 74:1255–1265PubMedCrossRefGoogle Scholar
  24. 24.
    Davies M, Thomas A (1984) Thrombosis and acute coronary artery lesions in sudden cardiac ischemic death. N Engl J Med 310:1137–1140PubMedCrossRefGoogle Scholar
  25. 25.
    Constantinides P (1966) Plaque fissures in human coronary thrombosis. J Atherosclerosis Res 6:1–17CrossRefGoogle Scholar
  26. 26.
    Falk E (1985) Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death: autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion. Circulation 71:699–708PubMedCrossRefGoogle Scholar
  27. 27.
    Ambrose J, Winters S, Stern A, Eng A (1985) Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol 5:609–616PubMedCrossRefGoogle Scholar
  28. 28.
    Sherman CT, Litvack F, Grundfest W, et al (1986) Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med 315:913–919PubMedCrossRefGoogle Scholar
  29. 29.
    Capone GJ, Meyer BB, Wolf NM, Meister SG (1984) Incidence of intracoronary thrombi in patients with active unstable angina pectoris. Circulation 70 (suppl II): 415 (abstract)Google Scholar
  30. 30.
    Theroux P, Ouimet H, McCans J, et al (1988) Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med 319:1105–1111PubMedCrossRefGoogle Scholar
  31. 31.
    Davies GJ, Chierchia S, Maseri A (1984) Prevention of myocardial infarction by very early treatment with intracoronary streptokinase. Some clinical observations. N Engl J Med 311:1488–1492PubMedCrossRefGoogle Scholar
  32. 32.
    Hackett D, Davies G, Chierchia S, Maseri A (1987) Intermittent coronary occlusion in acute myocardial infarction. Value of combined thrombolytic and vasodilator therapy. N Eng J Med 317:1055–1059CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • J. C. Kaski

There are no affiliations available

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