Summary
Coronary vasomotion plays an important role in the regulation of coronary perfusion at rest and during exercise. Normal coronary arteries show vasodilation of the proximal (+ 20%) and distal (+ 40%) segments during supine bicycle exercise.
Patients with normal coronary arteries and reduced coronary flow reserve (= microvascular angina) show exercise-induced vasoconstriction of the distal epicardial arteries (- 24%), whereas the proximal vessels show vasodilation (+ 25%). This abnormal reaction of the distal epicardial vessels to exercise is probably due to an abnormal neurohumoral tone which may cause or contribute to the paradoxical vascular response of the distal vessels during exercise.
Patients with coronary artery disease show exercise-induced vasoconstriction of the stenotic vessel segments. The exact mechanism of this exercise-induced stenosis narrowing is not clear, but might be related either to a passive collapse of the disease-free vessel wall, active vasoconstriction arising from alpha-adrenergic stimulation by circulating catecholamines, an insufficient production of the endothelium-derived relaxing factor due to atherosclerotic alterations of the stenotic vessel segment or to increased platelet aggregation with release of thromboxane A2 and serotonin.
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References
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Hess, O.M. et al. (1991). Quantitative coronary arteriography at rest and during exercise. In: Reiber, J.H.C., Serruys, P.W. (eds) Quantitative Coronary Arteriography. Developments in Cardiovascular Medicine, vol 117. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-3726-3_6
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DOI: https://doi.org/10.1007/978-94-011-3726-3_6
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