No abstract available.
Diagnosis* ; Echocardiography* ; Ergonovine*

No abstract available.
Echocardiography ; Ergonovine ; Humans

BACKGROUND: In patients with variant angina, previous data have been inconclusive as to whether basal coronary artery tone is elevated at the spastic sites and nonspastic sites. The purpose of this study was to assess the basal coronary artery tone and to evaluate the responsiveness to acetylcholine and ergonovine in patients with variant angina. METHODS: Basal coronary artery tone was assessed by obtaining the percent increase in coronary artery diameter induced by nitroglycerin in 66 patients with variant angina and 26 control subjects. We also compared the basal coronary tone and the constrictive responses to acetylcholine and ergonovine between the 31 patients with variant angina whom spasm was provoked by the low doses of acetylcholine(Ach; intracoronary, 20microg) or ergonovine(Erg; intravenous, 50microg)(Group 1) and the 35 patients provoked by higher doses of acetylcholine(intracoronary, 100microg) or ergonovine(intravenous cumulative dose of 350microg)(Group 2). RESULTS: Patients with variant angina whom spasm was provoked by low doses of acetylcoline and ergonovine, have a more tendency of combine fixed disease(mix disease), multivessel spasm and high disease activity. Basal coronary artery tone at the spastic sites was significantly elevated in the Group 1 in whom spasm was provoked by low doses of acetycholine and ergonovine than that in Group 2(44+/-17 vs 13+/-11%, respectively, p<0.05). Basal coronary artery tone of spasm-related artery, but not nonspasm related artery, at the non spastic site was greater in the Group 1 than that in Group 2 (26+/-14 vs 16+/-10%, respectively, p<0.05). In the patients with variant angina in whom spasm was provoked by higher dose of acetylcholine or ergonovine, basal coronary artery was comparable at the spastic and nonspastic sites and was not different from that in the control subjects. The magnitude of vasoconstrictive responses to acetylcoline and ergonovine, at the nonspastic sites, were also greater in Group 1 than those in Group 2 and the control groups(Ach; 40+/-20 vs 26+/-11. 27+/-12% : Erg ; 37+/-18 vs 12+/-8, 13+/-10%, respectively, p<0.05). CONCLUSION: These findings suggest that elevated basal coronary artery tone of the spastic sites and nonspastic sites of spasm-related artery in patients with variant angina may be related to occurrence of coronary spasm.
Acetylcholine* ; Arteries ; Coronary Vessels* ; Ergonovine* ; Humans ; Muscle Spasticity ; Nitroglycerin ; Spasm*

To evaluate the coronary vasomotor tone in vasospasic angina, we compared the diameters of non-spastic segments of vasospastic group with those of control group. The internal diameters of each segment of three major coronary arteries were measured on the basal coronary angiogram, and nitroglycerin administration after provocation with ergonovine or acetylcholine. The vasospastic angina group consisted of 26 patients(20 males, 6 females, mean age of 54 years) and control group consisted of 25 patients (7 males, 18 females, mean age of 55 years). The basal coronary arterial diameters in vasospastic angina group were smaller than those in control group(p<0.05) except the distal segment of right coronary artery. The percent dilation ratio in vasospastic angina group was greater than that in control group(p<0.05). In vasospastic angina group there was no significant difference in the degree of constriction after provocation with ergonovine or acetylcholine between proximal and distal segment. These observations suggest that in vasospastic angina, basal coronary arterial tone is increased in the entire coronary arterial tree and the localized spasm may reflect local hyperrespon siveness.
Acetylcholine ; Constriction ; Coronary Vessels ; Ergonovine ; Female ; Humans ; Male ; Nitroglycerin ; Spasm

Recent studies suggest that coronary endothelial dysfunction in atherosclerosis may contribute to the predisposition both for coronary spasm as well as for thrombus formation. The integrity of at least one aspect of endothelial function can be assessed by the intracoronary administration of acetylcholine. Eleven(13.4%, mean age 48+13, male 11) out of 82 consecutive patients with acute myocardial infarction showed angiographically normal or near normal coronary arteries at 7~10 in-hospital days. Ten(91%) had history of heavy smoking and 7 patients(64%) had no history of previous angina. Anterior myocardial infarction was in 8 and inferior in 3 patients. After intracoronary administration of acetylcholine(incremental dose of 20, 50ug for the right and 20, 50, 100ug for the left), 9(82) of 11 infarct related arteries showed total or subtotal occlusion, but only in 3(17%) out of 18 non-infarct related arteries of 10 patients. Multivessel spasm was noticed in 3. Ergonovine test(graded doses of 0.05, 0.1 and 0.2 mg intravenously) was performed 30 minutes after completion of acetylcholine test in 5 patients. In 1 patients, acetylcholine test was positive and but ergonovine test was negative. Conclusion : 1) Eleven(13.4%) out of 82 patients with acute myocardial infarction had angiographically normal coronary arteries. 2) Ach positive responses of infarct-related arteries are more frequent(82%) than that of non-infarct related arteries(17%), suggesting that the infarction might be related to coronary artery spasm. 3) Positive Ach responses of non-infarct related arteries occurred in 30% of Patients. 4) Ach and Erg induced vasospasm developed at the same site in 5, which suggests that local hyperreactivity might be related to spasm.
Acetylcholine* ; Arteries ; Atherosclerosis ; Coronary Vessels* ; Ergonovine ; Humans ; Infarction ; Male ; Myocardial Infarction* ; Smoke ; Smoking ; Spasm* ; Thrombosis

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial ischemia, which frequently presents as sudden death. The pathophysiology and treatment of SCAD have not been fully determined. Herein, a case of SCAD, manifesting as variant angina, which rapidly progressed during an ergonovine test, in which 3 drug-eluting stents were deployed using intravascular an ultrasound guidance, with an excellent immediate result, is reported.
Coronary Vessels* ; Death, Sudden ; Drug-Eluting Stents ; Ergonovine* ; Myocardial Ischemia ; Stents* ; Ultrasonography* ; Ultrasonography, Interventional

BACKGROUND: There is little data about the intravascular ultrasound (IVUS) findings in the patients with vasospastic angina, especially with respect to patterns of vascular remodeling. METHODS: Coronary spasm was documented by angiography and ECG evidence of ischemia in 36 patients after administration of ergonovine (cumulative doses up to 350 microgram). After relief of spasm using 1,000 microgram of intracoronary nitroglycerin, IVUS imaging was performed and analyzed using standard methodology. The 36 focal spasm sites were compared to the proximal and distal reference segments. RESULTS: The angiographic baseline minimum lumen diameter measured 1.78+/-0.66mm, which decreased to 0.66+/-0.38mm with ergonovine provocaton (p<0.0001), increased to 2.66+/-0.64mm after intracoronary nitroglycerin (p<0.0001 compared to baseline and post-ergonovine), and did not change after the IVUS imaging (2.66+/-0.63mm, p=.9). Coronary artery spasm was observed in angiographically normal segments in 6 patients and near normal segments (<10% angiographic diameter stenosis by visual estimate) in 30. Atherosclerotic lesions were observed at all coronary spasm sites; the mean plaque burden measured 56% at the spasm site and 35% at the reference site. The plaque composition of spasm site was hypoechoic in 31 and hyperechoic, noncalcific in 5; there was no calcium. Positive remodeling (spasm site arterial area>proximal reference) was present in 5; intermediate remodeling (proximal reference >spasm site >distal reference arterial area) was present in 7; and negative remodeling (spasm site arterial area Angiography ; Atherosclerosis ; Calcium ; Constriction, Pathologic ; Coronary Vessels ; Electrocardiography ; Ergonovine ; Humans ; Incidence ; Ischemia ; Nitroglycerin ; Spasm* ; Ultrasonography*

BACKGROUND: Intravenous ergonovine and intracoronary acetylcholine tests have been used to induce coronary artery spasm, however, potential preblems with each test require a safer and more specific test. METHODS: To evaluate the usefulness of the intracoronary ergonovine provocation test in patients with coronary artery spasm, this test was performed in 83 patients(male 47, female 36) with normal or near-normal looking coronary angiography or insignificant lesion less than 50% in diameter after routine diagnostic coronary angiography. Ten micrograms of ergonovine maleate diluted in 1 ml of saline was injected into right coronary artery up to 2 times and into left coronary artery up to 3 times. Induction of coronary arterial narrowing more than 75% of luminal diameter with typical chest pain and/or ECG changes in two or more adjacent leads was considered as a positive test. RESULTS: Intracoronary ergonovine provocation tests were positive in 33 patients among 83 patients. In 24 patients, coronary artery spasm was induced in RCA, 12 patients in LAD and 8 patients in LCX. Coronary artery spasm of 2 sites was observed in 11 patients. In 27 patients, typical chest pain was developed with spasm. The ECG changes during spasm were ST elevation in 19 patients, ST depression in 3 patients, T wave change only in 2 patients and no change in 9 patients. The provocation tests showed focal spasm in 23 patients(70%) and diffuse spasm in 10 patients(30%). CONCLUSION: Intracoronary ergonovine provocation test appears to be a safe and effective method to provoke the coronary artery spasm.
Acetylcholine ; Chest Pain ; Coronary Angiography ; Coronary Vessels* ; Depression ; Electrocardiography ; Ergonovine* ; Female ; Humans ; Phenobarbital ; Spasm*

BACKGROUND: The diagnostic significance of ECG ergonovine test and the incidence of vasospastic angina in patients with chest pain are still uncertain. METHODS: From May 1998 to June 1999, 133 consecutive patients with chest pain were admitted for diagnostic coronary angiography. ECG ergonovine provocation tests were performed in 64 patients who have a clinical history suggesting vasospatic angina, including 27 of 28 patients with vasospastic angina documented electrocardiographically, or who's coronary angiographic findings could not be explained by their clinical history. Ergonovine was administered intravenously in incremental dose of 0.05, 0.1, 0.2, 0.3, 0.4 mg up to total cumulative dosage of 1.0mg during coronary angiography(41 cases), in the exercise laboratory(21 cases) or both(2 cases). RESULTS: Of 133 patients with chest pain, vasospastic angina was documented in 32(24%), unstable angina in 52(34%), stable angina in 10(8%), and others in 39(29%). Angiography demonstrated coronary spasm in 4 additional patients as well as 22 patients with vasospastic angina documented electrocardiographically, but ergonovine tests in the exercise laboratory showed positive response in 5 of 6 patients with vasospastic angina documented. Among the 25 patients with coronary spasm proved angiographically during ergonovine test, ECG findings at the time of coronary spasm were ST segment elevation in 21(84%), depression in 1(4%) and no change in 3(12%) patients, who had branch vessel spasm, 3 vessel spasm or incomplete spasm on coronary angiogram. Of the 31 patients with vasospastic angina who underwent ergonovine tests, positive response occurred in 24(77%) after a cumulative dose of < or = 0.4mg and in additional 3(10%) after the higher dose of >0.4mg. However the other 4(13%) had no ECG changes even after the higher dose(>0.4mg) of ergonovine. CONCLUSION: This results suggest that vasospastic angina appear to be a common cause of chest pain, and ECG ergonovine test with high dose can improve diagnostic sensitivity but cannot detect some patients with vasospastic angina.
Angina, Stable ; Angina, Unstable ; Angiography ; Chest Pain ; Coronary Angiography ; Depression ; Electrocardiography* ; Ergonovine* ; Humans ; Incidence ; Spasm

Intracoronary acetylcholine and intravenous ergonovine tests have been used to induce coronary artery spasm. To evaluate the usefulness of these provocative tests, acetylcholine and ergonovine tests were performed in 86 patients with normal or near normal coronary angiograms(clinically variant angina in 30, effort angina in 6, unstable angina in 5, myocardial infarction in 6, atypical chest pain in 39 patients). Acetylcholine was injected into each coronary artery in incremental doses (0.02, 0.05 and 0.1 mg into left coronary artery, 0.02 and 0.05 mg into right coronary artery) and ergonovin was given intravenously in graded doses of 0.05, 0.1 and 0.2 mg after completion of acetylcholine test. The results were as follow : 1) Among 86 patients, both acetylcholine and ergonovine tests were positive in 29 patients, both tests were negative in 50 patients, and acetylcholine test was positive but ergonovine test was negative in 7 patients ; The responses of acetylcholine and ergonovine tests were concordant in 92% of patients. The sensitvity and specificity of the acetylcholine test with reference to ergonovine test were 100% and 88% respectively. 2) In 7 patients(8%) acetylcholine test was positive but ergonovine test was negative, and this group may represent a spectrum of coronary spasm syndrome. CONCLUSION: Acetylcholine test is a safe and useful provocative test for coronary artery spasm, especially in the multivessel spasm.
Acetylcholine* ; Angina, Unstable ; Chest Pain* ; Coronary Vessels ; Ergonovine* ; Humans ; Myocardial Infarction ; Sensitivity and Specificity ; Spasm ; Thorax*