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The Role of Coronary Artery Spasm in Acute Ischemic Syndromes

  • Robert A. Chahine

Abstract

Our concepts of the pathophysiology of myocardial ischemia have oscillated over the years like a pendulum. For more than a century since Allan Burns in 1809 [1] suspected coronary artery spasm as a cause of angina pectoris, until Sir William Osier in 1910 stated that he could not think of a better explanation of anginal pain [2], coronary artery spasm was believed to be the primary mechanism underlying acute myocardial ischemia. The pendulum began to swing away from spasm under the influence of Keefer and Resnik, who in the 1920s questioned the ability of rigid atherosclerotic coronary arteries to constrict or go into spasm [3]. Shortly after, Blumgart and co-workers focused attention on the association between the clinical history of angina and the finding of coronary atherosclerosis at autopsy [4]. Subsequently, the failure to find coronary artery spasm with any significant frequency during the first decade of coronary arteriography helped to shift thinking further away from spasm.

Keywords

Angina Pectoris Cold Pressor Test Normal Coronary Artery Coronary Arteriography Isosorbide Dinitrate 
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References

  1. 1.
    Burns A: Observations on some of the most frequent and important diseases of the heart; on aneurysm of the thoracic aorta; on preternatural pulsation in the epigastric region and on the unusual origin and distribution of some of the large arteries of the human body. London: Thomas Bryce and Co, 1809.Google Scholar
  2. 2.
    Osier W: Lumleian lectures on angina pectoris. Lancet 1: 697, 1910.Google Scholar
  3. 3.
    Keefer CS, Resnick WH: Angina pectoris: a syndrome caused by anoxemia of the myocardium. Arch Intern Med 41: 769, 1928.Google Scholar
  4. 4.
    Blumgart HL, Schlesinger MJ, David D: Studies on the relation of the clinical manifestations of angina pectoris, coronary thrombosis and myocardial infarction to the pathologic findings. Am Heart J 1: 19, 1940.Google Scholar
  5. 5.
    Oliva PB, Potts DE, Plus RG: Coronary arterial spasm in Prinzmetal angina: documentation by coronary arteriography. N Engl J Med 288: 745, 1973.PubMedCrossRefGoogle Scholar
  6. 6.
    Dhurandar RW, Watt DL, Silver MD, Trimble AS, Adelman AG: Prinzmetal’s variant form of angina with arteriographic evidence of coronary arterial spasm. Am J Cardiol 30: 902, 1972.CrossRefGoogle Scholar
  7. 7.
    King MJ, Zir LM, Kaltman AJ, Fox AC: Variant angina associated with angiographially demon-strated coronary artery spasm and REM sleep. Am J Med Sci 265: 419, 1973.PubMedCrossRefGoogle Scholar
  8. 8.
    Hart, NJ, Silverman ME, King SB: Variant angina pectoris caused by coronary artery spasm. Am J Med 56: 269, 1974.PubMedCrossRefGoogle Scholar
  9. 9.
    Kerin N, MacLeod GA: Coronary artery spasm associated with variant angina pectoris. Br Heart J 36: 224, 1974.PubMedCrossRefGoogle Scholar
  10. 10.
    Maseri A, Mimmo R, Chierchia S, Marchesi C, Pesóla A, L’Abbate A: Coronary artery spasm as a cause of acute myocardial ischemia in man. Chest 68: 625, 1975.CrossRefGoogle Scholar
  11. 11.
    Cheng, TO, Bashour T, Singh BK, Kelser GA: Myocardial infarction in the absence of coronary arterosclerosis: result of coronary spasm? Am J Cardiol 30: 680, 1972.PubMedCrossRefGoogle Scholar
  12. 12.
    Oliva PB, Brenchkenridge JC: Arteriographic evidence of coronary arterial spasm in acute myocardial infarction. Circulation 56: 366, 1977.PubMedGoogle Scholar
  13. 13.
    Johnson AD, Detwiler JH: Coronary spasm, variant angina, and recurrent myocardial infarctions. Circulation 55: 947, 1977.PubMedGoogle Scholar
  14. 14.
    Maseri A, L’Abbate A, Varoldi G, Chierchia S, Marzilli M, Ballestra AM, Severi S, Parodi O, Biagini A, Distante A, Pesola A: 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, 1978.PubMedCrossRefGoogle Scholar
  15. 15.
    Maseri A, Pesola A, Marzilli M, Severi S, Parodi O, L’Abbate A, Ballestra AM, Maltinti G, De Nes DM, Biagini A: Coronary vasospasm in angina pectoris. Lancet 1: 713, 1977.PubMedCrossRefGoogle Scholar
  16. 16.
    Marzilli, M, L’Abbate A, Ballestra AM, Maseri A: Coronary angiographic findings during angina at rest with ST-depression. Circulation (Suppl 2) 55 and 56: 83, 1977.Google Scholar
  17. 17.
    Chahine RA, Raizner AE, Luchi RJ: Coronary arterial spasm in classic angina pectoris. Cathet Cardiovasc Diagn 1: 337, 1975.PubMedCrossRefGoogle Scholar
  18. 18.
    Levene DL, Freeman MR: Alpha-adrenoceptor mediated coronary artery spasm. JAMA 236: 1018, 1976.PubMedCrossRefGoogle Scholar
  19. 19.
    Prchkov VK, Mookherjee S, Schiess W, Obeid AI: Variant anginal syndrome, coronary artery spasm, and ventricular fibrillation in absence of chest pain. Ann Intern Med 81: 858, 1974.PubMedGoogle Scholar
  20. 20.
    Wei JY, Genecin A, Greene HL, Achuff SC: Coronary spasm with ventricular fibrillation during thyrotoxicosis: response to attaining euthyroid state. Am J Cardiol 43: 335, 1979.PubMedCrossRefGoogle Scholar
  21. 21.
    Rentrop KP, Blanke H, Karsch KR, Wiegand V, Kostering G, Oster H, Leitz K: Acute myocardial infarction: intracoronary application of nitroglycerin and streptokinase. Clin Cardiol 2: 354, 1979.PubMedGoogle Scholar
  22. 22.
    De Wood MA, Spores J, Notske R: Prevalence of coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med 303: 897, 1980.CrossRefGoogle Scholar
  23. 23.
    Ganz W, Buchbinder N, Marcus H, Mondkar A, Maddahi J, Charuzi Y, O’Connor L, Shell W, Eishbein MC, Kass R, Miyamoto A, Swan HJC: Intracoronary thrombolysis in evolving myocardial infarction. Am Heart J 101: 4, 1981.PubMedCrossRefGoogle Scholar
  24. 24.
    Ganz W: Coronary spasm in myocardial infarction: fact or fiction? Circulation 63: 487, 1981.PubMedCrossRefGoogle Scholar
  25. 25.
    Chahine RA: Pathophysiology of ischemic heart disease. In: Blocker WP, CardusD(eds) Rehabilitation in ischemic heart disease. SP Medical and Scientific Books, 1982.Google Scholar
  26. 26.
    Chahine RA: Coronary artery spasm. Mt Kisco NY: Futura, 1983.Google Scholar
  27. 27.
    MacAlpin RN: Terminology and classification in coronary artery spasm. Chahine R (ed). Mt Kisco NY: Futura, 1983.Google Scholar
  28. 28.
    Conti CR, Pepine CJ, Feldman RL: Coronary artery spasm. Baylor College of Medicine Cardiology Series vol 4#2, Mcintosh HD (ed), 1981.Google Scholar
  29. 29.
    Endo M, Kanda T, Hosoda S, Mayashi H, Hirosawa H, Kono S: Prinzmetal’s variant form of angina pectoris: re-evaluation of mechanisms. Circulation 52: 33, 1975.PubMedGoogle Scholar
  30. 30.
    Chahine RA, Raizner AE, Ishimori T, Luchi RJ, Mcintosh HD: The incidence and clinical impli-cations of coronary artery spasm. Circulation 52: 972, 1975.PubMedGoogle Scholar
  31. 31.
    Fernandez D, Rosenthal JE, Cohen LS, Hammond G, Wolfson S: Alcohol-induced Prinzmetal variant angina. Am J Cardiol 32: 238, 1973.PubMedCrossRefGoogle Scholar
  32. 32.
    Ellis EF, Oelz O, Roberts LJ, Payne NA, Sweetman BJ, Nies AS, Gates J A: Coronary arterial smooth muscle contraction by a substance released from platelets: evidence that it is thromboxane A2. Science 193: 1135, 1976.PubMedCrossRefGoogle Scholar
  33. 33.
    Yasue H, Touyama M, Kato H, Tanaka S, Aki- yama F: Prinzmetal’s variant form of angina as a manifestation of alpha-adrenergic receptor- mediated coronary artery spasm: documentation by coronary arteriography. Am Heart J 91: 148, 1976.Google Scholar
  34. 34.
    Endo M, Kirosawa K, Kaneko, N, Hase K, Inoue Y, Konno S: Prinzmetal’s variant angina: coronary arteriogram and left ventriculogram during angina attack induced by methacholine. N Engl J Med 294: 252, 1976.PubMedCrossRefGoogle Scholar
  35. 35.
    Schroeder JS, Bolen JL, Quint RA, Clark DA, Hayden WG, Higgins CB, Wexler L: Provocation of coronary spasm with ergonovine maleate: new test with results in 57 patients undergoing coronary arteriography. Am J Cardiol 40: 487, 1977.PubMedCrossRefGoogle Scholar
  36. 36.
    Raizner AE, Ishimori T, Chahine RA: Recurrent catheter-induced coronary artery spasm. Cathet Cardiovasc Diagn 3: 187, 1977.PubMedCrossRefGoogle Scholar
  37. 37.
    Clark DA, Quint RA, Mitchell RL, Angell WW: Coronary artery spasm: medical management, surgical denervation, and autotransplantation. Thorac Cardiovasc Surg 73: 332, 1977.Google Scholar
  38. 38.
    Grondin CM, Limet R: Sympathetic denervation in association with coronary artery grafting in patients with Prinzmetal’s angina. Ann Thorac Surg 23: 111, 1977.PubMedCrossRefGoogle Scholar
  39. 39.
    Yasue H, Nagao M, Omoto S, Takizawa A, Miwa K, Tanaka S: Coronary arterial spasm and Prinzmetal’s variant form of angina induced by hyperventilation and trisbuffer infusion. Circulation 58: 56, 1978.PubMedGoogle Scholar
  40. 40.
    Heupler FA, Proudfit WL, Razavi M, Shirey EK, Greenstreet R, Sheldon WC: Ergonovine maleate provocative test for coronary arterial spasm. Am J Cardiol 41: 631, 1978.PubMedCrossRefGoogle Scholar
  41. 41.
    Maseri A, Severi A, De Nes M, L’Abbate A, ChierchiaS, MarzilliM, BallestraAM, Parodi A, Distante A: Variant angina: one aspect of a con-tinuous spectrum of vasospastic myocardial ischemia—pathogenetic mechanisms, estimated incidence and clinical and coronary artériographie findings in 138 patients. Am J Cardiol 42: 1019, 1978.PubMedCrossRefGoogle Scholar
  42. 42.
    Zacca N, Chahine RA, Raizner AE, Ishimori T, Luchi RJ, Miller RR: The angiographic spectrum of coronary artery spasm. Clin Res 27: 218A, 1979.Google Scholar
  43. 43.
    Chahine RA: Prinzmetal’s variant angina: a syndrome apart or another clinical presentation of atheromatous heart disease. Arch Intern Med 139: 26, 1979.PubMedCrossRefGoogle Scholar
  44. 44.
    Waters DD, Chairman BR, Dupras G, Theroux P, Mizgala HE: Coronary artery spasm during exercise in patients with variant angina. Circulation 59: 580, 1979.PubMedGoogle Scholar
  45. 45.
    Lewy RI, Wiener L, Smith JB, Walinsky P, Silver MJ, Saia J: Comparison of plasma concentration of thromboxane B2 in Prinzmetal’s variant angina and classical angina pectoris. Clin Cardiol 2: 404, 1979.PubMedCrossRefGoogle Scholar
  46. 46.
    Raizner AE, Chahine RA, Ishimori T, Verani MS, Zacca N, Jamal N, Miller RR, Luchi RJ: Provocation of coronary artery spasm by the cold pressor test: hemodynamic, artériographie and quantitative angiographic observations. Circulation 62: 925, 1980.PubMedGoogle Scholar
  47. 47.
    Dalai JJ, Sheridan DJ, Bloom AL, Henderson AH: Platelet aggregates and coronary artery spasm. Lancet 2: 1146, 1980.CrossRefGoogle Scholar
  48. 48.
    Fuller CM, Raizner AE, Chahine RA, Nahormek P, Ishimori T, Verani MS, Nitishin A, Mokotoff D, Luchi RJ: Exercise-induced coronary arterial spasm: angiographicdemonstration, documentation of ischemia by myocardial scintigraphy and results of pharmacologic intervention. Am J Cardiol 46: 501, 1980.CrossRefGoogle Scholar
  49. 49.
    MacAlpin RN: Relation of coronary arterial spasm to sites of organic stenosis. Am J Cardiol 46: 143, 1980.PubMedCrossRefGoogle Scholar
  50. 50.
    Cheng TO, Bashour T, Kelser GA, Weiss L, Bacos J: Variant angina of Prinzmetal with normal coronary arteriogram: a variant of the variant. Circulation 47: 476, 1973.PubMedGoogle Scholar
  51. 51.
    Raizner AE, Chahine RA: The treatment of Prinz-metal’s variant angina with coronary bypass surgery. In: Hurst JW (ed) Update II to The Heart. New York: McGraw-Hill, 1979, p. 85.Google Scholar
  52. 52.
    MacAlpin RN, Kattus AA, Alvaro AB: Angina pectoris at rest with preservation of exercise ca-pacity: Prinzmetal’s variant angina. Circulation 47: 946, 1973.PubMedGoogle Scholar
  53. 53.
    Shubrooks SJ, Bete JM, Hutter AM, Block PC, Buckley MH, Daggett WM, Mundth ED: Variant angina pectoris: clinical and anatomic spectrum and results of coronary bypass surgery. Am J Cardiol 36: 142, 1975.PubMedCrossRefGoogle Scholar
  54. 54.
    Higgins CB, Wexler L, Silverman JF, Schroeder JS: Clinical and arteriographic features of Prinzmetal’s variant angina: documentation of etiologic factors. Am J Cardiol 37: 831, 1976.PubMedCrossRefGoogle Scholar
  55. 55.
    Johnson AD, Stroud HA, Vieweg VR, Ross J: Variant angina pectoris: clinical presentations, coronary angiographic patterns, and the results of medical and surgical management in 42 consecutive patients. Chest 73: 786, 1978.PubMedCrossRefGoogle Scholar
  56. 56.
    Chahine RA, Verani MS: Diagnosis and docu-mentation. In: Chahine RA (ed) Coronary artery spasm. Mt Kisco NY: Futura, 1983.Google Scholar
  57. 57.
    Maseri A, Parodi D, Severi S, Pesóla A: Transient transmural reduction of myocardial blood flow, demonstrated by thallium-201 scintigraphy, as a cause of variant angina. Circulation 54: 280, 1976.PubMedGoogle Scholar
  58. 58.
    Chahine RA, Verani MS, Zacca NM, et al: Reversible segmental contraction abnormalities during exercise-induced coronary artery spasm and their effect on global left ventricular function. Am J Cardiol 47: 451, 1981.CrossRefGoogle Scholar
  59. 59.
    MacAlpin RN: Provoking variant angina. N Engl J Med 294: 277, 1976.PubMedCrossRefGoogle Scholar
  60. 60.
    Nelson C, Nowak B, Childs H, Weinrauch L, Forwand S: Provocative testing for coronary arterial spasm: rationale, risk and clinical illustrations. Am J Cardiol 40: 624, 1977.PubMedCrossRefGoogle Scholar
  61. 61.
    Helfant R: Coronary arterial spasm and provocative testing in ischemic heart disease. Am J Cardiol 41: 787, 1978.PubMedCrossRefGoogle Scholar
  62. 62.
    Bertrand ME, Rousseau MJ, Lablanche JM, Warembourg H, Carre AG, Lekieffre JP: La de-tection du spasme des arteres coronaires par le test a la methylergometrine. Arch Mai Coeur 72: 123, 1979.Google Scholar
  63. 63.
    Chahine RA: The provocation of coronary artery spasm. Cathet Cardiovasc Diagn 6: 1, 1980.PubMedCrossRefGoogle Scholar
  64. 64.
    Buxton A, Goldberg S, Hirshfeld JW, Wilson J, Mann F, Williams DO, Overlie P, Oliva P: Refractory ergonovine-induced coronary vasospasm: importance of intracoronary nitroglycerin. Am J Cardiol 46: 329, 1980.PubMedCrossRefGoogle Scholar
  65. 65.
    Bertrand ME, Lablanche JM, Tilmant PY: Frequency of provocated coronary artery spasm in 273 patients with chest pain. Am J Cardiol 45: 390, 1980.CrossRefGoogle Scholar
  66. 66.
    Yasue H: Electrocardiographic, hemodynamic and angiographic consequences. In: Chahine RA (ed) Coronary artery spasm. Mt Kisco NY: Futura, 1983.Google Scholar
  67. 67.
    Prinzmetal M, Ekmekci A, Kennamer R, Kwoczynski JK, Shubin H, Toyoshima H: Variant form of angina pectoris: previously undelineated syndrome. JAMA 174: 1794, I960.Google Scholar
  68. 68.
    Prinzmetal M, Kennamer R, Merlis R, Wada T, Bor N: Angina pectoris: a variant form of angina pectoris. Am J Med 27: 375, 1959.PubMedCrossRefGoogle Scholar
  69. 69.
    Chahine RA, Raizner AE: Another look at Prinz-metal’s variant angina. EurJ Cardiol 6: 71, 1977.Google Scholar
  70. 70.
    Meller J, Pichard A, Dack S: Coronary arterial spasm in Prinzmetal’s angina: a proven hypothesis. Am J Cardiol 37: 938, 1976.PubMedCrossRefGoogle Scholar
  71. 71.
    Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Tanaka S: Exertional angina pectoris caused by coronary arterial spasm: effects of various drugs. Am J Cardiol 43: 647, 1979.PubMedCrossRefGoogle Scholar
  72. 72.
    Boden WE, Bough EW, Korr KS, Benham I, Gheorghiade M, Caputi A, Shulman RS: Exer- cise-induced coronary spasm with S-T segment depression and normal coronary arteriography. Am J Cardiol 48: 193, 1981.PubMedCrossRefGoogle Scholar
  73. 73.
    Bertrand ME, LablancheJM, Tilmant PY, Thieu- leux F, Chahine RA: Ergometrine provocation in patients with significant atherosclerotic coronary lesions in the absence of Prinzmetal’s angina. Circulation (Suppl 4 ) 64: 244, 1981.Google Scholar
  74. 74.
    Specchia G, Servi S, Falcone C, Braumucci E, Angoli L, Mussine A, Marinoni GP, Montemartini C, Bobba P: Coronary arterial spasm as a cause of exercise-induced S-T segment elevation in patients with variant angina. Circulation 59: 948, 1979.PubMedGoogle Scholar
  75. 75.
    Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Tanaka: Circadian variation of exercise capacity in patients with Prinzmetal’s variant angina: role of exercise-induced coronary arterial spasm. Circulation 59: 938, 1979.PubMedGoogle Scholar
  76. 76.
    Chaitman BR, Waters DD, Theroux P, Hanson JS: S-T segment elevation and coronary spasm in response to exercise. Am J Cardiol 47: 1350, 1981.PubMedCrossRefGoogle Scholar
  77. 77.
    Verani MS, Kinney EL, Chahine RA: The role of coronary artery spasm in other clinical ischemic syndromes. In: Chahine RA (ed) Coronary artery spasm. Mt Kisco NY: Futura, 1983.Google Scholar
  78. 78.
    Gruntzig AR, Senning A, Siegenthaler WE: Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty. N Engl J Med 301: 61, 1979.PubMedCrossRefGoogle Scholar
  79. 79.
    Simpson JB, Baim DS, Robert EW, Harrison DC: A new catheter system for coronary angioplasty. Am J Cardiol 49: 1216, 1982.PubMedCrossRefGoogle Scholar
  80. 80.
    Oliva PB: Pathophysiology of acute myocardial infarction. Ann Intern Med 94: 236, 1981.PubMedGoogle Scholar
  81. 81.
    Luchi RJ, Chahine RA: Coronary artery spasm, coronary artery thrombosis and myocardial infarction. Ann Intern Med 93: 502, 1981.Google Scholar
  82. 82.
    Gertz SD, Uretsky G, Wajnberg RS, Navot N, Gotsman MS: Endothelial cell damage and thrombus formation after partial arterial constriction: relevance to the role of coronary artery spasm in the pathogenesis of myocardial infarction. Circulation 63: 476, 1981.PubMedCrossRefGoogle Scholar
  83. 83.
    Oliva PB: The role of coronary artery spasm in acute myocardial infarction. In: Chahine RA (ed) Coronary artery spasm. Mt Kisco NY: Futura, 1983.Google Scholar
  84. 84.
    Chahine RA: Coronary artery spasm: current therapy. Primary Cardiol 8: 60, 1982.Google Scholar
  85. 85.
    Guazzi M, Fiorentini C, Polese A, et al: Treatment of spontaneous angina pectoris with beta blocking agents: a clinical, electrocardiographic, and hemodynamic appraisal. Br Heart J 37: 1235, 1975.Google Scholar
  86. 86.
    Yasue H: Pathophysiology and treatment of coronary arterial spasm. Chest (Suppl) 78: 216, 1980.Google Scholar
  87. 87.
    Robertson RM, Wood AJ, Vaughn WK, Robertson D: Exacerbation of vasotonic angina pectoris by propranolol. Circulation 65: 281, 1982.PubMedCrossRefGoogle Scholar
  88. 88.
    Stone PH, Antman EM, Muller JE, Braunwald E: Calcium channel blocking agents in the treatment of cardiovascular disorders. II. Hemodynamic effects and clinical applications. Ann Intern Med 93: 886, 1980.PubMedGoogle Scholar
  89. 89.
    Kimura E, Kishida H: Treatment of variant angina with drugs: a survey of 11 cardiology institutes in Japan. Circulation 63: 844, 1981.PubMedCrossRefGoogle Scholar
  90. 90.
    Antman E, Muller JE, Goldberg S, et al: Nifedipine therapy for coronary artery spasm: experience with 127 patients. N Engl J Med 302: 1269, 1980.PubMedCrossRefGoogle Scholar
  91. 91.
    Rosenthal SJ, Ginsberg R, Lamb I, Baim D, Schroeder J: Efficacy of diltiazem for control of symptoms of coronary arterial spasm. Am J Cardiol 46: 1027, 1980.PubMedCrossRefGoogle Scholar
  92. 92.
    Johnson SM, Mauritson DR, WillersonJT, Hillis LD: A controlled trial of verapamil for Prinzmetal’s variant angina. N Engl J Med 304: 862, 1981.PubMedCrossRefGoogle Scholar
  93. 93.
    Waters DD, Theroux P, Szlachcic J, Dauwe F: Provocative testing with ergonovine to assess the efficacy of treatment with nifedipine, diltiazem, and verapamil in variant angina. Am J Cardiol 48: 123, 1981.PubMedCrossRefGoogle Scholar
  94. 94.
    Fauchier JP, Charbonnier B, Brochier R, Raynaud R: Amiodarone injectable et par voie orale dans le traitement de I’angor de Prinzmetal severe et syncopal. Ann Cardiol Angeiol 27: 193, 1978.Google Scholar
  95. 95.
    Bertand ME, Lablanche JM, Rousseau MF, Warembourg H, Stankowiak C, Soots G: Surgical treatment of variant angina: use of plexectomy with aortocoronary bypass. Circulation 51: 877, 1980.Google Scholar

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© Martinus Nijhoff Publishing, Boston/Dordrecht/Lancaster 1985

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  • Robert A. Chahine

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