Effects of Calcium Antagonists on Fixed and Dynamic Obstructions in Patients with Severe Coronary Artery Disease

  • P. R. Lichtlen
  • W. Rafflenbeul
Part of the Bayer-Symposium book series (BAYER-SYMP, volume 9)


Ischemia and angina pectoris due to an increase in vasomotor tone of large epicardial coronary arteries resulting in a critical reduction in lumen size have long been thought to be a distinct clinical entity. As long ago as 1772 Heberden [1], in his first description of angina pectoris, mentioned “spasmodic” alterations as a primary cause of the disease. The possibility of a functional component (spasm) in coronary artery disease leading to angina pectoris („funktionelle Störungen an den Koronararterien in Form von vasomotorischen Krampfzuständen“) was again discussed at a special meeting on angina pectoris held in Vienna in 1924 [2]. Furthermore, in 1947, Blumgart [3], in a famous editorial in the American Journal of Medicine on “The Question of Spasm of the Coronary Arteries,” analysed clinical events which in his opinion were provoked by spasm and enumerated several factors leading to increased vasomotor tone; he referred to a typical case of angina at rest accompanied by transient ST elevations, which had been published by Wilson and Johnston in 1941 [4]. A similar case was published in 1942 by Duchosal and Henny [5], who reported angina at rest with ST elevation in a patient suffering from hyperthyroidism. The breakthrough in the clinical characterization of “vasospastic angina” and its pathophysiology was brought about by observations of transient ST elevations recorded both in patients with angina at rest and in animals with ischemia, which were published by Prinzmetal et al. in 1959 [6, 7]; the authors concluded that these phenomena were definitely due to a “hypertonus of an atherosclerotic artery.”


Angina Pectoris Calcium Antagonist Atrial Pace Vasomotor Tone Smooth Muscle Tone 
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© Springer-Verlag Berlin Heidelberg 1985

Authors and Affiliations

  • P. R. Lichtlen
  • W. Rafflenbeul

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