Abstract
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.”
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Heberden W (1772) Some account of a disorder of the breast. Med Trans Col Physician (London) 2:59–67.
Wenckebach KF (ed) (1924) Angina pectoris. Verhandlungen der Gesellschaft für Innere Medizin und Kinderheilkunde. Moritz-Perles, Wien.
Blumgart HL (1947) The question of “spasm” of the coronary arteries. Am J Med 2:129.
Wilson FN, Johnston FD (1941) The occurrence in angina pectoris of electrocardiographic changes similar in magnitude and in kind to those produced by myocardial infarction. Am Heart J 22:64.
Duchosal PW, Henny G (1942) Angine de poitrine et hyperthyroidisme. Cardiologia 5:372.
Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N (1959) Angina pectoris. I. A variant form of angina pectoris. Am J Med 27:375.
Prinzmetal M, Ekmekci A, Toyoshima H, Kwoczynski JK (1959) Angina pectoris. III. Demonstration of a chemical origin of ST elevation in chronic angina pectoris, its variant form, early myocardial infarction, and some non-cardiac conditions. Am J Cardiol 3:276–293.
Lichtlen PR, Schönbeck M (1974) Ischämischer Koronarspasmus bei Angiographie. Z Kardiol 63:311–319.
Lichtlen PR (1981) Introductory remarks — some thoughts about unstable angina pectoris. In: Rafflenbeul W, Lichtlen PR, Balcon R (eds) Unstable angina pectoris. Thieme, Stuttgart, pp 1–7.
Maseri A, L’Abbate A, Pesola A, Ballestra AM, Marzilli M, Severi S, Maltini G, DeNes M, Parodi O, Biaggini A (1977) Coronary vasospasm in angina pectoris. Lancet 1:713–717.
Maseri A, Severi S, DeNes M, L’Abbate A, Chierchia S, Marzilli M, Ballestra AM, Parodi O, Biaggini A, Distante A (1978) Variant angina: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Pathogenetic mechanisms, estimated incidence and clinical and coronary arteriographic findings in 138 patients. Am J Cardiol 42:1019.
Maseri A, L’Abbate A, Chierchia S, Parodi O, Severi S, Biaggini A, Distante A, Marzilli M, Ballestra AM (1979) Significance of spasm in the pathogenesis of ischemic heart disease. Am J Cardiol 44:788–792.
Gould KL (1980) Dynamic coronary stenosis. Am J Cardiol 45:286.
Rafflenbeul W, Lichtlen PR (1982) Zum Konzept der dynamischen Koronarstenose. Z Kardiol 71:439–444.
Vlodaver Z, Edwards JE (1971) Pathology of coronary atherosclerosis. Prog Cardiovasc Dis 14:256–274.
Hort W, Moosdorf R, Kalbfleisch H, Köhler F, Milzner-Schwarz U, Frenzel H (1977) Postmortale Untersuchungen über Lokalisation und Form der stärksten Stenosen in den Koronararterien und ihre Beziehung zu den Risikofaktoren. Z Kardiol 66:333–340.
Freudenberg H, Lichtlen PR (1981) The normal wall segment in coronary stenoses — A postmortal study. Z Kardiol 70:863–869.
Gould KL, Lipscomb K (1974) Effect of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol 34:48.
Engel HJ, Lichtlen PR, Hundeshagen H (1982) Relations between coronary obstructions, left ventricular wall motion and regional myocardial blood flow in single vessel coronary artery disease. Z Kardiol 71:326–333.
Rafflenbeul W, Lichtlen PR (1983) Quantitative coronary angiography: Evidence of a sustained increase in vascular smooth muscle tone in coronary artery stenosis. Z Kardiol 72 (Suppl 3):87–91.
Lichtlen P, Engel HJ, Hundeshagen H (1985) Assessment of regional myocardial blood flow using invasive techniques, especially the precordial Xenon clearance technique. In: Diethelm L, Heuck F, Olsson O, Vieten H, Zuppinger A, Hundeshagen H (eds) Nuklearmedizin. Springer, Berlin Heidelberg New York, pp 65-111 (Handbuch der medizinischen Radiologie, vol 15).
Chierchia S, Maseri A, Simonetti I, Bondelli C (1977) Oxygen myocardial extraction in angina at rest. Evidence of a primary reduction of blood supply. Circulation 55/56 (Suppl 3):37.
Selwyn A (1985) Values of continuous ECG in detecting ST depression and arrhythmias. In: Controversies in the treatment of angina pectoris. Eur Heart J (in press).
Lichtlen PR (1980) Klinik, Diagnostik und Therapie der unstabilen Angina pectoris. Internist 21:636–645.
Lichtlen PR (1983) Unstabile Angina pectoris und Präinfarkt-Syndrom. Internist 24:372–382.
Lichtlen P (1984) Coronary heart disease, clinical aspects and drug therapy. Deutscher Ärzte-Verlag, Köln.
Maseri A, Parodi O, Severi S, Pesola A (1976) Transient transmural reduction of myocardial blood flow, demonstrated by 201-Thallium Scintigraphy as a cause of variant angina. Circulation 54:280.
Bertrand ME, Lablanche JM, Tilmant PY, Thieuleux FP (1981) Provoked coronary arterial spasm. In: Delius W, Gerlach E, Grobecker K, Kübler W (eds) Catecholamines and the heart. Springer, Berlin Heidelberg New York, pp 257–267.
Rafflenbeul W, Lichtlen PR (1983) Release of residual vascular tone in coronary artery stenoses with nifedipine and glyceryltrinitrate. In: Kaltenbach M, Neufeld HN (eds) 5th international adalat symposium. Excerpta Medica, Amsterdam, pp 300–308.
Lichtlen PR, Engel HJ, Rafflenbeul W (1984) Calcium entry blockers, especially nifedipine, in angina of effort. Possible mechanisms and clinical implications. In: Opie LH (ed) Calcium antagonists and cardiovascular disease. Raven, New York, pp 221–236.
Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Tanaka S (1979) Exertional angina pectoris caused by coronary arterial spasm: effect of various drugs. Am J Cardiol 43:647–652.
Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Tanaka S (1979) Circadian variation of exercise capacity in patients with Prinzmetal’s variant angina: role of exercise-induced coronary arterial spasm. Circulation 59:938–948.
Yasue H, Omote S, Takizawa A, Masao N, Hyon H, Nishida S, Horie M (1981) Comparison of coronary arteriographic findings during angina pectoris associated with ST elevation or depression. Am J Cardiol 47:539–546.
Matsuda Y, Ogawa H, Moritanika K, Fujii T, Yoshino F, Katayama K, Miura T, Toma Y, Matsuda M, Kusukawa R (1984) Coronary angiography during exercise-induced angina with ECG changes. Am Heart J 108:959–966.
Yasue H (1984) Coronary artery spasm and calcium ions. In: Opie LH (ed) Calcium antagonists and cardiovascular disease. Raven, New York, pp 117–128.
Brown BG (1983) Dilation of coronary artery stenosis: A major mechanism of the effect of nitrates. Z Kardiol 72 (Suppl 3):77–81.
Lee AB, Brown BG, Bolsen EL, Dodge HT (1982) Coronary stenosis constriction as a major factor in ischemic left ventricular dysfunction induced by isometric handgrip. Circulation 66 (Suppl 2):249.
Oliva PB, Breckinridge JC (1977) Arteriographic evidence of coronary arterial spasm in acute myocardial infarction. Circulation 56:366.
Marzilli M, Goldstein S, Trivella MG, Palumbo C, Maseri A (1980) Some clinical considerations regarding the relation of coronary vasospasm to coronary atherosclerosis: a hypothetical pathogenesis. Am J Cardiol 45:882–886.
Lichtlen PR (1979) Die Koronarographie beim akuten Infarkt. Z Kardiol 68:237.
Rentrop P, Blanke H, Karsch KR, Kaiser H, Köstering H, Leitz K (1981) Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris. Circulation 63:307–317.
Rafflenbeul W, Dzuiba M, Henkel B, Lichtlen P (1975) Morphometric analysis of coronary obstructions during life. Circulation 51/52 (Suppl 2):27.
Rafflenbeul W, Heim R, Dzuiba M, Henkel B, Lichtlen P (1976) Morphometric analysis of coronary arteries. In: Lichtlen PR (ed) Coronary angiography and angina pectoris. Thieme, Stuttgart, pp 255–265.
Rafflenbeul W, Reiber JHC, Bouman F, Freudenberg H, Lichtlen PR (1981) Zuverlässigkeit verschiedener Methoden zur Graduierung von Stenosen im Koronarangiogramm. Z Kardiol 70:302.
Freudenberg H, Lichtlen P (1979) Postmortale Koronarangiographie. In: Lichtlen PR (ed) Koronarangiographie. Straube, Erlangen, pp 341–357.
Rafflenbeul W, Amende I, Simon R, Engel HJ, Lichtlen P (1976) Qualitative and quantitative angiography before and after nitroglycerin. In: Roskamm H, Hahn CH (eds) Ventricular function at rest and during exercise. Springer, Berlin Heidelberg New York, p 53.
Rafflenbeul W, Urthaler F, Russell RO, Lichtlen P, James TN (1979) Dilatation of coronary artery stenosis after isosorbiddinitrate in man. Br Heart J 43:546.
Brown BG, Bolson E, Petersen RB, Pierce CD, Dodge HT (1981) The mechanism of nitroglycerin action: stenoses vasodilation as a major component of the drug response. Circulation 64:1089.
Schulz W, Wendt P, Klepzig H, Kober G (1982) Der Einfluß von intrakoronarem SIN 1 und Nitroglycerin auf koronar-venöse Sauerstoffsättigung und Weite von Koronargefäßen und Stenosen. In: Molsidomin — Symposium, Januar 1982, Rottach-Egern.
Schulz W, Wendt P, Kaltenbach M, Kober G (1983) Active and passive changes in coronary artery diameters after vasodilation. In: Kaltenbach M, Neufeld HN (eds) 5th International adalat symposium. Excerpta Medica, Amsterdam, pp 309–317.
Schulz W, Anderten W, Reiber JHC, Bernauer R, Kaltenbach M, Kober G (1983) Active and passive coronary vasodilation after intracoronary and sublingual nitroglycerin. Z Kardiol 72 (Suppl 3):82–86.
Conti CR, Hill JA, Feldman RL, Conti JB, Pepine CJ (1984) Comparison of nifedipine and nitrates: clinical and angiographic studies. In: Opie LH (ed) Calcium antagonists and cardiovascular disease. Raven, New York, pp 269–275.
Feldman RL, Hill JA, Conti JB, Conti CR, Pepine CJ (1983) Analysis of coronary responses to nifedipine alone, and in combination with intracoronary nitroglycerin in patients with coronary artery disease. Am Heart J 105:651–658.
Lichtlen PR, Engel HJ (1979) Assessment of regional myocardial blood flow using the inert gas washout technique. Cardiovasc Radiol 2:203–216.
Lichtlen P, Engel HJ, Amende I, Rafflenbeul W, Simon R (1976) Mechanisms of various antianginal drugs. Relationship between regional flow behaviour and contractility. In: Jatene AD, Lichtlen PR (eds) 3rd International adalat symposium. Excerpta Medica, Amsterdam, pp 14–29.
Engel HJ, Lichtlen PR (1981) Beneficial enhancement of coronary blood flow by nifedipine; comparison with nitroglycerin and beta-blocking agents. Am J Med 71:658–666.
Simon R, Amende I, Lichtlen PR (1982) Differential effects of nifedipine and nitroglycerin on hemodynamics in single coronary arteries in man. Circulation 66:11–119.
Bernstein L, Friesinger GC, Lichtlen PR, Ross RS (1966) The effect of nitroglycerin on the systemic and coronary circulation in man and dogs. Myocardial blood flow measured with Xenon-133. Circulation 33:107–116.
Lichtlen P, Halter J, Gattiker K (1974) The effect of isosorbiddinitrate on coronary flow, coronary resistance and left ventricular dynamics under exercise in patients with coronary artery disease. Basic Res Cardiol 69:402–421.
Schulz W, Kraus G, Kaltenbach M, Kober G (1981) Einfluß von intrakoronarem und intravenösem Nifedipin auf die allgemeine und lokale Gefäßweite von epikardialen Koronararterien bei stabiler Angina pectoris — ein antianginöser Wirkaspekt? Z Kardiol 70:809.
Rafflenbeul W (1983) Dilatation of coronary artery stenoses with diltiazem i.v. In: Fleckenstein A, Hashimoto K, Herrmann M, Schwartz A, Seipel L (eds) New Ca-antagonists — recent developments and concepts. Fischer, Stuttgart, p 181.
Bonzell T, Wollschlager H, Lölgen H, Müzel T, Wehrle B, Just H (1984) Effect of intravenous diltiazem on coronary artery diameter in patients with coronary artery disease. J Am Coll Cardiol 3:578.
Malacoff RF, Lorell BH, Mudge GH, Holman BL, Idoine J, Bifolck L, Cohn PF (1982) Beneficial effects of nifedipine on regional myocardial blood flow in patients with coronary artery disease. Circulation 65 (Suppl 1):32–37.
Amende I, Simon R, Hood WP, Hetzer R, Lichtlen PR (1983) Intracoronary nifedipine in human beings: magnitude and time course of changes in left ventricular contraction/relaxation and coronary sinus blood flow. J Am Coll Cardiol 2:1141–1145.
Lichtlen P (1975) The influence of nifedipine on left ventricular and coronary dynamics at rest and during exercise in patients with coronary artery disease. In: Hashimoto K, Kimura E, Kobayashi T (eds) 1st International nifedipine (adalat) — symposium. Tokyo Press, Tokyo, pp 114–120.
Amende I, Simon R, Hood WP, Daniel W, Lichtlen PR (1981) Differential effects of intracoronary nitroglycerin and nifedipine on coronary flow and myocardial function in man. Circulation 64:293.
Lichtlen P (1975) Coronary and left ventricular dynamics under nifedipine in comparison to nitrates, betablocking agents and dipyridamole. In: Lochner W, Braasch W, Kroneberg G (eds) 2nd International adalat — symposium. Springer, Berlin Heidelberg New York, pp 212–224.
Fleckenstein-Grün G, Fleckenstein A (1980) Calcium-Antagonismus — ein Grundprinzip der Vasodilatation. In: Fleckenstein A, Roskamm H (eds) Calcium-Antagonismus. Springer, Berlin Heidelberg New York, pp 191–206.
Kukowetz WR, Holzmann S (1983) Mechanism of nitrate-induced vasodilation and tolerance. Z Kardiol 72 (Suppl 3): 14–19.
Tauchert M, Behrenbeck DW, Hützel J, Hilger HH (1976) Ein neuer pharmakologischer Test zur Diagnose der Koronarinsuffizienz. Dtsch Med Wochenschr 101:35.
Tauchert MA, Osterspey J, Hützel J, Hilger HH (1976) Medikamentöse Induktion einer Angina pectoris als neuer Test in der Vorfelddiagnostik der koronaren Herzkrankheit. Verh Dtsch Ges Inn Med 1982:1153.
Berne RM, Belardinelli L, Harder DR, Speralakis N, Rubio R (1980) Response of large and small coronary arteries to adenosine, nitroglycerin, cardiac glycosides, and calcium antagonists. In: Fleckenstein A, Roskamm H (eds) Calcium-Antagonismus. Springer, Berlin Heidelberg New York, pp 208–220.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1985 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Lichtlen, P.R., Rafflenbeul, W. (1985). Effects of Calcium Antagonists on Fixed and Dynamic Obstructions in Patients with Severe Coronary Artery Disease. In: Fleckenstein, A., Van Breemen, C., Gross, R., Hoffmeister, F. (eds) Cardiovascular Effects of Dihydropyridine-Type Calcium Antagonists and Agonists. Bayer-Symposium, vol 9. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-70499-4_25
Download citation
DOI: https://doi.org/10.1007/978-3-642-70499-4_25
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-70501-4
Online ISBN: 978-3-642-70499-4
eBook Packages: Springer Book Archive