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Nifedipine-Induced Reperfusion in Stable Angina and Postinfarction Cases

  • R. F. Abarquez
  • V. M. Sison
  • R. G. Sy
  • N. S. Abelardo
  • R. R. Castillo
  • R. D. Jara
  • O. E. Enoveso
Conference paper

Abstract

Most of the diagnostic and therapeutic approaches to angina pectoris focus on epicardial coronary artery abnormalities. Yet, pathophysiologic and clinical manifestations are not always related to the degree or extent of the coronary pathology. Although significant occlusive disease with total coronary flow reduction results in transmural pathology, patients may have no angina, ischemia,electrophysiologic changes, or lactate production at rest [1–4], some may have angina due to subendocardial ischemia [5–6], and 28%-50% may have no myocardial infarction [7–9]. After coronary bypass surgery of noninfarction cases only 21%–75% have improved wall motion [10–12]. Thus, survival is predicted by the degree of residual left ventricular dysfunction rather than by the number or extent of diseased vessels [13]. Likewise, factors other than fixed obstuctive lesions of the epicardial vessels may contribute to ventricular function.

Keywords

Coronary Flow Reserve None None Coronary Arteriography Coronary Spasm Thallium Imaging 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Cannon PJ, Schmidt DH, Weiss MB et al. (1975) The relationship between regional myocardial perfusion at rest and arteriographic lesions in patients with coronary arteriosclerosis. J Clin Invest 56: 1442PubMedCrossRefGoogle Scholar
  2. 2.
    Klocke FJ, Bunnel IL, Greene DG, Wittenberg SM, Visco JP (1974) Average coronary blood flow per unit weight of left ventricle in patients with and without coronary artery disease. Circulation 50: 547PubMedGoogle Scholar
  3. 3.
    Gould KL, Lipscomb K, Hamilton GW (1974) Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. Am J Cardiol 33: 87Google Scholar
  4. 4.
    Gould KL, Lipscomb K (1974) Effects of coronary stenosis on coronary flow reserve and resistance. Am J Cardiol 34: 48PubMedCrossRefGoogle Scholar
  5. 5.
    Brandi G, McGregor M (1969) Intramural pressure in the left ventricle of the dog. Cardiovasc Res 3: 472PubMedCrossRefGoogle Scholar
  6. 6.
    Baird R, Mantelow R, Shah P, Amili FM (1970) Intramyocardial pressure - study of regional variations and its relationship to intraventricular pressure. J Thorac Cardiovasc Surg 5: 810Google Scholar
  7. 7.
    Levin DC (1974) Pathways and functional significance of the coronary collateral circulation. Circulation 50: 831PubMedGoogle Scholar
  8. 8.
    Hamby RI, Aintablian A, Schwartz A (1976) Reappraisal of the functional significance of the coronary collateral circulation. Am J Cardiol 38: 305CrossRefGoogle Scholar
  9. 9.
    Baroldi G (1973) Coronary heart disease significance of the morphologic lesions. Am Heart J 85: 1PubMedCrossRefGoogle Scholar
  10. 10.
    Hammermeister KE, Kennedy JW, Hamilton GW et al. (1974) Aortocoronary saphenous vein bypass; failure of successful grafting to improve resting left ventricular function in chronic angina. N Engl J Med 290: 186PubMedCrossRefGoogle Scholar
  11. 11.
    Mintz LJ, Ingels NB, Daughters GT II, Stinson EB, Alderman EL (1980) Sequential studies of left ventricular function and wall motion after coronary arterial bypass surgery. Am J Cardiol 45: 210PubMedCrossRefGoogle Scholar
  12. 12.
    Rozanski A, Berman DS, Gray R et al. (1981) Use of thallium 201 redistribution scintigraphy in the preoperative differentiation of reversible and non-reversible myocardial asynergy. Circulation 64: 936PubMedCrossRefGoogle Scholar
  13. 13.
    Mock MB, Ringquist I, Fisher LD, Davis KB. (1982) Survival of medically treated patients in the coronary artery surgery study ( CASS) registry. Circulation 66: 562Google Scholar
  14. 14.
    McLaughlin PR, Martin RP, Doherty P et al. (1977) Reproducibility of thallium 201myocardial imaging. Circulation 55: 497PubMedGoogle Scholar
  15. 15.
    Sanmarco ME, Pontius S, Selvester RH (1980) Abnormal blood pressure response and marked ischemic ST-segment depression as predictors of severe coronary artery disease. Circulation 61: 572PubMedGoogle Scholar
  16. 16.
    Battel AG, Behar VS, Peter RH, Orgain ES, Kong Y (1974) Graded exercise stress tests in angiographically documented coronary artery disease. Circulation 49: 348Google Scholar
  17. 17.
    Cheitlin MD, David JE, Castro CM, Barrow EA, Anderson WT (1975) Correlations of “critical” left coronary artery lesions with positive submaximal exercise tests in patients with chest pain. Am Heart J 89: 305PubMedCrossRefGoogle Scholar
  18. 18.
    Kramer N, Susmand A, Shekelle RB (1978) The false negative treadmill exercise test and left ventricular dysfunction. Circulation 57: 763PubMedGoogle Scholar
  19. 19.
    Goldman S, Tselos S, Cohn K (1976) Marked depth of ST-segment depression during treadmill exercise testing. Chest 69: 729PubMedCrossRefGoogle Scholar
  20. 20.
    Moran TJ, French WJ, Abrams HF, Criley JM (1982) Postmyocardial infarction angina and coronary spasm. Am J Cardiol 50: 197PubMedCrossRefGoogle Scholar
  21. 21.
    Feil H, Siegel MI (1928) Electrocardiographic changes during attacks of angina pectoris. Am J Med Sci 175: 255CrossRefGoogle Scholar
  22. 22.
    Wood FN, Wolferth CC (1931) Angina pectoris. The clinical and electrocardiographic phenomena of the attack and their comparison with the effects of experimental temporary coronary occlusion. Arch Intern Med 47: 339Google Scholar
  23. 23.
    Wilson FN, Johnston FD (1941) The occurrence in angina pectoris of electrocardiographic changes similar in magnitude and kind to those produced by myocardial infarction. Am Heart J 22: 64CrossRefGoogle Scholar
  24. 24.
    Abarquez RF jr, Freiman AH, Reichel F, LaDue JS (1960) The precordial electrocardiogram during exercise. Circulation 22: 1060PubMedGoogle Scholar
  25. 25.
    Moran LG, Flowers NC (1980) Electrocardiography and vectocardiography. In: Braunwald E (ed) Heart disease. W. B. Saunders, Philadelphia, p 231Google Scholar
  26. 26.
    Guyton RA, McClenathan JH, Newman GE, Michaels LL (1977) Significance of subendocardial ST-segment elevation caused by coronary stenosis in the dog. Am J Cardiol 40: 373PubMedCrossRefGoogle Scholar
  27. 27.
    Weintraub WS, Hattori S, Agarwal JB, Bodenheimer MM, Banka VS, Helfant RH (1981) The relationship between myocardial blood flow and contraction by myocardial layer in the canine left ventricle during ischemia. Circ Res 48: 430PubMedGoogle Scholar
  28. 28.
    Weintraub WS, Hattori S, Agarwal J, Bodenheimer MM, Banka VS, Helfant RH (1981) Variable effect of nifedipine on myocardial blood flow at three grades of coronary occlusion in the dog. Circ Res 48: 937PubMedGoogle Scholar
  29. 29.
    Rouleau J, Boerboom LE, Suijadhana A, Hoffman JIE (1979) The role of autoregulation and tissue diastolic pressures in the transmural distribution of left ventricular blood flow in anesthetized dogs. Circ Res 45: 804PubMedGoogle Scholar
  30. 30.
    Weiner L, Kasparian H, Duca PR et al. (1976) Spectrum of coronary arterial spasm. Clinical angiographic and myocardial metabolic experience in 29 cases. Am J Cardiol 38: 945CrossRefGoogle Scholar
  31. 31.
    Helfant RH (1979) Coronary spasm. Am J Cardiol 44: 839Google Scholar
  32. 32.
    Tri TB, Price HL, Sobol SM (1982) Nifedipine therapy for small vessel disease of the heart. Am J Cardiol 50: 211PubMedCrossRefGoogle Scholar
  33. 33.
    Pepine CJ, Feldmars RL, Conti CR (1980) Observations on the role of coronary artery spasm in stress induced angina. Circulation 62 [Suppl III]: 312Google Scholar
  34. 34.
    Waters DD, Szlachcic J, Theroux P, Dauwe F, Mizgala HF (1981) Ergonovine testing to detect spontaneous remissions of angina during long term treatment with calcium antagonist drugs. Am J Cardiol 47: 179PubMedCrossRefGoogle Scholar
  35. 35.
    Hempler FA jr, Proudfit WL, Razadi M, Shirly EK, Greenstreet R, Sheldon WC (1978) Ergonovine maleate provocative test for coronary arterial spasm. Am J Cardiol 41: 631CrossRefGoogle Scholar
  36. 36.
    Epstein SF, Palmeri ST, Patterson RE (1982) Evaluation of patients after acute myocardial infarction. Indications for cardiac catheterization and surgical intervention. N Engl J Med 307: 1487Google Scholar
  37. 37.
    Frazier J, Cooper N, Buckberg G (1974) The adequacy of subendocardial oxygen delivery; the interaction of determinants of low arterial oxygen content and myocardial oxygen need. Circulation 49: 968Google Scholar
  38. 38.
    Mair TW (1972) Subendocardial distribution of coronary blood flow and the effect of antianginal drugs. Circ Res 30: 621Google Scholar
  39. 39.
    Lipscomb K, Gould KL (1975) Mechanism of the effect of coronary artery stenosis on coronary flow in the dog. Am Heart J 89: 60PubMedCrossRefGoogle Scholar
  40. 40.
    Kavanagh T, Shepard RJ, Chisholn AW, Quereshi S, Kennedy J (1979) Prognostic indexes for patients with ischemic heart disease enrolled in an exercise-centered rehabilitation program. Am J Cardiol 44: 1225CrossRefGoogle Scholar
  41. 41.
    Sami H, Kraemer H, Debusk RF (1979) The prognostic significance of serial exercise testing after myocardial infarction. Circulation 60: 1238PubMedGoogle Scholar
  42. 42.
    Theroux P, Waters DD, Halyhen C, Debalsieux JS, Mizgala HR (1979) Prognostic value of exercise testing soon after myocardial infarction. N Engl J Med 301: 341PubMedCrossRefGoogle Scholar
  43. 43.
    Weiner DA, McCabe C, Lein MD, Ryan TJ (1978) ST-segment change post infarction: predictive value for multivessel coronary disease and left ventricular aneurysm. Circulation 58: 887PubMedGoogle Scholar
  44. 44.
    Castellanet MJ, Greenberg PS, Ellestad MH (1978) Comparison of ST-segment changes on exencise testing with angiographic findings in patients with prior myocardial infarction. Am J Cardiol 42: 29PubMedCrossRefGoogle Scholar
  45. 45.
    Chaitman BR, Waters DD, Corgara F, Bourassa MG (1978) Prediction of multivessel disease after inferior myocardial infarction. Circulation 57: 1085PubMedGoogle Scholar
  46. 46.
    Morris SN, McHenry RL (1978) Role of exercise stress testing in healthy subjects in patients with coronary artery disease. Controversies in cardiology. Am J Cardiol 42: 659Google Scholar
  47. 47.
    Cohn K, Kamm B, Fetcih N, Brand R, Goldschlager N (1979) Use of treadmill score to quantify response and predict extent of coronary disease. Circulation 59: 286PubMedGoogle Scholar
  48. 48.
    Koiwaya Y, Torri S, Takeshita A, Nakagaki O, Nakamura M (1982) Post-infarction angina caused by coronary arterial spasm. Circulation 65: 275PubMedCrossRefGoogle Scholar
  49. 49.
    Johnson AD, Deteviler JH (1979) Coronary spasm, variant angina and recurrent myocardial infarction. Circulation 59: 297Google Scholar
  50. 50.
    King SB, Mansour KA, Hatcher CR, Silverman ME, Hart NC (1973) Coronary spasm producing Prinzmetal’s angina and myocardial infarction in the absence of coronary atherosclerosis. Am Thorac Surg 16: 337CrossRefGoogle Scholar
  51. 51.
    Madias JE (1979) The syndrome of variant angina culminating in acute myocardial infarction. Circulation 59: 297PubMedGoogle Scholar
  52. 52.
    Ritchie J, Trobaugh G, Hamilton G et al. (1977) Myocardial imaging with thallium 201 at rest and during exercise: comparison with coronary arteriography and resting exercise ECG. Circulation 56: 66PubMedGoogle Scholar
  53. 53.
    Zaret BL (1977) Myocardial imaging with radioactive potassium and its analogs. Prog Cardiovasc Dis 20: 81PubMedCrossRefGoogle Scholar
  54. 54.
    Dash H, Massie BM, Bolvinick EH, Brundage BH (1979) The non-invasive identification of left main and three-vessel coronary artery disease by myocardial stress perfusion, scintigraphy and treadmill exercise electrocardiography. Circulation 60: 276PubMedGoogle Scholar
  55. 55.
    Massie BM, Bolvinick EH, Brundage BH (1979) Correlation of thallium 201 scintigrams with coronary anatomy; factors affecting region sensitivity. Am J Cardiol 44: 616PubMedCrossRefGoogle Scholar
  56. 56.
    Patterson RE, Horowitz SF, Eng C et al. (1983) Can non-invasive exercise test criteria identify patients with left main or three-vessel coronary disease after a first myocardial infarction? Am J Cardiol 51: 361PubMedCrossRefGoogle Scholar
  57. 57.
    Turner JD, Schwartz KW, Logic JR et al. (1980) Detection of residual jeopardized myocardium 3 weeks after myocardial infarction by exercise testing with thallium 201 myocardial scintigraphy. Circulation 61: 729PubMedGoogle Scholar
  58. 58.
    Freisinger GC (1982) The reasonable workup before recommending medical or surgical therapy: an overall strategy. Circulation 65 (II): 21CrossRefGoogle Scholar
  59. 59.
    Gunther S, Green L, Muller JE, Mudge GH jr, Grossman W (1979) Inappropriate coronary vasoconstriction in patients with coronary artery disease: a role for nifedipine. Am J Cardiol 44: 793PubMedCrossRefGoogle Scholar
  60. 60.
    De Servi S, Mussini A, Specchia G et al. (1980) Effects of nifedipine on coronary blood flow, coronary resistance during cold pressor test and isometric exercise in patients with coronary artery disease. Am Heart J 1 [Suppl D]: 43Google Scholar
  61. 61.
    Freedman B, Dunn RF, Richmond DR, Kelly DT (1981) Coronary artery spasm during exercise; treatment with verapamil. Circulation 64: 68PubMedCrossRefGoogle Scholar
  62. 62.
    Moskowitz RM, Piccini TA, Nacarelli GV, Zellis R (1979) Nifedipine therapy for stable angina pectoris: preliminary results of effects on angina frequency and treadmill exercise response. Am J Cardiol 44: 811PubMedCrossRefGoogle Scholar
  63. 63.
    Kallenback M, Schultz W, Kober G (1979) Effects of nifedipine after intravenous and intra-coronary administration. Am J Cardiol 44: 832CrossRefGoogle Scholar
  64. 64.
    Motz W, Strauer BE (1983) The influence of nifedipine on LV compliance and myocardial stiffness. J Am Coll Cardiol 1 (2): 1641Google Scholar
  65. 65.
    Ritchie JL (1982) Myocardial perfusion imaging. Am J Cardiol 49: 1341PubMedCrossRefGoogle Scholar
  66. 66.
    Mueller TM, Marcus ML, Ehrhardt JC, Chaudhurt T, Abboud FM (1976) Limitations of thallium 201 myocardial perfusion scintigrams. Circulation 54: 640PubMedGoogle Scholar
  67. 67.
    Dorer JS, Rosing DR, Miller RM et al. (1980) Natural history of left ventricular function during one year after acute myocardial infarction: comparison with clinical electrocardiographic and biochemical determinations. Am J Cardiol 46: 1CrossRefGoogle Scholar
  68. 68.
    Buda AJ, Dubbin JD, MacDonald IL, Straus HD, Orr SA, Meindok H (1982) Spontaneous changes in thallium 201 myocardial perfusion imaging after myocardial infarction. Am J Cardiol 50: 1272PubMedCrossRefGoogle Scholar
  69. 69.
    Brown G (1981) Coronary spasm observations linking the clinical spectrum of ischemic heart disease to the dynamic pathology of coronary atherosclerosis. Arch Intern Med 141: 716PubMedCrossRefGoogle Scholar
  70. 70.
    Maseri A, Pesola A, Marzilli M (1977) Coronary vasospasm in angina pectoris. Lancet i: 713Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • R. F. Abarquez
    • 1
  • V. M. Sison
    • 1
  • R. G. Sy
    • 1
  • N. S. Abelardo
    • 1
  • R. R. Castillo
    • 1
  • R. D. Jara
    • 1
  • O. E. Enoveso
    • 1
  1. 1.Philippine Heart CenterMedical Arts BuildingQuezon CityPhilippines

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