Abnormal Coronary Vasomotion in the Genesis of Transient Myocardial Ischemia

  • J. C. Kaski
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 6)


The vital role of coronary arteries was clearly demonstrated by the end of the 17th century, when Chirac occluded one of these vessels and provoked the death of the experimental animal [1]. The function of coronary arteries is dependent upon their vasomotion, and the possibility of altering its caliber is related to the mechanics of the smooth muscle in the wall of the artery. Under resting conditions these arteries are only moderately compliant as shown by Klassen et al. [2]. However, clinical observations and experimental studies have indicated that coronary epicardial vessels may experience intense spasm [3–8] which may lead to ischemic damage of the heart muscle and severe myocardial dysfunction [9, 10].


Myocardial Ischemia Coronary Flow Coronary Flow Reserve Coronary Blood Flow Chronic Stable Angina 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Chirac P (1698) De motu cordis adversaria analytica. MonspeliiGoogle Scholar
  2. 2.
    Klassen GA, Wong AYK (1982) Coronary artery compliance in the dog. Can J Physiol Pharmacol 60: 942–951PubMedCrossRefGoogle Scholar
  3. 3.
    Maseri A, Pesola A, Marzilli M, et al (1977) Coronary vasospasm in angina pectoris. Lancet 1: 713–717PubMedCrossRefGoogle Scholar
  4. 4.
    Maseri A, L’Abbate A, Baroldi G, et al (1978) Coronary vasospasm as a possible cause of myocardial infarction: a conclusion derived from the study of preinfarction angina. N Engl J Med 299: 1271–1277PubMedCrossRefGoogle Scholar
  5. 5.
    Maseri A, Mimmo R, Chierchia S, Marchesi C, Pesola A, L’Abbate A (1975) Coronary artery spasm as a cause of acute myocardial ischemia in man. Chest 68: 625–633CrossRefGoogle Scholar
  6. 6.
    Maseri A, Severi S, De Nes DM, et al (1978) “Variant” angina: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Am J Cardiol 42:1019–1034PubMedCrossRefGoogle Scholar
  7. 7.
    Chierchia S, Brunelli C, Simonetti I, Lazzari M, Maseri A (1980) Sequence of events in angina at rest: primary reduction in coronary flow. Circulation 61: 759–768PubMedGoogle Scholar
  8. 8.
    Yasue H, Horio Y, Makamura M, et al (1986) Induction of coronary artery spasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm. Circulation 74: 955–963PubMedCrossRefGoogle Scholar
  9. 9.
    Chierchia S, Lazzari M, Freedman B, Brunelli C, Maseri A (1983) Impairment of myocardial perfusion and function during painless myocardial ischemia. J Am Coll Cardiol 1 (3): 924–930PubMedCrossRefGoogle Scholar
  10. 10.
    Maeri A (1980) Pathogenetic mechanisms of angina pectoris: expanding views. Br Heart J 43 (6): 648–660CrossRefGoogle Scholar
  11. 11.
    Cox RH (1984) Mechanics of blood vessels: Conduit arteries. In: Stephens NL (ed) Smooth Muscle Contraction. Marcel Dekker, New York, pp 405–425Google Scholar
  12. 12.
    Greensmith JE, Duling BR (1984) Morphology of the constricted arteriolar wall: physiological implications. Am J Physiol 247: H687 - H698PubMedGoogle Scholar
  13. 13.
    Ginsburg R, Bristow MR, Kantrowitz N, Baim DS, Harrison DC (1981) Histamine provocation of clinical coronary artery spasm: implications concerning the pathogenesis of variant angina pectoris. Am Heart J 102: 819PubMedCrossRefGoogle Scholar
  14. 14.
    Kaski JC, Crea F, Meran D, et al (1986) Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina. Circulation 74: 1255–1265PubMedCrossRefGoogle Scholar
  15. 15.
    Kaski JC, Chierchia S, Crea F, Hackett D, Meran DO, Maseri A (1986) Mechanisms of coronary spasm in variant angina. Clin Res 34: 709AGoogle Scholar
  16. 16.
    Vatner SF, Macho P (1981) Regulation of large coronary vessels by adrenergic mechanisms in conscious dogs. Basic Res Cardiol 76: 408–517CrossRefGoogle Scholar
  17. 17.
    Feigl EO (1983) Coronary physiology. Physiol Rev 63: 1–205PubMedGoogle Scholar
  18. 18.
    Bayliss (1902) On the local reaction of the arterial wall to changes in internal pressure. J Physiol (Lond) 28: 220–231Google Scholar
  19. 19.
    Johnson PC (1980) The myogenic response. In: Bohr X, Somlyo AV, Sparks HV Jr (eds) Handbook of physiology section 2: The cardiovascular system, Vol 2. Vascular smooth muscle. American Physiological Society, Bethesda, pp 409–439Google Scholar
  20. 20.
    Maseri A, Chierchia S, Kaski JC (1985) Mixed angina pectoris. Am J Cardiol 56: 30E - 33EPubMedCrossRefGoogle Scholar
  21. 21.
    Gould KL, Lipscombe K (1974) Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol 34: 48–55PubMedCrossRefGoogle Scholar
  22. 22.
    Maseri A (1984) Spasm and dynamic coronary stenoses. J Cardiovasc Pharmacol 6 (4): 684–690Google Scholar
  23. 23.
    Maseri A, Chierchia S (1982) Coronary artery spasm: Demonstration, definition, diagnosis and consequences. Prog Cardiovasc Dis 25: 169–192PubMedCrossRefGoogle Scholar
  24. 24.
    Maseri A, Chierchia S (1982) Coronary artery spasm: demonstration, definition, diagnosis and consequences. Prog Cardiovasc Dis 25: 169PubMedCrossRefGoogle Scholar
  25. 25.
    Maseri A, L’Abbate A, Baroldi G, et al (1978) Coronary vasospasm as a possible cause of myocardial infarction. A conclusion derived from the study of “pre-infarction” angina. N Engl J Med 299: 1271–1277PubMedCrossRefGoogle Scholar
  26. 26.
    Hackett D, Larkin S, Chierchia S, Davies G, Kaski JC, Maseri A (1987) Induction of coronary artery spasm by a direct local action of ergonovine. Circulation 75: 577–582PubMedCrossRefGoogle Scholar
  27. 27.
    Vlodaver Z, Edwards JE (1971) Pathology of coronary atherosclerosis. Prog Cardiovasc Dis 14: 256–259PubMedCrossRefGoogle Scholar
  28. 28.
    Brown BG, Bolson E, Petersen RB, et al (1981) The mechanisms of nitroglycerin action: Stenosis vasodilatation as a major component of the drug response. Circulation 69: 108–997Google Scholar
  29. 29.
    Crea F, Margonato MD, Kaski JC, et al (1986) Variability of results during repeat exercise stress testing in patients with stable angina pectoris: Role of dynamic coronary flow reserve. Am Heart J 112: 249PubMedCrossRefGoogle Scholar
  30. 30.
    Deanfield JE, Maseri A, Selwyn AP, et al (1983) Myocardial ischaemia during daily life in patients with stable angina: its relation to symptoms and heart rate changes. Lancet 2: 753–758PubMedCrossRefGoogle Scholar
  31. 31.
    Chierchia S, Gallino A, Smith G, et al (1984) The role of heart rate in the pathophysiology of chronic stable angina. Lancet 2: 1353–1358PubMedCrossRefGoogle Scholar
  32. 32.
    Kaski JC, Plaza RL, Merano DO, Araujo L, Chierchia S, Maseri A (1985) Improved coronary supply: prevailing mechanism of action of nitrates in chronic stable angina. Am Heart J 110: 238–245PubMedCrossRefGoogle Scholar
  33. 33.
    Opherk D, Zebe H, Weihe E, et al (1981) Reduced coronary dilatory capacity and ultra-structural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation 63: 817–825PubMedCrossRefGoogle Scholar
  34. 34.
    Cannon RO, Watson RM, Rosing DR, et al (1983) Angina caused by reduces vasodilator reserve of the small coronary arteries. J Am Coll Cardiol 1: 1359–1373PubMedCrossRefGoogle Scholar
  35. 35.
    Kaski JC, Crea F, Nihoyannopoulos P, Hackett D, Maseri A (1986) Transient myocardial ischemia during daily life in patients with Syndrome X. Am J Cardiol 58: 1242–1247PubMedCrossRefGoogle Scholar
  36. 36.
    Poole-Wilson PA (1985) Recovery of myocardial function after ischaemia. In: Maseri A (ed) Hammersmith cardiology workshop series, vol 2. Raven Press, New York, p 65Google Scholar
  37. 37.
    Hackett D, Davies G, Chierchia S, Maseri A (1987) Intermittent coronary occlusion in acute myocardial infarction. N Engl J Med 317: 1055–1059PubMedCrossRefGoogle Scholar
  38. 38.
    Heyndrickx GR, Millard RW, McRitchie RJ, Maroko PR, Vatner SF (1975) Regional myocardial function and electrophysiological alterations after brief coronary artery occlusion in conscious dogs. J Clin Invest 56: 978–985PubMedCrossRefGoogle Scholar
  39. 39.
    Cox DA, Vatner SF (1982) Myocardial function in areas of heterogeneous perfusion after coronary artery occlusion in conscious dogs. Circulation 66: 1154–1158PubMedCrossRefGoogle Scholar
  40. 40.
    Roan P, Scales F, Saffer S, Buja M, Willerson JR (1979) Functional characterization of left ventricular segmented responses during the initial 24 h and 1 wk after experimental canine myocardial infarction. J Clin Invest 64: 1074–1088PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • J. C. Kaski

There are no affiliations available

Personalised recommendations