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PubMed1978

Variant forms of angina pectoris.

3 patients with different clinical and electrocardiographic manifestations of coronary artery spasm are discussed. All 3 patients had anginal attacks at rest. In addition, 2 of these patients, who did not have significant preexisting narrowing of their coronary arteries, also had anginal pain related to exercise. During pain, 1 patient showed ST-segment elevation, the other ST-segment depression, while the third showed ST-segment depression shortly followed by ST-elevation on the electrocardiogram. At coronary angiography, spontaneous or induced spasm of one of the major coronary arteries could be demonstrated in all 3 patients. In 2 cases, sublingual nitroglycerin failed to completely relieve the spasm. This raises the question whether a residual stenosis after NTG conclusively proves a fixed organic narrowing. It is concluded that the clinical spectrum of spasm of the coronary arteries is wider than was originally reported by Prinzmetal and coworkers. Clinical and electrocardiographic manifestations are probably dependent on the site and severity of the spasm, which may cause different degrees of myocardial ischemia.

Adult↗
PubMed1976

[Left anterior hemiblock in a variant form of angina pectoris].

Certain peculiarities of the anterior left hemiblock in a variant of angina pectoris are dynamically followed up. The recorded anterior left hemiblock indicates a certain parallelism and succession and follows the rest of the ECG changes. The deviations of the cardiac axis in the left anterior hemiblock in the variant form of angina pectoris has a certain diagnostic and especially prognostic significance. The character of the hemiblock is determined by the topic position and phyoxia degree. The clinic of the hemiblock is determined by the basic ailment.

Angina Pectoris↗
PubMed1980

Holter system electrocardiographic studies on 617 cases.

Holter system electrocardiograms were recorded for 617 patients who were treated at the Department of Cardiology, Tokai University Hospital. In cases of arrhythmia, ventricular premature contraction (VPC) was the most predominant, in 291 cases (69%) out of 423 with arrhythmia, followed by 59 (14%) with supraventricular premature contraction (SVPC), 23 (5.4%) with paroxysmal atrial tachycardia, 17 (4%) with second degree A-V block and 10 (2.3%) with transient atrial fibrillation (AF). In addition, nine (2.1%) cases of ventricular tachycardia (VT), one (0.2%) of transient ventricular fibrillation (VF) and one (0.2%) of third degree A-V block were found in particularly severe arrhythmia cases. Six out of nine cases of VT were cases of acute myocardial infarction (AMI) and all died suddenly while in the hospital or after discharge. Mild or moderate changes in ST-T were often observed even in normal subjects. Of the 617 cases, only 18 (2.9%) showed a significant elevation or depression of ST. Among these, three definitely had variant angina pectoris (Prinzmetal type). The above results indicate Holter EKGs are very useful for the diagnosis of arrhythmia and can also be used as a means of evaluating the prognosis in some cases, but there still are some problems in connection with its use for the diagnosis of ischemic heart disease except for the diagnosis of variant angina pectoris.

Adolescent↗
PubMed1976

[Prinzmetal angina: clinical aspects and coronarographic findings].

The clinical course and coronary arteriographic findings in 5 patients with Prinzmetal's variant angina pectoris are reviewed. In 4 patients who had ST-elevations inferiorly, 1 had minimal, 1 only slight, and 1 medium coronary artery disease; 1 had coronary spasm. 1 patient with ST-elevation anteriorly had severe stenosis of the anterior descending coronary artery. All 5 patients had normal left ventriculograms, 3 also had normal left enddiastolic pressure, and 2 slight elevation. Medical treatment was carried out in 2 patients and surgical revascularization in 2. Both treatments were accompanied by marked symptomatic improvement. Spontaneous loss of angina occurred in 1 patient. Prinzmetal's variant angina pectoris may be accompanied by a variety of coronary arteriographic findings and the prognosis appears to be more favorable than previously reported.

Adrenergic beta-Antagonists↗
PubMed1979

The effects of ergonovine maleate on coronary arterial size.

Changes in coronary arterial size due to ergonovine maleate are described and quantitated in 90 patients--18 with typical angina pectoris, 56 with atypical chest pain, nine with variant angina pectoris, and seven heart transplant (allograft) recipients. We observed two angiographic changes in the diameter of coronary arteries: 1) spasm, which was characterized by occlusion or marked (greater than 85%) focal or diffuse vessel narrowing, or 2) relatively mild and diffuse vessel narrowing, which was interpreted as the normal pharmacologic response to the drug. Serial bolus injections of 0.05 mg, 0.10 mg and 0.25 mg of ergonovine maleate produced diffuse narrowing of the diameter of coronary arteries of 10 +/- 1.5%, 16 +/- 1.4% and 20 +/- 1.3% (mean +/- SEM), respectively, in the 72 patients with anginal syndromes who did not develop coronary spasm. The degree of coronary arterial narrowing was the same in heart transplant recipients and in patients with normally innervated hearts who did not develop coronary spasm. We believe the normal pharmacologic response to ergonovine maleate was due to a direct vasoconstrictor action of the drug; this action was independent of neural control extrinsic to the heart.

Adult↗
PubMed1988

A new method for recording a three-lead electrocardiogram using a two-channel Holter system.

A technique for recording a three-lead electrocardiogram (ECG) without increasing the number of channels and electrodes in a commercially available two-channel Holter recorder was devised. On channel 1, a V5-like lead (CM5 lead) was recorded for 24 consecutive hours. On channel 2, the device could switch continuously between a V2-like lead (CM2 lead) and a II- or III- or a VF-like lead (CMf lead) every 30 sec. Fifty eight patients with angina pectoris were studied using this new device. There were 2 patients with variant angina pectoris, one of whom showed ST elevation in the CM2 lead coupled with ST depression in the CMf lead and the other ST elevation in the CMf lead coupled with ST depression in the CM2 lead. The number of patients having ST depression confined to the CM5 lead only, CM2 lead only and CMf lead only was 17, 2 and 3, respectively. In 41 patients, 127 transient episodes of ischemic type ST changes were observed during daily activity. Only 35 (28%) of these episodes were associated with anginal symptoms and the remaining 92 episodes occurred unrelated to such symptoms. Accordingly, 3-lead Holter monitoring using this device is useful, particularly for the detection of variant angina, and makes it less likely for asymptomatic ischemic ST changes to be overlooked as compared to the 2-lead conventional Holter monitoring system.

Adult↗
PubMed1980

'Variant' angina: evidence for small vessel coronary artery spasm?

A unique case of 'variant' angina pectoris has been observed in a patient with normal coronary arteries and typical chest pain appearing spontaneously at rest, and repeatedly provoked by ergonovine maleate (0.1 mg iv) associated with large transmural perfusion defects on 201Tl-imaging (after ergonovine) and a marked increase in T wave voltage despite no demonstrable spasm of a major coronary artery after the same doses of ergonovine. While saline solution could not provoke chest pain and treatment with a beta-blocking agent increased the frequency of ischemic attacks, a calcium antagonist therapy reduced and eventually eliminated the attacks. Thus, this case provides evidence for yet another aspect of a 'variant' form of angina pectoris: small vessel coronary artery spasm.

Adult↗
PubMed1983

[24-hour ECG monitoring of patients with different clinical forms of stenocardia].

A total of 60 patients with coronary heart disease were examined and divided into 2 groups: (I)53 patients with classical angina pectoris at rest and of effort; (II)7 patients with variant angina pectoris. The results of 24-hour ECG monitoring, bicycle exercise test and coronary angiography were studied. By giving an objective ECG pattern during myocardial ischemia attack. 24-hour ECG monitoring enabled one to differentiate various clinical forms of angina pectoris, establish their connection with heart rhythm disturbances, thus forming the basis for the differential approach to the treatment.

Adult↗
PubMed1979

Coronary arterial spasm as a cause of exercise-induced ST-segment elevation in patients with variant angina.

Four patients with variant angina pectoris exhibited reproducible exercise-induced chest pain and ST-segment elevation. Coronary arterial spasm was documented with arteriography during exercise-induced ST-segment elevation (three patients) or after intravenous administration of ergonovine maleate (one patient). Our observations show that in patients with variant angina exercise can trigger coronary arterial spasm, thus inducing anginal pain and ST-segment elevation.

Adult↗