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Results for “Angina Pectoris, Variant”

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At least 469 records · Page 26Linked to original sources
PubMed1996

Basal release of endothelium-derived nitric oxide at site of spasm in patients with variant angina.

OBJECTIVES: The aim of this study was to investigate the basal release of nitric oxide at spastic sites in patients with variant angina. BACKGROUND: We previously reported that endothelium-dependent dilator responses to acetylcholine, substance P and bradykinin are preserved at the site of coronary artery spasm. However, it is not known whether the basal release of endothelium-derived nitric oxide is altered at the spastic site. METHODS: The effects of intracoronary N(G)-monomethyl-L-arginine (L-NMMA, an inhibitor of nitric oxide synthesis) at cumulative doses of 50, 100 and 200 micromol on basal coronary artery tone were investigated in eight patients with variant angina and normal coronary angiograms and in eight control subjects. The lumen diameters of large epicardial coronary arteries were assessed by quantitative coronary arteriography. RESULTS: Coronary spasm was provoked by the intracoronary administration of acetylcholine in all patients with variant angina. L-NMMA did not alter the arterial pressure and heart rate but significantly decreased the coronary artery diameter at spastic and nonspastic sites. Constrictive responses to L-NMMA were significantly greater (p < 0.01) at the spastic site (constriction by 200 micromol, 22+/-7%, mean +/- SD) than at the nonspastic site (10+/-7%). Constrictive responses to L-NMMA at the nonspastic site in patients with variant angina were comparable to those in the control subjects. CONCLUSIONS: These findings support the hypothesis that the basal release of nitric oxide may not be decreased at the spastic site in patients with variant angina.

Aged↗
PubMed1999

HLA antigens in patients with variant angina in Japan.

There have been few reports on examining the susceptibility of variant angina. Accordingly, the major histocompatibility complexes (HLA-A, -B, -C, -DR) of unrelated Japanese patients with variant angina were examined. There were no significant differences in the frequency of HLA-A,-B, -C, and -DR antigens between patients and controls (n = 100). Although endothelial dysfunction with pathological abnormalities is suggested to be one of the etiological factors in vasospasm, immunogenetic abnormalities linked to HLA system might not play a role in the pathogenesis of variant angina.

Adult↗
PubMed1986

The haemodynamic response to myocardial ischaemia in ambulant patients with variant angina.

The haemodynamic response to myocardial ischaemia in patients with variant angina during ambulatory activity is unknown. Ambulatory pulmonary artery pressure monitoring with a transducer tipped catheter and simultaneous frequency modulated electrocardiograms was used to assess changes in left ventricular function in five male patients (mean age 51.8 years) during variant angina; four patients had coronary artery stenosis and one had normal coronary arteries. Two hundred and seventy hours of ambulatory recordings were analysed. Twenty episodes (12 painful, 8 silent) of ST segment change greater than 1 mm occurred. Episodes tended to occur more frequently in the early morning hours. Six episodes of painful ST elevation were associated with a rise in pulmonary artery diastolic pressure. In the remaining episodes ST segment elevation was of shorter duration and there was no rise in pulmonary artery diastolic pressure. Pain was usually a late feature. Silent ST segment elevation occurred at rest and pulmonary artery diastolic pressure increased in all but one episode. Silent exertional ST segment depression was associated with a greater increase in pulmonary artery diastolic pressure than that seen during ST segment elevation. ST segment depression preceded or followed ST segment elevation in two episodes. The onset of ST segment elevation nearly always preceded the onset of a rise in pulmonary artery diastolic pressure. Ergometrine maleate provocation produced a rise in pulmonary artery diastolic pressure in three patients. In one there was no response to 1000 micrograms but spontaneous episodes of ST segment elevation were recorded during ambulatory monitoring. Treadmill exercise resulted in both ST segment elevation and depression with a similar haemodynamic response during both types of electrocardiographic change. When there is important coronary artery disease in two or more vessels ST segment changes may occur in different territories during treadmill exercise and during spontaneous episodes. Ambulatory pulmonary artery diastolic pressure monitoring is a useful technique for the investigation of variant angina.

Adult↗
PubMed1987

Relative roles of preload increase and coronary constriction in ergonovine-induced myocardial ischemia in stable angina pectoris.

To assess the relative role of increased ventricular preload and critical coronary lesions in ergonovine-induced myocardial ischemia, 9 normal subjects (group A), 7 patients with stable angina (group B) and 5 with variant angina (group C) were studied. In all patients, the 12-lead electrocardiogram, blood pressure and left ventricular (LV) volume (technetium-99m blood pool) were continuously recorded before and during administration of incremental doses of ergonovine given at 5-minute intervals. In all subjects, an initial LV dilatation developed; in group B and C patients, this was followed by a decrease in stroke volume and ejection fraction with subsequent onset of electrocardiographic changes and angina. The interval between these events was significantly shorter in group C and in 3 group B patients; in these patients, signs of ischemia appeared with smaller ergonovine doses and at minimal preload increase, coronary constriction being the likely mechanism of ischemia. In the remaining 4 group B patients, the onset of stroke volume, ejection fraction, electrocardiographic changes and angina was significantly delayed, occurring after administration of larger ergonovine doses when LV volume was already considerably increased. This finding suggests that the loading effect of ergonovine on LV volume, rather than on coronary constriction, could be the prevailing mechanism of ergonovine-induced ischemia in these patients.

Angina Pectoris↗
PubMed1989

Different responses of coronary artery and internal mammary artery bypass grafts to ergonovine and nitroglycerin in variant angina.

The dynamic responses of a coronary artery and an internal mammary artery (IMA) graft to pharmacological intervention were examined by arteriography in 5 patients with variant angina who had undergone coronary artery bypass grafting with an in situ IMA to the left anterior descending coronary artery. Preoperative electrocardiographic findings included elevated ST segments in chest leads during attacks of angina, and all patients had severe fixed lesions in addition to marked spasm of the left anterior descending coronary artery after the administration of ergonovine maleate. Postoperatively with ergonovine stimulation, complete occlusion or marked subtotal narrowing was again observed at the primary fixed lesion in the proximal portion of the left anterior descending coronary artery, but the IMA graft and the coronary artery distal to the anastomotic site maintained satisfactory patency with no further occurrence of anginal pain or ST segment elevation. By computer-assisted graphic analysis, which allows highly reproducible measurements of vascular internal diameters, the diameter of the IMA showed only small changes under ergonovine (p = not significant) or nitroglycerin (p less than 0.05) stimulation in contrast to the marked vascular reactivity of the coronary artery (p less than 0.05 and less than 0.01, respectively). These findings indicate that the IMA graft is unresponsive to ergonovine at least in the amount required to produce coronary artery spasm in patients with variant angina and fixed lesions. The IMA graft appears to function well from a clinical and pharmacological viewpoint in patients with variant angina.

Adult↗
PubMed2004

Brachytherapy: potential therapy for refractory coronary spasm.

OBJECTIVES: We sought to demonstrate that brachytherapy reduces coronary spasm in refractory and highly symptomatic variant angina. BACKGROUND: In some patients with variant angina due to extensive vasoconstriction, intensive drug therapy fails to sufficiently relieve symptoms. METHODS: In 18 patients with frequent angina episodes despite triple anti-anginal therapy, coronary spasm was induced by intracoronary acetylcholine (ACh) infusion. Five patients had spasm in a second vessel. Intracoronary radiation (20 Gy) was applied to vasospastic segments using a beta-emitting ((32)P) wire source centered within a Galileo balloon. Parameters of vessel function before and after brachytherapy were investigated. RESULTS: Before brachytherapy, artery diameters decreased (p < 0.0001) from 2.8 +/- 0.4 mm to 1.0 +/- 0.4 mm for the first vessels and from 3.1 +/- 0.3 mm to 1.0 +/- 0.2 mm for the second vessels. After brachytherapy (143 +/- 106 and 80 +/- 52 days for first and second vessels, respectively), ACh-induced vasoconstriction was significantly reduced. The ACh-induced changes in artery diameter before and after brachytherapy were -1.5 +/- 0.5 mm and -0.5 +/- 0.3 mm (p < 0.0001) for the first vessels and -1.4 +/- 0.3 mm and -0.4 +/- 0.2 mm (p < 0.01) for the second vessels, respectively. In non-irradiated spastic vessels, ACh-induced vasoconstriction remained unchanged (e.g., -1.7 +/- 0.6 mm, -1.6 +/- 0.3 mm, and -1.5 +/- 0.5 mm for second vessels, at first investigation, first follow-up, and immediately before brachytherapy, respectively). Angina frequency decreased from 15.6 +/- 6.0 to 2.2 +/- 2.4 angina episodes/week (p < 0.001) in treated patients. CONCLUSIONS: Brachytherapy is a potential therapy in patients with highly symptomatic variant angina.

Adult↗
PubMed1980

Variant angina--correlation of clinical, electrocardiographic and angiographic features: results of medical and surgical management.

Angiographic coronary artery disease (CAD) was correlated with clinical features, electrocardiographic (ECG) findings and the results of medical management or aortocoronary bypass in 42 patients with angina at rest associated with transient ST segment elevation (variant angina). Patients were divided into three sub-sets based on the coronary arteriographic findings. On the basis of greater than 75% luminal diameter narrowing, 28 patients had multiple vessel, ten had single vessel and four had minimal (less than 50% narrowing) CAD. The angiographic sub-sets did not differ significantly in age, sex, coronary risk factors, time from onset of rest pain to coronary angiography, or in the presence of arrhythmias during ischaemic episodes. Patients with multiple vessel CAD more commonly had prior coronary events (P less than 0.01), an abnormal baseline ECG (P less than 0.05) or both (P less than 0.001). These features did not distinguish patients with single vessel from those with minimal CAD. ST elevation in the inferior leads during episodes of myocardial ischaemia was more common (P less than 0.005) in patients with minimal CAD. Twenty--four patients with multiple vessel and six with single vessel CAD underwent aortocoronary by-pass surgery and relief of variant angina was achieved in all 25 long-term survivors during an average follow-up period of 36 months. Twelve patients (four of each subset) were treated medically. Among those with multiple vessel CAD, the small medically treated numbers precluded valid comparison of medical and surgical results. Patients with single vessel CAD followed for an average period of 17 months compared unfavourably with the operated group. Calcium antagonists with the operated group. Calcium antagonists or nitrates controlled variant angina in patients with minimal CAD followed for an average of 27 months.

Adult↗
PubMed1983

Comparative sensitivity of exercise, cold pressor and ergonovine testing in provoking attacks of variant angina in patients with active disease.

Exercise, ergonovine and the cold pressor test have been used to provoke variant angina attacks. The sensitivity of these three tests was compared in 34 hospitalized patients with well documented, active variant angina who had recently undergone coronary arteriography. The three tests were usually performed on three consecutive days, and 28 of the 34 had the three tests within 1 week. Angina was provoked by ergonovine in all 34 patients, by exercise in 17 and by cold pressor test in only five (p less than 0.005). ST elevation developed during the ergonovine test in 32 (94%), during exercise in 10 (29%) and during the cold pressor test in only three (9%). With ergonovine, one patient had only ST depression and one had no ECG changes. During the cold pressor test two patients had pseudonormalization of abnormally negative T waves and 29 had no ECG changes. Exercise induced T-wave pseudonormalization in four patients, ST depression in nine others and no ECG changes in 11. ST elevation was more frequent with ergonovine than with either of the other tests (p less than 0.0001). ST elevation or T-wave pseudonormalization occurred more often with exercise than with cold (p less than 0.05), but both occurred less often than with ergonovine (p less than 0.0001). We conclude that the sensitivity of the ergonovine test is very high in patients with active variant angina and that exercise will provoke angina with ST elevation in about 30% of these cases. In contrast, the sensitivity of the cold pressor test is too low to be of much clinical value in the diagnosis of variant angina.

Adult↗
PubMed1994

Clinical and angiographic characteristics of patients with multivessel coronary spasm in variant angina. Significance of progressive course of angina and disease activity.

The purpose of this study was to investigate the incidence of multivessel coronary spasm and compare the clinical characteristics between patients with and without multivessel coronary spasm. In variant angina, it is controversial whether coronary hyperreactivity to vasoconstrictor stimuli is localized to a segmental lesion in only one coronary artery. Moreover, the clinical characteristics of patients with multivessel coronary spasm have never been investigated. Sixty-three patients (51 men and 12 women; mean age, 56 years; range 35-72 years) with variant angina and documented ST-segment elevation during a spontaneous attack underwent spasm provocation testing with selective intracoronary injection of ergonovine. All but 4 patients who experienced spontaneous attacks during cardiac catheterization had induced coronary spasm associated with ST-segment elevation and chest pain. Multivessel coronary spasm was found in 27 (43%) of 63 patients. By univariate analysis, a high frequency of angina (> or = 3 times/week), occurrence of a spontaneous attack within 24 hours after withdrawal of medication, a long history of angina and a progressive course of angina were significantly associated with multivessel coronary spasm. Multivariate analysis indicated a positive correlation between multivessel coronary spasm and progressive angina. Multivessel coronary spasm was found in 43% of patients with variant angina. Patients with multivessel coronary spasm have some unique clinical features. These results may increase the understanding of the pathophysiology and natural course of variant angina.

Adult↗
PubMed2002

Sudden death and variant angina.

Variant angina is defined by chest pain occurring at rest associated with transitory ST segment elevation on ECG, and is caused by a spasm of a coronary artery. Frequently, variant angina is associated with atherosclerotic coronary obstruction and patients with normal coronary arteries are rare. Patients with variant angina and normal coronary arteries have good prognosis, and the development of ventricular arrhythmias or sudden death is rare. The authors present two cases of sudden cardiac death in patients with variant angina and normal coronary arteries.

Angina Pectoris, Variant↗
PubMedDate not supplied

Variant angina: a nursing approach.

Variant angina presents as an atypical form of angina caused by coronary artery spasm. Due to the sudden disruption of blood and oxygen supply to the myocardium, a number of severe hemodynamic changes may occur, including life-threatening dysrhythmias, and left ventricular dysfunction. Rapid intervention can alleviate the symptoms caused by the arterial spasm and prevent catastrophic results. The critical care nurse plays a vital role in the diagnosis of variant angina and rapid treatment of the patient.

Adult↗
PubMed1989

Effect of intracoronary nicardipine on methylergonovine-induced coronary artery spasm in patients with variant angina.

In a double-blind, randomized placebo controlled study, the effect of intracoronary (IC) nicardipine (0.4 mg) on methylergonovine (0.4 mg) induced coronary artery spasm was assessed in 16 patients with a history of variant angina. Reversal of the methylergonovine-induced coronary artery spasm was observed in 100% of patients treated with IC nicardipine and 25% of patients treated with placebo (p less than 0.01). There were no significant differences between the nicardipine and placebo treatment groups with respect to heart rate, blood pressure, proportion of patients experiencing chest pain or ST segment changes. These findings demonstrate that IC nicardipine is safe and could be effective in the reversal of coronary artery spasm in patients with variant angina.

Angina Pectoris, Variant↗