Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Angina Pectoris, Variant”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 757 records · Page 42Linked to original sources
PubMed1981

Treatment of Prinzmetal's variant angina. Role of medical treatment with nifedipine and surgical coronary revascularization combined with plexectomy.

This study describes three forms of treatment of Prinzmetal's variant angina. Coronary spasm, frequently found at coronary arteriography in patients with Prinzmetal's variant angina, can be treated with intravenous or intracoronary injection of nitroglycerin as well as of nifedipine. Nifedipine (0.2 mg) was injected directly into the involved artery in 12 patients and suppressed spasm in 9; in 3 patients, nifedipine increased coronary sinus flow, which had been decreased by spasm in one of the branches of the left coronary artery. Patients with Prinzmetal's variant angina who have spasm superimposed on atherosclerotic lesions can benefit from coronary arterial bypass grafting combined with partial denervation of the heart. This combination yielded acceptable results (83.4 percent favorable outcome); recurrence of attacks occurred in only 6.7 percent of this group. In those forms of angina in which spasm occurs in angiographically normal coronary arteries, therapy is essentially medical. In 13 patients treated with oral nifedipine (30 to 40 mg/day), suppression of attacks was achieved in 11 instances. During the period of treatment, the methergine provocative test, which had been consistently positive before treatment, converted to negative in 12 patients. Transient withdrawal of nifedipine caused recurrence of pain in two patients.

Adult↗
PubMed1979

[Prinzmetal's angina initiated by interruption of exercise. 5 cases with normal coronary radiograms].

Five male patients, aged between 31 and 58 years, presented with anginal chest pain with nausea and sweating after the interruption of exercise. Prinzmetal variant angina was observed during the recovery phase of exercise tolerance testing. Coronary arteriography and selective left ventricular angiography were normal in all cases. Ergonovine, used in one case, induced coronary artery spasm. The angina was eased by Nifedipine in three patients and passed off with time in the other two patients. In one case attack occurred with amiodarone therapy and in another with glyceril trinitrate, after normal exercise tolerance tests. Vagotonia, all the more pronounced when sympathetic tonus is increased, and hyperventilation seem to be the causative factors of what probably results from coronary artery spasm. Nifedipine, a calcium-blocking agent would appear to be the treatment of choice.

Adult↗
PubMed1980

Exercise-induced S-T segment elevation in variant angina.

Five patients with known ischemic heart disease had an unusual pattern of S-T segment depression during treadmill exercise testing followed by S-T segment elevation and chest pain in the postexercise period. Thallium-201 scintigraphy revealed reversible exercise-induced myocardial ischemia, in areas supplied by severely narrowed coronary arteries as documented by coronary arteriography. Ambulatory electrocardiographic recording for S-T segment shift using a frequency-modulated system showed S-T segment depressions and elevations at rest in the same leads that showed similar shifts during exercise tests. Three of the five patients had a myocardial infarction within 8 weeks of diagnosis, and two died. This syndrome may be associated with severe coronary artery disease and may have a very poor prognosis.

Ambulatory Care↗
PubMed1982

Regional coronary artery dilation response in variant angina.

We examined segmental left coronary artery responses to nitroglycerin in 17 variant angina patients and in 34 nonvariant angina patients using a quantitative angiography technique. In those patients with left anterior descending vasospasm, there was a marked exaggeration in the degree of dilation to nitroglycerin in those segments which at other times were involved with spasm. This observation was consistent when these segments were compared to (1) other left coronary segments in the same patient, (2) the same left coronary segments in nonvariant angina patients, and (3) the same left coronary segments in patients with right coronary spasm. These data suggest that a localized disorder in coronary vasomotion is present in patients with coronary spasm that is not limited to constriction but also involves increased dilation in response to nitroglycerin.

Adult↗
PubMed1978

Angiographic and pathologic correlations in Prinzmetal variants angina.

The coronary-arteriographic and pathologic findings in a case of Prinzmetal's angina are reported. Right coronary arteriograms performed in the absence of pain showed only minor stenotic changes, whereas those performed during an anginal attack revealed a spastic occlusion involving almost the entire vessel. Anatomic examination revealed obstructive lesions of the right coronary artery, more pronounced at the site where spasm had started, due to concentric atherosclerotic thickening of the inner wall, whereas the elastic fibers and the muscular ring of the tunica media were preserved. These findings suggest (1) the need for great caution before assuming on purely angiographic bases that spasm may affect a normal coronary artery and (2) the possibility that spasm occurs in a markedly diseased and stenotic segment of a coronary artery as long as the contractile tissue of the tunica media is preserved.

Angina Pectoris↗
PubMed1998

[Clinical significance of heart rate variability: analysis of silent myocardial ischemia].

To study the potential role of dynamic electrocardiogram(DEG) in silent myocardial ischemia (SMI) patients, we measured the extension of ischemia and heart rate variation-time-domain analysis in 148 patients with SMI and 30 healthy controls by DEG and followed up all patients for 1.5 years. The results were that the extension of myocardial ischemia (the extension of ST segment depression, episodes of SMI attack, and the total ischemia time), the incidence rate of ventricular premature heat increased gradually and the difference of heart rate. Heart rate variant hinder(HRVI), and SDNN decreased gradually in SMI I, III, II types. And the extension of ischemia had positive correlation with the lowest heart rate and the incidence rate of ventricular premature beat, while negative correlation with HRVI and SDNN, indicating that the impairment of cardial autonomic nerves is associated with the extension of ischemia. Also, we found that 23 patients out of 148 patients with SMI died and the levels of HRVI and SDNN of the patients who died were lower than that of the survivals. We conclude that the heart rate variability can serve as a prognosis index of SMI.

Aged↗
PubMed1981

[Clinical, angiographic and therapeutic aspects of variant angina (author's transl)].

A report is given on seven patients with Prinzmetal's variant angina. Rest angina occurred in all patients. In contrast, exertional angina was observed only on patients with significant (greater than 70%) coronary stenosis. Likewise, electrocardiographic changes (negative T) were only demonstrable in patients with severe coronary obstruction. The coronary angiogram was normal in one patient, demonstrated insignificant lesions in two and significant stenosis in four cases. In patients with insignificant coronary lesions obstructive coronary spasm was provoked by ergonovine maleate and this group responded well to a combination of nifedipine and isosorbide dinitrate therapy. The patients with significant coronary stenosis were free from pain after coronary bypass surgery; one of these suffered a perioperative anterior myocardial infarction. On the basis of these observations promising therapy is possible if the coronary morphology is known.

Adrenergic beta-Antagonists↗
PubMed1998

Variant angina in isolated adrenocorticotropin deficiency, inappropriate vasopressin secretion and Hashimoto's thyroiditis.

We report a 62-year-old male patient who had variant angina and isolated adrenocorticotropic hormone (ACTH) deficiency. His serum sodium concentration was low and vasopressin was inappropriately high for the low plasma osmolality. Serum free thyroxine (FT4) was low and thyroid stimulating hormone (TSH) was high with positive anti-thyroperoxidase antibodies, compatible with Hashimoto's thyroiditis. Treatment with Amrodipine and hydrocortisone relieved chest symptoms and hyponatremia, and hypothyroidism was also normalized. It is suggested that coronary artery spasm may be related to cortisol deficiency and/or inappropriately high vasopressin secretion and that hypothyroidism was ameliorated because the reduced responsiveness to TSH returned to normal due to hydrocortisone supplement.

Adrenocorticotropic Hormone↗
PubMed1979

[Methyl-ergometrin maleate test during coronary arteriography in spontaneous chest pain].

This coronary spasm provocation test with methyl-ergometrine maleate was carried out during coronary arteriography in 47 patients presenting with spontaneous chest pain. Coronary spasm was triggered in 16 cases, reproducing the chest pain in 11 patients, and accompanied by electrical changes in 15 cases, 12 subepicardial ischaemias and 3 subendocardial ischaemias. This test is not without danger to the patient as arrhythmias and conduction defects were recorded in 6 cases although the spasm was readily reversible on injection of intravenous glyceryl trinitrate. Of 7 patients with Prinzmetal variant angina, the test was positive 6 times, in three of which on pre existing severe organic lesions, so confirming the mechanism of this syndrome and the reliability of the test. Of 40 patients presenting with spontaneous chest pain, 10 had a positive test. In 2 of these cases the chest pain was subsequently observed with subepicardial ischaemic electrical changes, so confirming the screening value of this test. In the 7 cases where coronary spasm gave rise to electrical changes with or without pain, the logical diagnosis would appear to be spastic angina. In the 30 cases where the test was negative the subsequent outcome did not provide any proof in favour of a coronary origin of the chest pain.

Adult↗
PubMed2005

Endothelial function and coronary spastic angina.

Coronary spasm plays an important role in the pathogenesis of not only variant angina but also coronary heart disease in general including acute coronary syndromes, especially in the Japanese population. The vascular endothelium has been reported to be a multifunctional organ whose integrity is essential for normal vascular physiology. Vascular endothelial dysfunction can be a critical factor in the pathogenesis of ischemic heart disease. Acetylcholine and methacholine cause vasodilation by endothelium-derived relaxing factor when the endothelium is functioning normally, whereas they cause vasoconstriction when the endothelium is removed or damaged. Coronary spasm can be induced by a variety of stimuli with different mechanisms of action, including acetylcholine and methacholine. Patients with coronary spasm may have a disturbance in endothelial function as well as local hyperreactivity of the coronary arteries.

Angina Pectoris, Variant↗
PubMed1979

Coronary spasm: Prinzmetal's variant angina vs. catheter-induced spasm; refractory spasm vs. fixed stenosis.

An analysis of 2,394 selective coronary angiograms yielded 23 examples of coronary artery spasm. Of these, nine occurred in patients with Prinzmetal's variant angina and 14 were instances of catheter-induced spasm. Angiographic criteria can distinguish between the spasm of variant angina and catheter-induced spasm. The latter is usually asymptomatic, almost invariably in the right coronary artery, at the catheter tip, smooth, concentric, and less than 2 mm long. The former can occur in any coronary artery at a distance of 1--4 cm from the catheter tip, is usually irregular and eccentric, and is associated with angina, ST segment elevation, hypotension, and dysrhythmia. Response to nitroglycerin is often, but not always, complete in both. Stenoses that seem to be fixed in patients with Prinzmetal's angina should be suspected to be spasm even if unresponsive to nitroglycerin, especially when the rest of the vessel is normal. Additional pharmacologic manipulation and even recatheterization may be necessary to prove the dynamic nature of the lesion and avoid unnecessary surgery.

Adult↗
PubMed1983

Coronary arteriography and left ventriculography during spontaneous and exercise-induced ST segment elevation in patients with variant angina.

The present study is an angiographic demonstration of coronary artery spasm during both spontaneous and exercise-induced angina in three patients with variant angina. In each case, clinical, ECG, coronary angiographic, and left ventriculographic observations were made at rest, during spontaneous angina, and during exercise-induced angina. The character of chest pain was similar during spontaneous and exercise-induced episodes. ST segment elevation was present in the anterior ECG leads during both episodes. The left anterior descending coronary artery became partially or totally obstructed during both types of attacks. When coronary spasm was demonstrated during both types of attacks, left ventriculography disclosed akinetic or dyskinetic wall motion in the area supplied by the involved artery. In those patients with reproducible exercise-induced ST segment elevation and chest pain, thallium-201 scintigraphy showed areas of reversible anteroseptal hypoperfusion. Thus in selected patients exercise-induced attacks of angina were similar to spontaneous episodes.

Angina Pectoris, Variant↗
PubMed1984

[Comparative study of the effectiveness of korinfar, izoptin and obzidan in patients with variant stenocardia combined with effort stenocardia].

Twelve patients with variant angina combined with angina of effort were examined. Repeated exercise tests prior to the administration of antianginal drugs revealed the spontaneous variability of the patients' tolerance to the exercise and of the pulse-pressure index at the exercise peak which may serve as an indirect sign of the angiospastic factor involvement in clinical manifestations of angina of effort. The treatment of such patients with corinfar and isoptin was associated with the elimination and significant reduction of spontaneous attacks of angina attended by a considerable increase in the exercise tolerance and in the pulse-pressure index at the exercise peak. The treatment with obsidan in these cases was less effective: the incidence of spontaneous anginal attacks changed insignificantly, the tolerance to exercise increased with the reduction of the maximum value of the pulse-pressure index.

Adult↗
PubMed1981

Long-term transtelephonic electrocardiographic monitoring in the detection and evaluation of variant angina.

To facilitate the outpatient diagnosis of variant angina by documenting transient ST segment evaluation during chest pain, we studied the feasibility of transtelephonic ECG monitoring during angina episodes. Eight patients with known coronary artery spasm underwent simultaneous continuous ambulatory and transtelephonic ECG monitoring during a 24-hour period. Five patients (62%) had transient diagnostic ST segment shifts on both continuous ambulatory and transtelephonic monitoring. Another eight patients with coronary spasm underwent 24-hour continuous ambulatory monitoring and separate 14-day period of transtelephonic monitoring. The addition of this longer monitoring period provided diagnostic ST segment shifts in three patients. We conclude that transtelephonic monitoring in patients with suspected coronary artery spasm can provide important additional diagnostic information to continuous ambulatory monitoring, particularly in the patient with infrequent or predictable chest pain.

Adult↗
PubMed1977

Conduction system in a patient with Prinzmetal's angina and transient atrioventricular block.

His bundle recordings obtained during and between attacks of Prinzmetal's variant angina and transient atrioventricular (A-V) block were followed by a comprehensive serial section study of the conduction system in a 33 year old woman. Recordings between attacks showed normal A-H and H-V intervals. During an attack there was block proximal to the His bundle recording site. Pathologic studies revealed severe narrowing of the right coronary artery. Arteriolosclerosis of the heart was diffuse. Insignificant changes were found in the approaches to the A-V node and the A-V node itself. Major changes found in the left bundle branch had no counterpart in the electrocardiogram; the discordance in these findings is discussed.

Adolescent↗
PubMed1989

Programmed ventricular stimulation during variant angina: report of a case.

Programmed ventricular stimulation was performed in a 74-year-old patient who had a history of syncope following chest pain. In the baseline state, ventricular tachycardia was not inducible. Immediately following the study protocol, the patient complained of her usual chest pain and ST elevation was documented in lead II with reciprocal ST depression in leads AVF and V1. Programmed ventricular stimulation was repeated (presumably during the occlusive phase of coronary spasm) and a polymorphic ventricular tachycardia with a cycle length of 200 msec was repeatedly induced. Following intravenous nitroglycerin and resolution of chest pain, ventricular tachycardia was not inducible. Coronary angiography with ergonovine testing confirmed coronary spasm of the right coronary artery. We speculate that syncope was caused by ventricular tachycardia following coronary artery spasm. During a 12-month follow-up with calcium blockers and nitrates, there has been no recurrence of chest pain or syncope.

Aged↗
PubMed1992

Preservation of endothelium-dependent vasodilation in the spastic segment of the human epicardial coronary artery by substance P.

The objective of this study was to determine if endothelium-dependent vasodilation is preserved in the spastic segment of the epicardial coronary artery. Segmental responses of the coronary artery to substance P were examined by the use of a quantitative angiographic technique in 21 patients with variant angina. Coronary diameter at the basal state did not differ between the spastic and the nonspastic segments (2.3 +/- 0.2 mm, 2.3 +/- 0.4 mm, p greater than 0.05). Changes in coronary diameter in response to substance P did not differ between segments with ergonovine-induced spasm and nonspastic segments. Maximal dilation averaged 27.1 +/- 9.5% in the spastic segment and 24.4 +/- 9.6% in the nonspastic segment (expressed as a percent increase over the value before drug administration). It appears that both the potential of the endothelium to release endothelium-dependent relaxing factor and the dilating response of the smooth muscle to endothelium-dependent relaxing factor are preserved, even in the spastic segment.

Angina Pectoris, Variant↗
PubMed1977

Another look at Prinzmetal's variant angina.

Prinzmetal's variant angina is commonly referred to as a syndrome apart from the usual spectrum of atherosclerotic disease. 2 well-studied patients with this form of angina gave past histories compatible with classical angina. They were found to have, in addition to severe atheromatous lesions, coronary artery spasm resulting in complete obstruction of the vessel during Prinzmetal attacks. The concomitant electrocardiographic ST segment elevations are probably the reflection of transmural ischemia injury resulting from the transient complete occlusion of the corresponding coronary artery. Electrocardiograms taken during milder resting anginal attacks showed minimal nonspecific changes of the electrocardiogram or T wave inversions which may possibly reflect less severe ischemia, secondary to milder coronary spasm. These observations support the possibility that at least in some cases, Prinzmetal's angina may just be a phase in the life history of patients with atherosclerotic disease, during which recurrent severe coronary spasms may occur.

Angina Pectoris↗