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At least 127 records · Page 7Linked to original sources
PubMed1993

Correlation of basal coronary artery tone with constrictive response to ergonovine in patients with variant angina.

OBJECTIVES: This study was conducted to examine whether basal coronary artery tone is elevated at the spastic site in patients with variant angina and to determine the significance of basal artery tone in predicting provocation of coronary artery spasm. BACKGROUND: Previous data have been conflicting on whether basal coronary artery tone is elevated in patients with variant angina. METHODS: We assessed basal coronary artery tone by obtaining the percent increase in coronary artery diameter induced by nitroglycerin in 20 patients with variant angina and 24 control subjects. We also examined the correlation between basal coronary artery tone and the constrictive response to ergonovine. RESULTS: In the patients with variant angina in whom spasm was provoked by the lower doses (1 or 5 micrograms) of ergonovine, basal coronary artery tone was greater (p < 0.05) at the spastic site (54 +/- 15% or 36 +/- 16%, respectively) than at the nonspastic site (40 +/- 25% or 25 +/- 15%, respectively). Basal coronary tone at the nonspastic site in these patients was greater (p < 0.01) than that in control subjects (15 +/- 6%). In the patients with variant angina in whom spasm was provoked only by the higher doses (15 or 50 micrograms) of ergonovine, basal coronary artery tone was comparable at the spastic and nonspastic sites and was not different from that in control subjects. The diagnostic sensitivity and specificity of elevated basal coronary artery tone (> or = 40%) in predicting provocation of spasm were 26% and 98%, respectively. CONCLUSIONS: These results indicate that elevated basal coronary artery tone may be useful in predicting provocation of coronary spasm, but the normal level of basal coronary artery tone does not exclude such provocation.

Adult↗
PubMed1997

Comparison of coronary flow reserve between focal and diffuse vasoconstriction induced by ergonovine in patients with vasospastic angina.

Decreased coronary flow reserve has been reported in patients with ergonovine-induced coronary vasoconstriction by the thermodilution method. To assess the difference of coronary flow reserve between patients with focal and diffuse vasospasm, after the vasospasm is discontinued by injection 3 mg of isosorbide dinitrate, phasic flow velocities of the diseased coronary artery were recorded at rest and during hyperemia (140 microg/kg/min of adenosine infusion intravenously) using a 0.014-inch, 15-MHz Doppler guidewire in 26 patients with ergonovine-induced coronary vasospasm (0.2-mg ergonovine injection intravenously), including 12 patients with focal (>90% stenosis), 14 patients with diffuse vasospasm (>50%), and 11 controls with normal coronary arteries without vasospasm. Although time-averaged peak velocity in cases with diffuse and focal vasospasm was not significantly different compared with that in controls at baseline (22 +/- 7, 18 +/- 5 vs 20 +/- 7 cm/s, respectively, NS), it was significantly lower in patients with diffuse vasospasm than in cases with focal vasospasm and in controls during hyperemia (43 +/- 13 vs 64 +/- 18, 61 +/- 19 cm/s, respectively, p <0.01). As a result, coronary flow reserve obtained from the ratio of hyperemic/baseline time-averaged peak velocity was significantly lower in patients with diffuse vasospasm than that in controls (1.9 +/- 0.4 vs 3.1 +/- 0.4, p <0.01), although it was not significantly different between the subjects with focal vasospasm and controls (3.5 +/- 0.7 vs 3.1 +/- 0.4, NS). Thus, coronary flow reserve is maintained normally in patients with focal vasospasm and limited in those with diffuse vasospasm. Microvascular impairment could exist further in cases with diffuse vasospasm, although similar endothelial dysfunction of the epicardial coronary artery is observed in focal and diffuse vasospasm.

Adult↗
PubMed2002

[Acute pulmonary edema with normal coronary arteries: mechanism identification by ergonovine stress echocardiography].

Coronary spasm is a constriction of the epicardial coronary arteries that produces myocardial ischemia. It is considered the main mechanism of the dynamic coronary artery stenosis. The standard method for diagnosing coronary spasm is the ergonovine test during diagnostic coronary angiography. Another test currently used is stress echocardiography with intravenous ergonovine injection. We present the case of a patient with angina, acute pulmonary edema and normal angiographic coronary arteries in which stress echocardiography with ergonovine demonstrated transient severe mitral regurgitation.

Acute Disease↗
PubMed2000

Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm.

OBJECTIVES: We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of coronary vasospasm (CVS). BACKGROUND: The safety of ergonovine provocation for CVS performed outside the catheterization laboratory has been questioned. METHODS: We performed a retrospective analysis of the results of bedside ergonovine provocation testing by monitoring left ventricular regional wall motion abnormalities (RWMAs) using two-dimensional echocardiography (Erg Echo). RESULTS: After confirming that there was no significant epicardial coronary stenosis, Erg Echo was performed on 1,372 patients from July 1991 to December 1997. Ergonovine echocardiography was terminated prematurely in 13 patients (0.9%) because of limitations caused by side effects unrelated to myocardial ischemia. Among 1,359 completed tests, 31% (n = 421) showed positive results, with development of RWMAs in 412 tests (98%) or ST displacement in electrocardiograms of nine tests (2%). Arrhythmias developed in 1.9% (26/1,372), including transient ventricular tachycardia (n = 2) and atrioventricular block (n = 4), which were promptly reversed with nitroglycerin. There was no mortality or development of myocardial infarction. Based on the angiographic criteria of 218 patients, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91%, respectively. Since 1994, Erg Echo has become a more popular diagnostic method than invasive spasm provocation testing in the catheterization laboratory and has comprised more than 95% of all spasm provocation tests during the last three years. In the outpatient clinic, 453 patients underwent Erg Echo safely. CONCLUSIONS: Although this is a retrospective study in a single center, we believe that Erg Echo is highly feasible, accurate and safe for the diagnosis of CVS and can replace invasive angiographic spasm provocation testing in the catheterization laboratory.

Adult↗
PubMed1983

Variability in coronary hemodynamics in response to ergonovine in patients with normal coronary arteries and atypical chest pain.

Because an increase in coronary vascular resistance in response to ergonovine maleate has been suggested as a possible diagnostic aid for variant angina, changes were evaluated in coronary hemodynamics and serial myocardial thallium-201 perfusion scans in 15 patients without angina and with normal coronary arteries in response to ergonovine (0.05, 0.10 and 0.20 mg intravenously). For the group, heart rate-blood pressure product increased significantly (p less than 0.001) without any change in coronary sinus flow, coronary vascular resistance, myocardial oxygen extraction, arterial-coronary sinus oxygen difference and lactate extraction. In 7 of 15 patients, however, coronary vascular resistance increased (mean 39%, range 11 to 75%, probability [p] less than 0.001), and coronary sinus flow decreased (14%, p less than 0.001), despite an increase in heart rate-blood pressure product (36%, p less than 0.02). No electrocardiographic, metabolic or thallium-201 scan abnormalities occurred. Therefore, significant increases in coronary vascular resistance in response to ergonovine may occur in patients with normal coronary arteries and atypical chest pain.

Adolescent↗
PubMedDate not supplied

Comparison of the effects of dihydroergotamine and ergonovine on functional changes caused by beta-adrenergic stimulation in normally and underperfused canine myocardium.

We studied the effects of dihydroergotamine (DHE) and ergonovine on myocardial function in normally perfused myocardial areas and in myocardial areas with restricted coronary flow. Regional function at rest and during isoproterenol (ISO)-induced cardiac stimulation was assessed by two pairs of piezoelectric transducers. Constriction of the circumflex branch with a decrease in coronary blood flow from 24.9 +/- 2.6 to 18.1 +/- 2.2 ml/min had little effect on resting regional function. Intravenous bolus injection of ISO (0.5 microgram/kg) prior to constriction induced a marked decrease in end-diastolic segment length and an increase in percentage shortening. Intravenous bolus injection of ISO (0.5 microgram/kg) after constriction of the circumflex branch induced transient regional dysfunction, as shown by a maximum decrease of percentage shortening by 54.4% in the underperfused area. Intravenous infusion of DHE (2 micrograms/kg; 5 min) did not significantly affect resting function and effectively inhibited ISO-induced regional dysfunction. This improvement in regional function during ISO-induced cardiac stimulation can be attributed to the fact that DHE decreased heart rate and left ventricular power, thus reducing myocardial oxygen demand and improving the energetic situation in the underperfused myocardium. In contrast, ergonovine (5 micrograms/kg; 5 min) induced an impairment in regional function in both segments at rest and further aggravated ISO-induced transient dysfunction. The present study confirms the adverse effect of ergonovine on blood flow and regional function in underperfused myocardial areas and demonstrates a beneficial effect of DHE on regional function in underperfused myocardial areas during ISO-induced cardiac stimulation.

Animals↗
PubMed1984

Unusual vasomotor coronary arterial responses after reversal of ergonovine induced spasm with glyceryl trinitrate.

Unusual vasomotor responses in the coronary arteries occurred in two patients after the administration of glyceryl trinitrate to relieve spasm induced by ergonovine maleate. In one patient after treatment with glyceryl trinitrate and despite dilatation of the adjoining segments a new severe reduction in diameter occurred distally to the segments of the right coronary artery where the ergonovine induced spasm developed. In the other patient the left anterior descending artery filled very slowly after the completely occlusive spasm of the right coronary artery had resolved with glyceryl trinitrate though the circumflex did not. These vasomotor changes were associated with chest discomfort and electrocardiographic abnormalities in both cases. These findings indicate that caution is needed when performing provocative tests even after the ergonovine induced spasm has been reversed with glyceryl trinitrate.

Adult↗
PubMed1991

Response of canine coronary collateral vessels to ergonovine and alpha-adrenergic stimulation.

The ability of moderately well-developed coronary collateral vessels to undergo vasoconstriction in response to alpha-adrenergic stimulation and to ergonovine was studied. Studies were performed in 15 dogs 4-16 wk after embolic occlusion of the left anterior descending coronary artery had been performed to stimulate collateral vessel growth. Interarterial collateral flow was measured as retrograde flow from the cannulated left anterior descending coronary artery, while microvascular collateral flow was measured as continuing tissue flow determined with radioactive microspheres administered during the retrograde flow collection. Studies were performed after beta-adrenergic blockade with propranolol. Neither cardiac sympathetic nerve stimulation nor alpha 1-adrenergic stimulation with phenylephrine caused significant change in retrograde blood flow or myocardial tissue flow. The selective alpha 2-adrenergic agonist, B-HT 933, decreased tissue flow in the collateral-dependent region but did not significantly alter retrograde flow. Although these data indicate that intramural microvascular collateral communications are capable of vasoconstriction in response to alpha 2-adrenergic stimulation, the larger interarterial collaterals are unresponsive to alpha-adrenergic influences. However, under the conditions of the experiment, adrenergic activity did not appear to influence collateral function, since neither alpha 1-adrenergic blockade with prazosin nor alpha 2-adrenergic blockade with rauwolscine altered collateral flow. Ergonovine, 0.2-0.8 microgram.kg-1.min-1, caused a 22 +/- 4% decrease in retrograde flow (P less than 0.01) but did not alter microvascular collateral flow. Thus, of the agents tested, only ergonovine caused vasoconstriction of the large interarterial coronary collateral vessels.

Adrenergic alpha-Agonists↗
PubMed1994

Dexamethasone and ergonovine effects on cerebrospinal fluid pressure in conscious rats.

Prior work showed that intracerebroventricular (i.c.v.) infusions of artificial cerebrospinal fluid (aCSF), at a rate of 8 microliters/min x 10 min, elevated CSF pressure (CSFp) of conscious rats after a 2-hour delay. The rise was associated with an increased resistance to outflow and decreased intracranial compliance. When maintained by a continuous infusion of 0.25 microliter/min into each lateral ventricle, CSFp recordings can be made for 24 h and a higher CSFp occurs. Here, we pretreated rats with ergonovine or dexamethasone to determine their effects on the delayed CSFp rise. Ergonovine (0.5 mg/kg i.p.) pretreatment, in a 6-hour protocol using only the 10-min infusion, slightly reduced CSFp (p < 0.05, one-tail test) but the time course of the delayed rise in CSFp was unchanged (p > 0.05). Ergonovine increased intracranial compliance (p < 0.05) 20 min after infusion when CSFp was normal, but not when CSFp was elevated at 4 h (p > 0.05). Dexamethasone (40 micrograms i.m.) pretreatment was tested in the 24-hour protocol. It reduced (p < 0.05) normal CSFp during the 2-hour lag after infusion and the CSFp rise was reduced (p < 0.05) for about 8 h. However, the time course and ending CSFp were unchanged (p > 0.05). Thus, prior cerebral vasoconstriction or a steroidal anti-inflammatory drug have partial efficacy in reducing CSFp, but do not prevent the unknown events that precede the delayed CSFp rise after i.c.v. infusions.

Animals↗
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↗
PubMed1987

Limited coronary flow reserve after dipyridamole in patients with ergonovine-induced coronary vasoconstriction.

Patients with anginal chest pain despite angiographically normal coronary arteries and left ventricles may have abnormalities of coronary flow reserve. Twenty-five patients were found to have limited flow reserve during rapid atrial pacing after administration of 0.15 to 0.30 mg iv ergonovine, associated with precipitation of chest pain and hemodynamic and metabolic evidence of myocardial ischemia. No significant narrowing occurred in epicardial coronary artery luminal diameter. An additional 15 patients had no chest pain during pacing; because they developed significantly higher great cardiac vein flow and lower coronary resistance they were considered to have normal vasodilator reserve. After administration of dipyridamole (0.5 to 0.75 mg/kg iv), the lowest absolute levels to which coronary resistance fell (0.79 +/- 0.23 vs 0.47 +/- 0.12 mm Hg X min/ml; p less than .001) and the maximal absolute levels to which great cardiac vein flow rose (134 +/- 34 vs 202 +/- 45 ml/min; p less than .001) were impaired in the 25 patients with ergonovine-induced flow limitation compared with the 15 patients without flow limitation after ergonovine. In addition, 18 of the 25 patients with limited flow reserve after dipyridamole experienced chest pain despite an increase in coronary flow. In these patients, dipyridamole-induced increased flow across small prearteriolar coronary arteries, which were narrowed because of abnormal tonus or sensitivity to vasoconstrictor stimuli, could have resulted in a transmural redistribution of blood flow away from the subendocardium, precipitating subendocardial ischemia. These studies suggest that patients with anginal chest pain despite normal epicardial coronary arteries may have exaggerated coronary responses to vasoconstrictor stimuli, which can result in myocardial ischemia during stress, as well as attenuated responses to coronary vasodilator stimuli.

Adult↗
PubMed1981

Depressant effect of trapidil on dog coronary arterial contraction induced by ergonovine.

Effects of trapidil on ergonovine-induced contractions of isolated dog coronary arteries were investigated in vitro. Ergonovine produced dose-dependent contractions of helical strips cut from the left circumflex branches of coronary arteries. Trapidil significantly depressed these-contractions. 5-HT also produced dose-dependent contractions of the strips, which were depressed by trapidil. In isolated rabbit femoral arterial preparations, norepinephrine dose-dependently contracted the strips. Phentolamine significantly depressed these contractions, and trapidil depressed them when relatively high doses were applied previously. Results indicate that trapidil has a depressant effect on coronary arterial contractions induced by ergonovine, partly through antagonism to 5-HT receptor and/or adrenergic alpha receptor.

Animals↗
PubMed1999

Evaluation of adjunctive intracoronary administration of acetylcholine following intravenous infusion of ergonovine to provoke coronary artery spasm.

A dilemma arises in patients with chest pain or other symptoms suggestive of coronary artery disease but without significant coronary artery stenosis or spasm even after the spasm provocation test by either ergonovine or acetylcholine. Incremental doses of intracoronary acetylcholine (up to 100 micrograms for left coronary artery and 50 micrograms for right coronary artery) were administered when intravenous infusion of ergonovine 0.4 mg showed negative results. A total of 39 patients were studied. Provocation test was performed because of chest pain suggestive of coronary artery disease (n = 19), atypical chest pain (n = 6), post balloon angioplasty status (n = 6), silent ischemia (n = 4), Adams-Stokes syndrome (n = 3), and dead-on-arrival (n = 1). Characteristics of chest pain indicated variant angina (n = 11), rest angina (n = 4), and effort angina (n = 4). No electrocardiographic evidence of ischemia was detected before this test in any patient. Spasm was induced in 23 patients (59.0%) with complete obstruction in 7 (30.4%), diffuse vasoconstriction (90-99%) in 14 (60.9%), and focal spasm in 2 (8.7%). The patients with chest pain showed the highest positive rate of 78.9%. Further, the patients with atypical chest pain and miscellaneous reasons also revealed positive rates of 33.3% and 42.9%, respectively. One ventricular tachycardia and 2 atrial fibrillations occurred but terminated spontaneously. This test is useful for detecting spasm in a variety of patients in whom intravenous ergonovine infusion fails to induce spasm.

Acetylcholine↗
PubMed1992

[The use of ergonovine in the hemodynamics laboratory].

In our department we have reviewed the use of ergonovine maleate as a provocative agent for inducing coronary spasm during coronary arteriography. From January 1978 to December 1991 the test has been performed in 116 patients. According to their symptoms, the patients were divided into 4 groups: (A) patients with exertional angina: 16 patients (13.8%), (B) patients with angina at rest: 64 patients (55.2%), (C) patients with atypical chest pain: 29 patients (25%), and (D) patients with previous myocardial infarct: 7 patients (6%). We have subdivided the patients with angina at rest, according to the electrocardiogram recorded during pain, into: (1) 16 patients with ST-segment elevation; (2) 14 patients with ST-segment depression or T wave inversion; (3) 5 patients with electrocardiogram unchanged during angina; (4) 29 patients with no electrocardiogram recorded during angina. In 67 patients (57.7%) the coronaries were normal, 17 patients (14.6%) had mild irregularities, 26 patients (22.4%) had non critical fixed obstructions (< or = 70%), and in 6 patients (3.5%) there were fixed coronary narrowings > or = 70%. The left ventricle was normal in 85 subjects (73.2%), hypo or akinetic in 31 (26.8%). After routine coronary angiography and ventriculography, ergonovine maleate, 0.05 up to 0.4 mg, was given intravenously. The ergonovine test was considered positive when a focal spasm narrowed a normal coronary artery, or one with a mild fixed obstruction (< or = 50%) to more than 70%, or when a 70% stenosis became occluded. The development of angina and/or electrocardiographic changes were not taken as a criteria of positivity. Thirteen tests (11.2%) were considered positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[The ergonovine test: an episode of hallucinations].

The ergonovine maleate provocation test for the diagnosis of coronary spasm is widely used in patients with rest angina. A patient who developed an episode of psychotomimetic symptoms after the administration of intravenous ergonovine is presented. This side effect of ergonovine maleate had not been previously reported.

Coronary Vasospasm↗
PubMed1986

[Usefulness and limitations of the ergonovine maleate test in the evaluation of calcium-antagonist therapy in Prinzmetal variant angina].

Ergonovine testing was carried out in a selected group of 25 patients with Prinzmetal's variant angina treated with calcium-antagonists in order to: define its usefulness in the evaluation of the short-term effectiveness of calcium-antagonist treatment; compare the results of the test with those of Holter monitoring; verify if the results of the test during the acute phase are correlated with the long-term response to treatment. In all patients a control period lasting 2-6 days was carried out, after which a treatment period with calcium-antagonists (nifedipine, diltiazem, verapamil), lasting 2-8 days, was instituted. In 20 patients only 1 calcium-antagonist was evaluated, in 1 patient 2 calcium-antagonists and in 4 all of them. Scalar ergonovine test was carried out in control conditions and repeated during each calcium-antagonist treatment period. During both control and treatment periods all patients underwent Holter monitoring for evaluation of frequency of the spontaneous attacks. After the acute phase 21 of the 25 patients were discharged on calcium-antagonist treatment and followed-up for a mean period of 11 +/- 7 months. In control conditions ergonovine test was positive in 24 patients at a mean dose of 0.11 +/- 0.09 mg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

The nature of ventricular arrhythmias during ergonovine-induced vasospastic angina pectoris.

The peak incidence of ventricular fibrillation in acute myocardial infarction usually occurs during the first hours after the onset. Electrophysiological changes immediately after the onset have been studied in animal models, but are still incompletely understood in humans. For clarification of the characteristic features of ventricular arrhythmias during acute myocardial ischemia, ventricular arrhythmias were studied in 81 patients with vasospastic angina pectoris induced by ergonovine. Ventricular arrhythmias occurred in 45 of these patients, including ventricular tachycardia in 15, and ventricular fibrillation requiring repeated DC defibrillation in two patients. Most ventricular extrasystoles occurred before the ST segment reached maximum elevation, while reperfusion arrhythmias were less common. In many patients the coupling intervals varied, and the configuration was multiform. It is concluded that ventricular arrhythmias occurring during ergonovine-induced coronary spasm show different characteristics from those occurring during chronic ischemia. As the arrhythmias in this study seem, in some ways, to resemble arrhythmias occurring at the onset of myocardial infarction, the results might provide useful information on ventricular arrhythmias in myocardial ischemia in humans.

Angina Pectoris, Variant↗