Coronary artery spasm during exercise in patients with variant angina.

Waters, David D.; Chaitman, Bernard R.; Dupras, G; Théroux, Pierre; Mizgala, Henry F.

doi:10.1161/01.cir.59.3.580

Cited by 112 publications

(17 citation statements)

References 21 publications

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“…Exercise-induced STsegment elevation (compared with the resting ECG) always occurred in one of the leads where the ST segment was already abnormal at rest, but it did not necessarily occur in all such leads, nor was it necessarily restricted to these leads. In all but two of the 27 patients the left ventricular angiogram revealed a segmental wall motion abnormality at the site corresponding to the ECG leads that showed ST-segment elevation; two of these segments were hypokinetic, 10 akinetic and 13 dyskinetic. Twenty-five of the 27 patients had a left anterior descending coronary stenosis of 70% or greater: nine of these arteries were completely occluded and in 20 of 27 the stenosis was .…”

Section: Resultsmentioning

confidence: 95%

“…No one precordial lead detected all 27 cases, but leads V, and V3 were most sensitive, detecting 24 (89%) and 22 (8 1%) of 27, respectively. STsegment elevation .…”

Section: Resultsmentioning

confidence: 96%

“…On the other hand, exercise-induced ST-segment elevation has been reported in patients with variant angina. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Most have no evidence of left ventricular dysfunction and some have no fixed coronary stenoses. 27 Finally, Bruce et al28 noted ST-segment elevation during exercise testing in 0.5% of asymptomatic, presumably healthy subjects.…”

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confidence: 99%

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Clinical and angiographic correlates of exercise-induced ST-segment elevation. Increased detection with multiple ECG leads.

Waters¹,

Chaitman²,

Bourassa³

et al. 1980

Circulation

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SUMMARY ST-segment elevation was observed in 47 of 720 patients who underwent treadmill exercise testing using 14 ECG leads 1 day before coronary arteriography. This abnormality was detected in lead V. in only 13 of 47 patients (28%) and in lead CM5 in only nine of 47 patients (19%). In 36 patients previous myocardial infarction (27 anterior, nine inferior) was diagnosed on the resting ECG; in all cases the ST-segment elevation during exercise occurred in leads with Q waves. In 34 of 36 patients (94%) a corresponding left ventricular wall motion abnormality was present, usually (33 of 36, 92%) a dyskinetic or akinetic segment. All but two of the 36 patients had a coronary stenosis > 70% in the artery perfusing the involved region.Ten of the 11 patients with no ECG evidence of myocardial infarction had documented variant angina. In all 10 cases ST-segment elevation during exercise occurred in the same ECG leads as during spontaneous resting attacks. All 10 had normal left ventricular angiograms and only three had a coronary stenosis 2 70%. A large perfusion defect corresponding to the site of ST-segment elevation and not present at rest was detected in each of the six who had exercise thallium-201 scans. Four patients retested during treatment with nifedipine did not develop angina, ST changes or perfusion defects.These findings suggest that exercise-induced ST-segment elevation is probably caused directly by a segmental wall motion abnormality in patients with previous myocardial infarction, but by coronary artery spasm in patients with variant angina.THE CLINICAL SIGNIFICANCE of ST-segment depression during exercise testing is well understood.' In contrast, the mechanism for exercise-induced STsegment elevation, a more unusual finding, is controversial and the associated clinical and angiographic features vary widely from one study to another.2`9 Many authors2' 5-8 conclude that localized left ventricular dysfunction, which is present in nearly all of these patients,2 accounts for ST-segment elevation during exercise; however, others1 3, 4suggest that severe myocardial ischemia is the cause, because most patients also have critical coronary stenoses. On the other hand, exercise-induced ST-segment elevation has been reported in patients with variant angina. 10 At our institution 720 patients have undergone clinical evaluation and treadmill exercise testing with 14 ECG leads on the day before coronary and left ventricular angiography. The primary purpose of this study was to examine the clinical and angiographic features of the patients in this population who developed ST-segment elevation during exercise. In addition, we have compared the sensitivity of different ECG leads in detecting this abnormality. Methods Patient SelectionMaximal treadmill exercise tests using a 14-lead ECG system were performed on 720 consecutive patients 1 day before coronary and left ventricular angiography. Those with unstable angina, associated valvular, cardiomyopathic or congenital heart disease, overt heart failure or limiting ort...

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Section: Resultsmentioning

confidence: 95%

“…No one precordial lead detected all 27 cases, but leads V, and V3 were most sensitive, detecting 24 (89%) and 22 (8 1%) of 27, respectively. STsegment elevation .…”

Section: Resultsmentioning

confidence: 96%

mentioning

confidence: 99%

See 1 more Smart Citation

Clinical and angiographic correlates of exercise-induced ST-segment elevation. Increased detection with multiple ECG leads.

Waters¹,

Chaitman²,

Bourassa³

et al. 1980

Circulation

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“…Exercise-induced coronary artery spasm has been reported in patients with VA [9][10][11][12][13][14][15][16][17] and it can be easily and reliably detected by Tl-SPECT. 10,11,[15][16][17] Furthermore, Tl-SPECT has several advantages over exercise tests because it can detect silent myocardial ischemia, 4 the ischemic region of the spastic coronary artery, and the occurrence of multivessel coronary spasm.…”

Section: Tl-spectmentioning

confidence: 99%

Prognostic Value of I-123 Metaiodobenzylguanidine Imaging in Vasospastic Angina Without Significant Coronary Stenosis

Sakata

Iida

Kudo

et al. 2005

Circ J

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“…Coronary artery spasm is a major cause of variant angina pectoris with normal coronary arteries (Hillis and Braunwald, 1978), and also occurs in certain patients during exercise (Waters et al, 1979). Coronary spasm is unlikely in our patients since they had persistent predictable effort-induced angina pectoris and not variant angina, with ST-segment depression on effort and not ST elevation.…”

Section: Discussionmentioning

confidence: 78%

Verapamil in effort‐induced angina pectoris in patients with normal coronary arteries

Hasin¹,

Rod²,

Lewis³

et al. 1982

Clinical Cardiology

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Summary: Two patients with classical effort‐induced angina pectoris associated with abnormal ST‐segment depression on graded exercise testing and normal coronary arteriograms are described. Both patients deteriorated during treatment with propranolol, and became asymptomatic during treatment with verapamil with normal graded exercise tests. Verapamil may thus improve an inadequate vasodilatatory response of the coronary vascular bed to effort.

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Coronary artery spasm during exercise in patients with variant angina.

Cited by 112 publications

References 21 publications

Clinical and angiographic correlates of exercise-induced ST-segment elevation. Increased detection with multiple ECG leads.

Clinical and angiographic correlates of exercise-induced ST-segment elevation. Increased detection with multiple ECG leads.

Prognostic Value of I-123 Metaiodobenzylguanidine Imaging in Vasospastic Angina Without Significant Coronary Stenosis

Verapamil in effort‐induced angina pectoris in patients with normal coronary arteries

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