Ergonovine maleate provocative test for coronary arterial spasm

Summary:The relationship between inverted U wave in leads V5 and I1 and the location of myocardial ischemia was studied in 52 positive patients and in 50 negative patients with ergonovine provocation test, Development of a biphasic or negative U wave, or increased negativity of U wave (inverted U wave) was observed in 15 of 17 patients with spasm in only the right coronary artery (RCA), in 6 of 8 with spasm in only the left anterior descending artery (LAD), in 2 of 8 with spasm in only the left circumflex artery (LCx), and in 23 of 24 with spasm in two or more vessels. Of 52 positive patients in the ergonovine provocation test, 46 (88.5%) had inverted U wave. Of these, 17 (32.7%) had inverted U wave without discernible ST deviation. Of 50 negative patients, 2 had inverted U wave. Inverted U wave in lead Vs was frequently seen in patients with spasm of LAD, but this finding was not uncommon in spasm of RCA or LCx. On the other hand, inverted U wave in lead I1 was frequently seen in spasm of RCA and LCx, but not in spasm of LAD. These findings suggest that inverted U wave in lead V5 is not specific for myocardial ischemia due to spasm of LAD and that inverted U wave in lead I1 is specific for spasm of RCA and LCx.

Section: Discussionmentioning

confidence: 99%

Inverted U wave in ergonovine‐induced vasospastic angina

Yano

Hiasa

Aihara

et al. 1987

“…In order to define the role of coronary spasm in angina at rest, an attempt was made to induce anginal attacks with ergonovine maleate in the remaining 30 patients (Heupler et at .. 1978;Specchia et al .. 1976Specchia et al .. , 1978.…”

Section: Methodsmentioning

confidence: 99%

Coronary arterial spasm in angina at rest associated with transient ST‐segment changes

Servi

Specchia

et al. 1980

Summary: In order to clarify the role of coronary arterial spasm in the pathogenesis of angina at rest, coronary arteriography was performed during spontaneous chest pain or following intravenous administration of ergonovine maleate in 40 patients with angina at rest. Coronary vasospasm was demonstrated in 23 patients with ST-segment elevation during chest pain (group I), in 7 with ST-segment depression (group II), and in 4 with both ST-segment depression and elevation (group III).Complete spastic occlusion of the proximal or of the midportion of the left anterior descending artery was always associated with ST-segment elevation in anterior leads. In contrast, transient ST -segment depression in anterior leads was associated with diffuse narrowing of the left anterior descending artery with slow progression of the contrast medium, or complete occlusion of a small branch or of the distal segment of the left anterior descending artery. ST -Segment elevation in inferior leads was associated with complete spastic occlusion or with significant spastic narrowing of the right coronary artery or of the circumflex artery.We conclude that coronary spasm can be demonstrated in a selected cohort of patients with angina at rest associated with transient ST-segment changes. In some cases the site and the severity of the spasm may produce varying degrees of ischemia, thus determining the direction of the ST -segment shift.

“…It can be administered safely via an intravenous or an intracoronary route to provoke coronary artery spasm. [2][3][4][5] We report an unusual case, in whom intracoronary administration of ergonovine produced a biphasic response: an initial dilation with low dose and a subsequent constriction with high dose, of the large epicardial coronary artery.…”

Section: Introductionmentioning

confidence: 99%

Biphasic response of coronary arterial diameter to intracoronary ergonovine

Mohri

Okamatsu

Nakamura

1988

Summary: This report presents a case of paradoxical cornnary arterial dilation induced by intracoronary ergonovine. When compared with the control angiogram, the right coronary artery obviously dilated with selective, intracoronary administration of cumulative doses of 5 pg and 15 p g ergonovine without concomitant hemodynamic changes. Additional intracoronary infusion of 35 p g ergonovine into the right coronary artery inversely increased vascular tone of the vessel associated with a focal hyperconstriction. Such a biphasic response of arterial diameter to intracoronary ergonovine was also observed in the left coronary artery, but the degree of dilation was much smaller.