SUMMARY 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 perfornmed on three consecutive days, and 28 of the 34
Methods Patient PopulationThe following criteria were required for the diagnosis of variant angina: burning or squeezing retrosternal chest pain at rest; relief of pain by sublingual nitroglycerin in less than 5 minutes; ST-segment elevation of at least 0.2 mV not present on the baseline ECG but documented during pain and disappearing after relief of pain; and no evidence of myocardial infarction.The 34 study patients met these criteria, had recently undergone coronary arteriography (table 1) and were hospitalized in the coronary care unit with continuous electrocardiographic monitoring. Except for sublingual nitroglycerin given to relieve angina, the patients were receiving no cardiovascular drugs. Their mean age was 50.5 years (range 32-70 years); 30 were men and four were women. Three had multivessel disease, 16 had a one-vessel stenosis >70% and 15 had no lesions -70%, including three whose coronary arteries appeared normal. Left ventriculography was normal in 29 cases; a hypokinetic or akinetic zone was present in patients 6, 14, 28, 32 and 33. The baseline ECG was normal in 25 cases; patient 1 had minimal ST depression in leads V4 to V6, and eight patients had abnormally negative T waves (patients 5, 8, 11, 15, 25, 28, 32 and 33).The site of ST elevation was the anterior ECG leads in 19 and the inferior leads in 15. The frequency of anginal attacks for each patient during the study period is listed in table 1. Asymptomatic episodes of transient ST elevation occurred in eight patients, all of whom were also experiencing frequent symptomatic attacks. In addition, nearly all patients had brief angina episodes that disappeared spontaneously or with nitroglycerin before electrocardiographic abnormalities could be detected. Both types of attacks were counted.