Hemodynamic and myocardial metabolic effects of ergonovine in patients with chest pain.

Curry, R. Charles; Pepine, Carl J.; Sabom, Michael B.; Feldman, Robert L.; Christie, Leonard G.; Varnell, J H; Conti, C. Richard

doi:10.1161/01.cir.58.4.648

Cited by 36 publications

(6 citation statements)

References 21 publications

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“…1 2 However, spontaneous attacks are often difficult to document. For example, in a consecutive series of 162 variant angina patients who underwent coronary arteriography at our institution, only 32 had spontaneous spasm during the study.3 Similarly, coronary spasm occurred spontaneously during arteriography in 17 of the 107 variant angina patients reported by Maseri et al 4 The administration of ergonovine induces coronary spasm5 7 or transient ST elevation3 8 in almost all patients with active variant angina. Exercise testing has been reported to provoke angina and ST elevation in approximately 30% of variant angina patients;9, 10 however, the incidence varies greatly, depending upon the underlying degree of disease activity.…”

mentioning

confidence: 91%

Comparative sensitivity of exercise, cold pressor and ergonovine testing in provoking attacks of variant angina in patients with active disease.

et al. 1983

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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.

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confidence: 91%

Comparative sensitivity of exercise, cold pressor and ergonovine testing in provoking attacks of variant angina in patients with active disease.

et al. 1983

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“…The peak response occurs 2-5 min after administration, although onset of spasm 15-20 min later has been reported. In its classical description, coronary spasm leads to chest pain, ST segment elevation on the electrocardiogram, increased left ventricular end-diastolic pressure, and myocardial lactate release [ 407 ]. In as many as half of patients with vasospastic angina, the response to ergonovine is less intense.…”

Section: Coronary Vasospasmmentioning

confidence: 99%

Coronary Angiography

Wilson

2015

Coronary Artery Disease

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“…Although ergonovine is known to cause large coronary artery constriction in man (11,27), it has been described as having minimal or no effects on the coronary arteries of dogs (5). Based on these previous findings, the canine model would not be a useful model for studying coronary artery spasm caused by ergonovine.…”

Section: Ergonovinementioning

confidence: 99%

“…These results provide conflicting data on the effect of ergonovine on large and small coronary arteries in experimental preparations. However, in human coronary arteries, an ergonovine constrictor effect is well described, and ergonovine is used as a diagnostic agent for detection of coronary spasm (11).…”

Section: Introductionmentioning

confidence: 99%

Effects of angiotensin and ergonovine on large and small coronary arteries in the intact dog

et al. 1985

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Angiotensin (ATN) and ergonovine (ERG) are known to cause vasoconstriction of the coronary bed. However, ATN effects have been described mainly on the coronary resistance vessels, while ERG effects have been described on proximal conductance vessels. Recent studies have shown that proximal and distal coronary arteries are regulated independently. To examine both proximal and distal effects of ATN and ERG on the same heart, we studied 7 intact dogs, anesthetized with Innovar (Fentanyl 0.4 mg, Droperidol 20 mg, in 1 ml) and nitrous oxide, which were subjected to direct left anterior (LAD) coronary infusion of angiotensin (0.1, 0.5 and 5 micrograms/min) and ergonovine (0.5, 5, and 25 micrograms/min). Using a quantitative angiographic technique to measure artery dimensions and microspheres to measure flow, ERG infusion showed significant large artery constriction at all doses (maximum: 38.9 +/- 7.8% area reduction), and a significant decrease in LAD coronary artery flow, while endocardial/epicardial flow ratio remained unchanged. ATN produced a biphasic effect on the large coronary arteries. The lowest dose produced constriction (12.3 +/- 3.7% area reduction), which returned toward control value with the 0.5 micrograms/min dose (6.0 +/- 1.0% area reduction), and the 5 micrograms/min dose (1.5 +/- 9.5% area reduction), and no significant changes were observed in LAD flow with ATN infusion. Endocardial/epicardial ratio was unchanged, but aortic pressure was significantly increased during 0.5 and 5 micrograms/min ATN infusion. Coronary resistance (pressure/flow) increased with both ERG and ATN. ERG and ATN produce large and small coronary artery constriction. The coronary response to ERG in dogs is similar to the human coronary response, even though previous data indicated a minimal constrictor response to ERG in canine coronary arteries.

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Hemodynamic and myocardial metabolic effects of ergonovine in patients with chest pain.

Cited by 36 publications

References 21 publications

Comparative sensitivity of exercise, cold pressor and ergonovine testing in provoking attacks of variant angina in patients with active disease.

Comparative sensitivity of exercise, cold pressor and ergonovine testing in provoking attacks of variant angina in patients with active disease.

Coronary Angiography

Effects of angiotensin and ergonovine on large and small coronary arteries in the intact dog

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