Induction of coronary artery spasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm.

Abstract

We injected acetylcholine (ACh), the neurotransmitter of the parasympathetic nervous system, into the coronary arteries of 28 patients with variant angina. Injection of 10 to 80 gg ACh into the coronary artery responsible for the attack induced spasm together with chest pain and ST segment elevation or depression on the electrocardiogram in 30 of the 32 arteries of 25 of the 27 patients. The injection of 20 to 100 gg ACh into the coronary artery not responsible for the attack in 18 patients resulted in various degrees of constriction in most of them, but no spasm in any of them. After intravenous injection of 1.0 to 1.5 mg atropine sulfate, the injection of ACh into the coronary artery responsible for the attack did not induce spasm or attack in any of the nine coronary arteries injected in eight patients. We conclude that the intracoronary injection of ACh induces coronary spasm and attack in patients with variant angina and that the activity of the parasympathetic nervous system may play a role in the pathogenesis of coronary spasm. We also conclude that the intracoronary injection of ACh is a useful test for provocation of coronary spasm. Circulation 74, No. 5, 955-963, 1986. IT IS NOW widely accepted that spasm of an epicardial coronary artery (coronary spasm) plays an important role in the pathogenesis, not only of variant angina, but also of other forms of resting angina, some types of exertional angina, and types of acute myocardial infarction. quently Endo et al.'0 confirmed our results. On the basis of this fact and the fact that the activity of the parasympathetic nervous system is enhanced at rest and is suppressed by physical activity," we postulated that the activity of parasympathetic nervous system might be related to the pathogenesis of variant angina or coronary spasm.7 It has been shown that stimulation of the parasympathetic (vagus) nerve or intracoronary injection of ACh causes coronary vasodilatation, as demonstrated by an increase in coronary blood flow in dogs,'2-'5 and that ACh dilates isolated epicardial coronary arteries in dogs'6 and monkeys. 17 In humans subcutaneous injection of methacholine causes profound dilatation of systemic vasculature, resulting in a transient fall in blood pressure and compensatory tachycardia due to reflex sympathetic discharge.7 We therefore speculated that coronary spasm might be induced by sympathetic discharge by way of a-adrenergic stimulation.7 Recently, however, reports have appeared that show that ACh contracts strips of human coronary arteries obtained from hearts of transplant recipients'8 or cadav-955

Increased plasma thioredoxin in patients with acute myocardial infarction

“…The SEA group consisted of 30 patients (20 men, 10 women; mean age 68 ± 9 years) who had typical exertional angina, ≥ 90% narrowing of the major coronary arteries, and no coronary spasm induced by acetylcholine. 5 The CPS group consisted of 30 patients (18 men, 12 women; mean age 63 ± 8 years) who had no significant coronary artery stenosis (< 25% of luminal diameter), and no coronary spasm was demonstrated by the intracoronary injection of acetylcholine. 5 …”

“…5 The CPS group consisted of 30 patients (18 men, 12 women; mean age 63 ± 8 years) who had no significant coronary artery stenosis (< 25% of luminal diameter), and no coronary spasm was demonstrated by the intracoronary injection of acetylcholine. 5 …”

Coronary Spastic Angina in Patients With Connective Tissue Disease

“…During coronary arteriography, coronary spasm (total or subtotal occlusion) was demonstrated angiographically during the anginal attack of chest pain, with ST-segment changes during intracoronary infusion of acetylcholine, as previously reported. 12 Acetylcholine, 20-100 mg, was injected into the left and right coronary arteries separately in all patients. The sensitivity and specificity of this method for provoking coronary spasm have been validated by Okumura et al 13 The stable exertional angina group comprised 12 patients (4 men, 8 women; mean age 62±14 years) who had typical exertional chest discomfort associated with horizontal or down-sloping ST segment depression >1.0 mm on an exercise test, ≥90% narrowing of the major coronary arteries, and no acetylcholine-induced coronary spasm.…”

Spasm Provocation Tests Performed under Medical Therapy: A New Approach for Treating Patients with Refractory Coronary Spastic Angina on Emergency Admission

“…Acetylcholine (ACh) (1)(2)(3)(4) and ergonovine (ER) (5-7) are often employed as a spasm provocation test as a means of invasively diagnosing patients with coronary spastic angina (CSA). After definitively confirming the presence of positive coronary spasms, vasoactive drugs, such as long-acting calcium-channel antagonists, nitrates and nicorandils, are administered.…”