Refractory ergonovine-induced coronary vasospasm: Importance of intracoronary nitroglycerin

Buxton, Alfred E.; Goldberg, Sheldon; Hirshfeld, John W.; Wilson, John R.; Mann, Tift; Williams, David O.; Overlie, P; Oliva, Philip B.

doi:10.1016/0002-9149(80)90080-6

Cited by 253 publications

(64 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ergonovine maleate administration is not without potential severe complications, as suggested by our case 4. Buxton et al 18 reported five such cases with three subsequent deaths. Heupler proposed several guide lines to limit the risk of complication."'…”

mentioning

confidence: 99%

Spasm of a normal or minimally narrowed coronary artery in the presence of severe fixed stenoses of the remaining vessels: clinical and angiographic observations.

Mercurio¹,

Kronzon²,

Winer³

1982

Circulation

View full text Add to dashboard Cite

PATIENTS with stable angina occasionally experience symptomatic exacerbation. Their anginal pain occurs more frequently and can also appear at rest. This may represent worsening coronary artery disease, and if the angina is unresponsive to medical therapy, coronary angiography is considered. If severe, operable lesions are found, coronary bypass surgery is then considered,We present four patients in whom this sequence occurred. However, most of their symptoms were apparently due to spasm of a normal or minimally diseased coronary artery. In our laboratory, coronary artery spasm was induced with ergonovine maleate using the following protocol: 0.05-mg doses are administered intravenously at 3-minute intervals until either chest pain or electrocardiographic abnormalities are noted or a total dose of 0.2 mg is given. Failure to identify the etiologic role of the coronary spasm would have led to inappropriate clinical decisions.

show abstract

mentioning

confidence: 99%

Spasm of a normal or minimally narrowed coronary artery in the presence of severe fixed stenoses of the remaining vessels: clinical and angiographic observations.

Mercurio¹,

Kronzon²,

Winer³

1982

Circulation

View full text Add to dashboard Cite

show abstract

“…Although serious complications of invasive spasm provocation tests, such as ventricular fibrillation, ventricular tachycardia, shock, hypotension and bradycardia, have been reported (20)(21)(22), invasive spasm provocation tests are safer than non-invasive spasm provocation tests. In the cardiac catheterization laboratory, it is possible to manage refractory spasms via the intracoronary injection of nitrates in addition to various interventions.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

View full text Add to dashboard Cite

Objective There are no objective methods for evaluating the severity of vasospasms in patients with refractory coronary spastic angina (R-CSA) under adequate medical therapy. We examined whether spasm provocation tests performed under adequate medication are useful for evaluating the severity of disease in R-CSA patients on emergency admission. Methods and ResultsWe performed spasm provocation tests before and after the administration of medical therapy in eight R-CSA patients, including one ventricular fibrillation survivor (VF-S) and seven patients with unstable angina (UAP) on emergency readmission. We also performed these tests only after medical therapy on urgent admission in four R-CSA patients, including two patients with UAP, one patient with VF-S and one patient with acute coronary syndrome. All 12 R-CSA patients had been medicated with ! 2 vasodilator drugs. Positive coronary spasms were defined as >99% transient narrowing. The coronary artery spasms disappeared in three patients under medication, and mitigation of vasospasticity was observed in three patients. In these six cases we continued the same medications. Meanwhile in two patients, we recommended a consultation for psychosomatic medicine. In contrast, the remaining six R-CSA patients exhibited higher levels of vasospasticity, irrespective of the administration of aggressive medical therapy, in which the doses of vasoactive drugs were increased in order to suppress coronary artery spasms. Conclusion In some R-CSA patients on emergency admission, performing spasm provocation tests under medical therapy is useful for determining the subsequent treatment strategy. Therefore, this test may become a new tool in the treatment of R-CSA.

show abstract

“…Ergot provocation has been similarly abrupt (3-5 min after intravenous drug administration) (Curry et al, 1979), while the mechanism is less certain, being independent of intact autonomic innervation (Cipriano et al, 1979) and largely dose-dependent (Cipriano et al, 1979;Goldberg et al, 1979). Questions concerning diagnostic utility (Gerry et al, 1979) and safety (Buxton et al, 1980) prompted avoidance of ergot methodology in this series.…”

Section: Discussionmentioning

confidence: 99%

Methacholine provocation of prinzmetal's variant angina pectoris: A revised perspective

Stang

Kolibash

Bush

et al. 1982

Clinical Cardiology

View full text Add to dashboard Cite

Summary:We report 13 patients with unequivocal Prinzmetal's variant angina pectoris as the entire experience with this syndrome during a 7-year period in a single institution. The clinical diagnosis of this relatively uncommon disorder is emphasized. Five patients were given 10 mg of methacholine subcutaneously. Three demonstrated subsequent delayed appearance of chest pain, ECG change, and coronary vasospasm following early appearance of muscarinic effects. Two Prinzmetal patients had no provocation of variant angina following met hacholine, though they did experience significantly less blood pressure fall in response to muscarinic provocation. Another 23 subjects with incompletely explained chest pain given methacholine had neither ECG change nor spasm. Methacholine provocation of variant angina need not necessarily implicate a parasympathomimetic mechanism for otherwise spontaneous episodes. Rather, provocation would appear to occur via the customary reflex adrenergic response to drug-induced hypotension. Methacholine is probably safe though unreliable as an agent to be used for spasm provocation.

show abstract

Refractory ergonovine-induced coronary vasospasm: Importance of intracoronary nitroglycerin

Cited by 253 publications

References 12 publications

Spasm of a normal or minimally narrowed coronary artery in the presence of severe fixed stenoses of the remaining vessels: clinical and angiographic observations.

Spasm of a normal or minimally narrowed coronary artery in the presence of severe fixed stenoses of the remaining vessels: clinical and angiographic observations.

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

Methacholine provocation of prinzmetal's variant angina pectoris: A revised perspective

Contact Info

Product

Resources

About