Selective coronary angiography in primary myocardial disease.

To clarify the pathogenesis of chest pain in patients with cardiomyopathies, we compared coronary blood flow and other indicators of ischemia at rest and during pacing-induced tachycardia in nine patients with cardiomyopathy (four hypertrophic and five congestive) and in five control subjects. Coronary blood flow was reduced at rest and during pacing in cardiomyopathy patients compared with controls. In patients with hypertrophic cardiomyopathy, pacing induced chest pain in all, increased ST-segment depression in three patients and increased coronary venous lactate concentration. With pacing, two of five patients with congestive cardiomyopathy had chest discomfort and three had increased ST-segment depression, but coronary venous lactate concentration did not change significantly. In both groups of cardiomyopathies, the ratio of the systolic and diastolic pressure-time indexes tended to decrease more than in controls during pacing. Thus, myocardial perfusion is decreased in patients with cardiomyopathy, both at rest and during pacing. The changes detected during pacing point to subendocardial ischemia as the likely mechanism for angina in hypertrophic and possibly also in congestive cardiomyopathy.

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“…4 Heart Institute. Four patients had hypertrophic obstructive cardiomyopathy and five congestive cardiomyopathy.…”

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Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries.

Pasternac¹,

Noble²,

Streulens³

et al. 1982

Circulation

222

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“…T h e details of the methodology a n d techniques have been described. [26][27][28] Left ventriculography was performed in the right anterior oblique view. T h e left ventriculogram was analyzed a n d the degree of ventricular asynergy or abnormal movement was estimated.20 Ventricular volumes were measured b y t h e uniplane technique of Greene et al 30 Selective coronary arteriography was performed b y the Judkins method in different oblique positions, using a 35 m m cine technique with a 6-inch image intensifier.31-34 Coronary arteriograms were analyzed for normality, site, degree a n d extent of arterial stenosis or obstruction, the presence of additional nonobstructive atheromatous plaques a n d t h e pat- cent or more) of the right coronary artery: this was located in the middle third of the main artery in four and in the proximal third in one ( Fig 1 ) .…”

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confidence: 99%

Isolated Obstruction of the Right Coronary Artery

Bakst

Lewis

Mitha

et al. 1974

Chest

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“…Esses resultados são consistentes com os de outros estudos que demonstraram aumento do calibre coronário e do fluxo sanguíneo miocárdico em corações com aumento da massa miocárdica e dilatação ventricular decorrente de diversas cardiopatias 13 .…”

Section: Discussionunclassified

“…As bordas do vaso são detectadas semi-automaticamente (porção superior da figura) e o cálculo dos diâmetros do vaso naquele segmento arterial selecionado é exposto na porção inferior da ilustração. O aumento do diâmetro médio a partir da condição basal foi de 2,98 mm para 3,35 mm após dinitrato de isossorbida (aumento porcentual de calibre de 12% da literatura de que a distribuição coronariana se correlaciona com a massa ventricular subtendida 14 , e de que a dilatação das artérias coronárias também pode ser evidenciada em outras formas de miocardiopatia dilatada que não a chagásica 13 .…”

Section: Discussionunclassified

Tônus e diâmetro arterial coronário não se correlacionam com o grau de denervação autonômica em pacientes com cardiopatia chagásica crônica

Simões¹,

Marin²,

Antloga³

et al. 2008

Rev. Bras. Cardiol. Invasiva

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Background: Chronic Chagas Cardiomyopathy (CCC) induces early severe cardiac dysautonomia, potentially causing derangements in the regulation of coronary vasomotion and leading to myocardial ischemia and fibrosis. We assessed the correlation between dysautonomia severity and coronary artery diameter and tonus. Methods: Eighteen patients with CCC (55±9 yrs, 8 males) and 23 normal volunteers (37±11 yrs, 16 males) were investigated. Both groups underwent evaluation of baroreflex sensitivity (BRS) by means of invasive arterial pressure (AP) monitoring and transient increases of AP induced by intravenous phenilephrinefrin injections (50-150µg). Patients with CCC had cardiac catheterization and coronary angiography at baseline and 5 min. after administration of 5mg of isosorbidedinitrate (ISDN). Quantitative coronary analysis was performed off-line for both conditions (baseline and post-ISDN). Baseline coronary artery tonus was calculated by the percent diameter increase after ISDN. LVEF was calculated by Dodge biplane method from contrast ventriculography and 2D-echocardiogram was used for the measurement of LV diastolic diameter and mass. Results: CCC patients showed severe reduction of the BRS (4.1 ± 1.7 ms/mmHg) as compared to controls (15.0 ± 1.5 ms/mmHg), p < 0.001. Mean coronary artery diameter was 2.2 ± 0.3 mm, and was significantly correlated with parameters of LV remodeling: LEFF (p = 0.017, R = 0.554), LVDD (p = 0.0036, R = 0.648) and LV mass (p = 0.022, R = 0.534). No significant correlation occurred between coronary diameter and the BRS (p = 0.457, R = 0.187).

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Selective coronary angiography in primary myocardial disease.

Cited by 11 publications

References 12 publications

Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries.

Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries.

Isolated Obstruction of the Right Coronary Artery

Tônus e diâmetro arterial coronário não se correlacionam com o grau de denervação autonômica em pacientes com cardiopatia chagásica crônica

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