The effects of ergonovine maleate on coronary arterial size.

Abstract

SUMMARY Changes in coronary arterial size due to ergonovine maleate are described and quantitated in 90 patients -18 with typical angina pectoris, 56 with atypical chest pain, nine with variant angina pectoris, and seven heart transplant (allograft) recipients. We observed two angiographic changes in the diameter of coronary arteries: 1) spasm, which was characterized by occlusion or marked (>85%) focal or diffuse vessel narrowing, or 2) relatively mild and diffuse vessel narrowing, which was interpreted as the normal pharmacologic response to the drug. Serial bolus injections of 0.05 mg, 0.10 mg and 0.25 mg of ergonovine maleate produced diffuse narrowing of the diameter of coronary arteries of 10 ± 1.5%, 16 ± 1.4% and 20 ± 1.3% (mean ± SEM), respectively, in the 72 patients with anginal syndromes who did not develop coronary spasm. The degree of coronary arterial narrowing was the same in heart transplant recipients and in patients with normally innervated hearts who did not develop coronary spasm. We believe the normal pharmacologic response to ergonovine maleate was due to a direct vasoconstrictor action of the drug; this action was independent of neural control extrinsic to the heart. CORONARY ARTERIAL SPASM is recognized as a cause of angina pectoris. In attempts to identify patients with this condition, various pharmacologic agents, including methacholine," 2 epinephrine,2 propranolol,2 and ergonovine maleate (EM),3 have been used to provoke coronary vasospasm during coronary arteriography. EM has been shown to induce coronary artery spasm at sites where spontaneous spasm was observed3' 5, 8 and vasospastic coronary artery disease has been demonstrated during coronary angiography by administering this drug. In this study we describe and quantitate the changes in coronary arterial diameter produced by EM when given to patients with various anginal syndromes. In addition, EM was given to heart transplant (allograft) recipients in an attempt to define the mechanism by which this drug affects coronary arterial size. would be given a drug that produced marked coronary artery narrowing which appeared to explain the cause of chest pain in some patients. Patients were told that we expected the results of the study to yield information that would be helpful in their medical treatment. The 90 patients studied included 47 men and 43 women ranging in age from 25-75 years (mean age 48 years). Eighty-three patients were given EM to determine if their anginal syndromes were related to coronary artery spasm. Eighteen of these 83 had typical angina pectoris produced by exercise and relieved by rest or nitrites. Fitly-six patients had chest pain that was not predictably related to stress or relieved by rest or nitrites, and at the time of study we did not know if their pain was cardiac in origin. Nine patients had variant angina pectoris, characterized by nonexertional chest pain that frequently occurred at night and was accompanied by ST-segment elevation. EM was also given to seven clinically stable heart transplant (all...

Histamine-induced coronary spasm in regions of intimal thickening in miniature pigs: roles of serum cholesterol and spontaneous or induced intimal thickening.

“…30 31 In our preliminary studies,'4 changes in diameter in response to ergonovine were not enhanced 30 min after denudation, but they increased significantly at the denuded but not at the contralateral site 3 -6 months after denudation. In addition, 3 The coronary spasm provoked by histamine in five pigs before denudation (group 1), which was of a similar degree in groups 2 and 3, suggests the importance of structural changes in the vessel, rather than serum cholesterol levels or balloon denudation per se, as an immediate cause of vascular hypercontraction. The exponential relationship between the degree of vascular hypercontraction and the thickness of the intima suggests an important role of vascular intima in the altered responsiveness to histamine.…”

Prinzmetal's Angina: Atypical Angiographic Features of Atypical Angina Pectoris

“…' Comments Demonstration of reversible, focal epicardial spasm is the cornerstone upon which the diagnosis of coronary artery spasm now rests. 5,12,34 In this extraordinarily illustrative case, however, angina pectoris and marked elevation in the left ventricular end diastolic pressure occurred in the absence of such changes and in the absence of an increased double product to suggest secondary myocardial ischemia. Several possible explanations for this phenomenon exist.…”

Coronary Angiography

“…Normal patients also exhibit mild, diffuse coronary constriction in The Rentrop semi-quantitative scale for grading collateral blood fl ow to a coronary artery [ 398 ] the epicardial arteries (10-20 % decrease in diameter) [ 410 ]. The response is more pronounced in the distal vessels.…”