Skip to main content

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 217))

  • 95 Accesses

Abstract

In 1959 Prinzmetal et al1 described a variant form of angina, which, in contrast with the more common effort angina, occurs exclusively or predominantly at rest, often without apparent cause, and is characterized by elevation, rather than depression, of the ST-segment on the electrocardiogram (ECG). The authors hypothesized that this form of angina was caused by an increase in “tonus” at the site of a subcritical coronary stenosis.1 Indeed, no increase in the hemodynamic determinants of myocardial oxygen consumption can be detected by continuous hemodynamic monitoring before the appearance of ischemia.2,3

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 299.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 379.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Prinzmetal M, et al. Angina pectoris. I. The variant form of angina pectoris. Am J Med 1959: 27: 375.

    Article  PubMed  CAS  Google Scholar 

  2. Guazzi M, et al. Left ventricular performance and related haemodynamic changes in Prinzmental’s variant angina pectoris. Br Heart J 1971: 33: 84.

    Article  PubMed  CAS  Google Scholar 

  3. Maseri A, et al. Coronary spasm as a cause of acute myocardial ischemia in man. Chest 1975: 68: 625–33.

    Article  Google Scholar 

  4. Oliva PB, et al. Coronary arterial spasm in Prinzmetal angina: documentation by coronary arteriography. N Engl J Med 1973: 288: 745–50.

    Article  PubMed  CAS  Google Scholar 

  5. Cheng TO, et al. Variant angina of Prinzmetal with normal coroanry arteriograms. A variant of the variant. Circulation 1973: 47: 476.

    Article  PubMed  CAS  Google Scholar 

  6. Maseri A, et al. “Variant” angina: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Am J Cardiol 1978: 42: 1019.

    Article  PubMed  CAS  Google Scholar 

  7. Maseri A, et al. Transient transmural reduction of myocardial blood flow, demonstrated by thallium-201 scintigraphy., a cause of variant angina. Circulation 54: 280.

    Google Scholar 

  8. Fujii H, et al. Hyperventilation-induced simultaneous multivessel coronary spasm in patients with variant angina: an echocardiography and arteriographic study. J Am Coll Cardiol 1988: 12: 1184.

    Article  PubMed  CAS  Google Scholar 

  9. Hoshio A, et al. Significance of coronary artery tone in patients with vasospastic angina. J Am Coll Cardiol 1989: 14: 604.

    Article  PubMed  CAS  Google Scholar 

  10. Kaski JC, et al. Comparison of epicardial coronary artery tone and reactivity in Prinzmetal’s variant angina and chronic stable angina pectoris. J Am Coll Cardiol 1991: 17: 1058.

    Article  PubMed  CAS  Google Scholar 

  11. Kaski JC, et al. Spontaneous coronary artery spasm in variant angina results from a local hyperreactivity to a generalized constrictor stimulus. J Am Coll cardiol 1989: 14: 1456.

    Article  PubMed  CAS  Google Scholar 

  12. Yasue H, et al. Prinzmetal’s variant form of angina as a manifestation of alpha-adrenergic receptor mediated coroanry artery spasm: documentation by coronary arteriography. Am Heart J 1976: 91: 148.

    Article  PubMed  CAS  Google Scholar 

  13. Crea F, et al. Dopamine-induced coronary spasm. Circulation 1985: 72: 111–415

    Google Scholar 

  14. Yasue H, et al. 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. Circulation 74: 955–63.

    Google Scholar 

  15. Heupler F, et al. Ergonovine maleate provocative test for coronary arterial spasm. Am J Cardiol 1978: 41: 631.

    Article  PubMed  Google Scholar 

  16. McFadden EP, et al. Effect of intracoronary serotonin on coronary vessels in patients with stable angina and patients with variant angina. N Engl J Med 1992: 324: 648.

    Article  Google Scholar 

  17. Ginsburg R, et al. Histamine provocation of clinical coronary artery spasm: implications concerning the pathogenesis of variant angina pectoris. Am Heart J 102: 819.

    Google Scholar 

  18. Chierchia S, et al. Alpha-adrenergic receptors and coronary spasm: an elusive link. Circulation 1984: 8.

    Google Scholar 

  19. Chierchia S, et al. failure of thromboxane A2 blockade to prevent attacks of vasospastic angina. Circulation 1982: 66: 702.

    Article  PubMed  CAS  Google Scholar 

  20. De caterina R, et al. A double-blind, placebo-controlled study of ketanserin in patients with Prinzmetal’s angina. Evidence against a role for serotonin in the genesis of coronary vasospasm. Circulation 1984: 69: 889.

    Article  PubMed  Google Scholar 

  21. Vanhoutte PM, Shimokawa H. Endothelium-derived relaxing factor and coronary vasospasm. Circulation 1989: 80: 1.

    Article  PubMed  CAS  Google Scholar 

  22. Mc Alpin RN. Contribution of dynamic vascular wall thickening to luminal narrowing during coronary arterial constriction. Circulation 1980: 71: 296.

    Article  Google Scholar 

  23. Roberts WC, et al. Sudden death in Prinzmental’s angina with coronary spasm documented by angiography, nalysis of three necropsy patients. Am J Cardiol 1982: 50: 203.

    Article  PubMed  CAS  Google Scholar 

  24. Maseri A, et al. Coronary artery spasm and vasoconstriction. The case for a distinction. Circulation 1990: 81: 1983.

    Article  PubMed  CAS  Google Scholar 

  25. Specchia G, et al. Coronary arterial spasm as a cause of exercise-induced ST-segment elevation in patients with variant angina. Circulation 1979: 59: 948.

    Article  PubMed  CAS  Google Scholar 

  26. Raizner AE, et al. Provocation of coronary artery spasm by the cold pressor test. Hemodynamic arteriographic and quantitative angiographic observations, circulation 1980, 62: 925.

    CAS  Google Scholar 

  27. Winniford MD, et al. Alpha-adrenergic blockade for variant angina: a long-term double-blind, randomized trial. Circulation 1983: 67: 1185.

    Article  PubMed  CAS  Google Scholar 

  28. Tzivoni D, et al. Prazosin therapy for refractory variant angina. Am Heart J 1983: 105: 262–6.

    Article  PubMed  CAS  Google Scholar 

  29. Robertson RM, et al. Exacerbation of ischemia in vasotonic angina pectoris by propranolol. Am J Cardiol 47: 463.

    Google Scholar 

  30. Robertson RM, et al. Arterial and coronary sinus catecholamines in the course of spontaneous coronary artery spasm. Am Heart J 1983: 105: 901.

    Article  PubMed  CAS  Google Scholar 

  31. Waters D, Miller D. Circadian variation in variant angina. Am J Cardiol 1984: 54: 61.

    Article  PubMed  CAS  Google Scholar 

  32. Lanza GA, et al. Role of Autonomic Tone in the Induction of Coronary Spasm in Patients With Variant Angina With or Without Obstructive Coronary Stenoses. J Am Coll Cardiol 1995: 25 (Abstr Suppl.): 195A.

    Google Scholar 

  33. Tada M, et al. Elevation of thromboxane B2 levels in patients with classic and variant angina pectoris. Circulation 1981: 64: 1107.

    Article  PubMed  CAS  Google Scholar 

  34. Robertson RM, et al. Thromboxane A2 in vasotonic angina. N Engl J Med 1981: 304: 998.

    Article  PubMed  CAS  Google Scholar 

  35. Chierchia S, et al. Increased fibrinopeptide A during anginal attacks in patients with variant angina. J Am Coll Cardiol 1989: 14: 589.

    Article  Google Scholar 

  36. Irie T, et al. Increased fibrinopeptide A during anginal attacks in patients with variant angina. J Am Coll Cardiol 1989: 14: 589.

    Article  PubMed  CAS  Google Scholar 

  37. Toyo-Oka T, et al. Increased plasma level of endothelin-1 and coronary spasm induction in patients with vasospastic angina pectoris. Circulation 1991: 83: 476.

    Article  PubMed  CAS  Google Scholar 

  38. Larkin SW, et al. Intracoronary endothelium induces myocardial ischemia by small vessel constriction in the dog. Am J Cardiol 1989: 64: 956.

    Article  PubMed  CAS  Google Scholar 

  39. Bertrand M, et al. Frequency of provoked coronary arterial spasm in 1089 consecutive patients undergoing coronary angiography. Circulation 1982: 65: 1299.

    Article  PubMed  CAS  Google Scholar 

  40. Fernandez D, et al. Alcohol-induced Prinzmetal variant angina. Am J Cardiol 1973: 32: 238.

    Article  PubMed  CAS  Google Scholar 

  41. Shimokawa H, et al. Cimetidine induces coronary artery spasm in patients with vasospastic angina. Canad J Cardiol 1987: 3: 177.

    CAS  Google Scholar 

  42. Miwa K, et al. Exercise-induced angina provoked by aspirin administration in patients with variant angina. Am J Cardiol 1981: 47: 1210.

    Article  PubMed  CAS  Google Scholar 

  43. Scholl JM, et al. Comparison of risk factors in vasospastic angina without significant fixed coronary narrowing to signigicant fixed coronary narrowing and no vasospastic angina. Am J Cardiol 1986: 57: 199.

    Article  PubMed  CAS  Google Scholar 

  44. Caralis DG, et al. Smoking is a risk factor for coronary spasm in young women. Circulation 1992: 85: 905.

    Article  PubMed  CAS  Google Scholar 

  45. Miller D, et al. Is variant angina the coronary manifestation of a generalized vasospastic disorder? N Engl J Med 1981: 304: 763.

    Article  PubMed  CAS  Google Scholar 

  46. Kerin NZ, et al. Arrhythmias in variant angina pectoris. Relationships of arrhythmias to ST segment elevation and R wave changes. Circulation 1979: 60: 1343.

    Article  PubMed  CAS  Google Scholar 

  47. Maseri A, et al. Role of coronary arterial spasm in sudden coronary ischemic death. Ann NY Acad Sci 1982: 382: 204.

    Article  PubMed  CAS  Google Scholar 

  48. Rozanski J, et al. Non-mechanical ST segment alternance in Prinzmetal’s angina. Am Int Med 1978: 89: 76.

    CAS  Google Scholar 

  49. Meller J, et al. Transient Q waves in Prinzmetal’s angina. Am J Cardiol 1975: 35: 691.

    Article  PubMed  CAS  Google Scholar 

  50. Buxton AE, et al. Refractory ergovine induced coronary vasospasm: importance of intracoronary nitroglycerin. Am J Cardiol 1980: 46: 329.

    Article  PubMed  CAS  Google Scholar 

  51. Magarian GJ, Mazur DJ. The Hyperventilation challenge test. Chest 1991: 99: 199.

    Article  PubMed  CAS  Google Scholar 

  52. Yasue H, et al. Coronary arterial spasm and Prinzmetal’s variant angina induced by hyperventilation and Tris-buffer infusion. Circulation 1978: 58: 56.

    Article  PubMed  CAS  Google Scholar 

  53. Phibbs B, et al. Frequency of normal coronary arteriograms in three academic mediacal centers and one community hospital. Am J Cardiol 1988: 62: 472–74

    Article  PubMed  CAS  Google Scholar 

  54. Maseri A, et al. Mechanisms of angina pectoris in syndrome X. J Am Coll Cardiol 1991: 17: 499.

    Article  PubMed  CAS  Google Scholar 

  55. Opherk D, et al. Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation 1981: 63: 817.

    Article  PubMed  CAS  Google Scholar 

  56. Cannon RO, Epstein SE. “Microvascular angina” as a cause of chest pain with angiograph-ically normal coronary arteries. Am J Cardiol 1988: 61: 1338.

    Article  PubMed  Google Scholar 

  57. Egashira K, et al. Evidence of impaired endothelium-dependent coronary vasolidation in patients with angina pectoris and normal coronary angiograms. N Engl J Med 1993: 328: 1659.

    Article  PubMed  CAS  Google Scholar 

  58. Epstein SE, Cannon RO. Site of increased resistance to coronary flow in patients with angina pectoris and normal epicardial coronary arteries. J Am Coll Cardiol 1986: 8: 459.

    Article  PubMed  CAS  Google Scholar 

  59. Chauhan A, et al. Effect of hyperventilation and mental stress on coronary blood flow in syndrome X. Br Heart J 1993: 69: 516.

    Article  PubMed  CAS  Google Scholar 

  60. Kaski JC, et al. Transient myocardial ischemia during daily life in patients with syndrome X. Am J Cardiol 1986: 58: 1242.

    Article  PubMed  CAS  Google Scholar 

  61. Lanza GA, Stazi F. Circadian variation of ischemic threshold in syndrome X. Am J Cardiol 1995: 683.

    Google Scholar 

  62. Vrints CJM, et al. Impaired endothelium-dependent cholinergic coronary vasolidation in patients with angina and normal coronary arteries. J Am Coll Cardiol 1992: 19: 21.

    Article  PubMed  CAS  Google Scholar 

  63. Bugiardini R, Pozzati A. Vasotonic angina: a spectrum of ischemic syndromes involving functional abnormalities of the epicardial and microvascular coronary circulation. J Am Coll Cardiol 1993: 22: 417.

    Article  PubMed  CAS  Google Scholar 

  64. Kaski JC, Rosano GMC. Cardiac syndrome X: clinical characteristics and left ventricular function. Long-term follow-up study. J Am Coll Cardiol 1995: 25: 807.

    Article  PubMed  CAS  Google Scholar 

  65. Severi S, et al. Long-term prognosis of “variant” angina with medical treatment. Am J Cardiol 1980: 46: 226.

    Article  PubMed  CAS  Google Scholar 

  66. Waters DD, et al. Factors influencing the long-term prognosis of treated patients with variant angina. Circulation 1983: 68: 258.

    Article  PubMed  CAS  Google Scholar 

  67. MacAlpin R. Treatment of vasospastic angina. In: Golgberg S (ed). Coronary Artery Spasm and Thrombosis. Philadelphia, F A Davis, 1983, p.129.

    Google Scholar 

  68. Maseri A, et al. Rational approach to the medical therapy of angina pectoris: the role of calcium antagonists. Prog Cardiovasc Dis 1983: 15: 269.

    Article  Google Scholar 

  69. Yasue H, et al. Long-term prognosis for patients with variant angina and influential factors. Circulation 1988: 78: 1.

    Article  PubMed  CAS  Google Scholar 

  70. Previtali M, et al. Treatment of angina at rest with nifedipine: a short-term controlled study. Am J Cardiol 1980: 45: 875.

    Article  Google Scholar 

  71. Johnson SM, et al. A controlled trial of verapamil for Prinzmetal’s variant angina. N Engl J Med 1981: 304: 862–66

    Article  PubMed  CAS  Google Scholar 

  72. Feldman RL, et al. Short-and long-term responses to diltiazem in patients with variant angina. Am J cardiol 1982: 49: 554.

    Article  PubMed  CAS  Google Scholar 

  73. Hill JA, et al. Randomized double-blind comparison of nifedipine and isosorbide dinitrate in patients with coronary arterial spasm. Am J Cardiol 1982: 49: 431.

    Article  PubMed  CAS  Google Scholar 

  74. Bertrand ME, et al. Complete denervation of the heart (autotransplantation) for treatment of severe, refractory coronary spasm. Am J Cardiol 1981: 47: 1375.

    Article  PubMed  CAS  Google Scholar 

  75. Clark DA, et al. Coronary artery spasm: medical management, surgical denervation, and autotransplantation. J Thorac Cardiovasc Surg 1977: 73: 332.

    PubMed  CAS  Google Scholar 

  76. Lefroy DC, et al. Medical treatment of refractory coronary artery spasm. Cor Art Dis 1992: 3: 745.

    Google Scholar 

  77. Frenneaux M, et al. Refractory variant amgina relieved by guanethidine and clonidine. Am J Cardiol 1988: 62: 832.

    Article  PubMed  CAS  Google Scholar 

  78. Bertrand ME, et al. Percutaneous transluminal coronary angioplasty in patients with spasm superimposed on atherosclerotic narrowing. Br Heart J 1987: 58: 469.

    Article  PubMed  CAS  Google Scholar 

  79. Bertrand ME, et al. Surgical treatment of variant angina: use of plexectomy with aortocoronary bypass. Circulation 1980: 61: 877.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer Science+Business Media New York

About this chapter

Cite this chapter

Maseri, A., Lanza, G.A. (1999). Vasospastic Angina. In: Contemporary Concepts in Cardiology. Developments in Cardiovascular Medicine, vol 217. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5007-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-5007-5_6

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-7274-5

  • Online ISBN: 978-1-4615-5007-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics