Dynamic variations in resistance of coronary arterial narrowings in angina pectoris at rest

• Published in: The American journal of cardiology Vol. 59; no. 1; pp. 66 - 70
• Main Authors: Ganz, Peter, Abben, Richard P., Barry, William H.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 1987; Elsevier
• Subjects: Angina Pectoris - diagnostic imaging; Angina Pectoris - drug therapy; Angina Pectoris - physiopathology; Angiography; Arteries; Biological and medical sciences; Cardiology. Vascular system; Coronary Angiography; Coronary heart disease; Coronary Vessels - physiopathology; Electrocardiography; Heart; Hemodynamics - drug effects; Humans; Medical sciences; Nitroglycerin - therapeutic use; Rest; Vascular Resistance; Human; Resistance; Coronary artery; Stenosis; Cardiovascular disease; Hemodynamics; Angina pectoris; Coronary vessel; Coronary heart disease
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(87)80071-1

The coronary hemodynamic events in 4 patients with frequent episodes of spontaneous rest angina were investigated. The basal coronary transstenotic pressure gradients showed more severe stenosis than that seen on coronary arteriography, suggesting that angiography in this setting may underestimate the true extent of coronary atherosclerosis. Episodes of angina were triggered by marked, sudden increases in the transstenotic coronary pressure gradient and a decrease in coronary blood flow without alterations in systemic arterial pressure or heart rate. These changes in coronary hemodynamics were promptly reversed by the intracoronary administration of nitroglycerin. No such spontaneous variations in transstenotic coronary pressure gradients were observed in 37 patients with a history of classic exertional angina but no rest angina. These unique data represent direct hemodynamic evidence that an increase in resistance at the site of a coronary stenosis, most likely the result of an increase in arterial tone, can be a cause of transient myocardial ischemia in patients with angina at rest.