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Circulation, Vol 61, 759-768, Copyright © 1980 by American Heart Association
S Chierchia, C Brunelli, I Simonetti, M Lazzari and A Maseri
To investigate the events that lead to acute myocardial ischemia we
monitored continuously the ECG, the left ventricular (four patients) or
aortic (two patients) pressure and the great cardiac vein oxygen saturation
(CSO2S) by a fiberoptic catheter in six patients with frequent anginal
attacks at rest. We recorded 137 transient ischemic episodes (10 with chest
pain) characterized by ST-segment elevation in 28 episodes, depression in
three episodes and by pseudonormalization of previously inverted or flat T
waves in 106 episodes. The onset of electrocardiographic and hemodynamic
changes was preceded by a large drop in CSO2S in all 135 episodes with ST-T
changes in the anterior leads but not in two episodes with ST elevation on
inferior leads. The fall in CSO2S, consistently followed by signs of left
ventricular function impairment and never preceded by any detectable
increase in the hemodynamic determinants of myocardial oxygen consumption,
probably reflects a reduction in regional perfusion. Thus, a reduction in
coronary flow may cause transient ischemia in patients with angina at rest.
These episodes may be associated with variable, often minor
electrocardiographic changes and occasionally with anginal pain.
ARTICLES
Sequence of events in angina at rest: primary reduction in coronary flow
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