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Circulation, Vol 65, 825-830, Copyright © 1982 by American Heart Association

ARTICLES

Spasm of a normal or minimally narrowed coronary artery in the presence of severe fixed stenoses of the remaining vessels: clinical and angiographic observations

P Mercurio, I Kronzon and H Winer

Four patients with medically refractory unstable angina are presented. Each patient had ST-segment abnormalities during some episode of pain. Three patients had at least one episode of documented ST-segment elevation with their spontaneously occurring chest pain. One had recurrent ventricular tachycardia. Two patients had prior myocardial infarction. Angiography demonstrated localized left ventricular akinesis and a severe fixed stenosis in the coronary artery supplying the abnormal segment. There were severe, fixed lesions in two coronary arteries in two patients and in one vessel in two patients. After i.v. ergonovine maleate, coronary artery spasm was documented in a normal or minimally diseased coronary artery in each patient. In two patients, ergonovine-induced spasm not only occluded the vessel, but also markedly decreased retrograde filling of a vessel with severe, fixed narrowing. Each patient's characteristic symptoms appeared with the ergonovine-induced spasm. Thus, ergonovine maleate can provoke spasm of a normal coronary artery, even in the presence of severe fixed stenoses of the remaining vessels. This observation may have an important role in the diagnosis and clinical management of patients with chest pain.

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				N.-I Yang, M.-J. Hung, and W.-J. Cherng Coronary Artery Spasm-Related Acute Coronary Syndrome in Patients With Coexisting Spasm of Angiographically Normal Coronary Artery and Fixed Narrowing of the Remaining Vessels Angiology, April 1, 2007; 58(2): 156 - 160. [Abstract] [PDF]