Circulation, Vol 81, 164-172, Copyright © 1990 by American Heart Association
F Crea, G Pupita, AR Galassi, H el-Tamimi, JC Kaski, G Davies and A Maseri
The intravenous infusion of adenosine provokes anginalike chest pain. To
establish its origin, an intracoronary infusion of increasing adenosine
concentrations was given in 22 patients with stable angina pectoris. During
adenosine infusion, 20 patients had chest pain without electrocardiographic
signs of ischemia. They all reported that the chest pain was similar to
their usual anginal pain. In 10 of the 22 patients adenosine was also
infused into the right atrium, but it never produced symptoms at the doses
that had provoked chest pain during intracoronary infusion. In seven other
patients, the intracoronary adenosine infusion was repeated after
intravenous administration of aminophylline, an antagonist of adenosine
P1-receptors. Aminophylline decreased the severity of adenosine-induced
chest pain (assessed with a visual analog scale) from 42 +/- 22 to 23 +/-
17 mm (p less than 0.002). In the remaining five of the 22 patients,
monitoring of blood oxygen saturation in the coronary sinus during
intracoronary adenosine administration showed that maximum coronary
vasodilation was achieved at doses lower than those responsible for chest
pain. A single-blind, placebo-controlled, randomized trial of the effect of
aminophylline on exercise-induced chest pain was also performed in 20 other
patients with stable angina. Aminophylline, compared with placebo,
decreased the severity of chest pain at peak exercise from 67 +/- 21 to 51
+/- 23 mm (p less than 0.02), despite the achievement of a similar degree
of ST- segment depression. Finally, the effect of intravenous adenosine was
compared in 10 patients with predominantly painful myocardial ischemia and
in 10 patients with predominantly silent ischemia.(ABSTRACT TRUNCATED AT
250 WORDS)
ARTICLES
Role of adenosine in pathogenesis of anginal pain
Cardiovascular Unit, RPMS-Hammersmith Hospital, London, UK.
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