Provocation of coronary artery spasm by the cold pressor test. Hemodynamic, arteriographic and quantitative angiographic observations.
Albert E. Raizner,Robert A. Chahine,Tetsuo Ishimori,Mario S. Verani,Zacca Nm,N Jamal,Richard R. Miller,Robert J. Luchi +7 more
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The cold pressor test can provoke focal coronary artery spasm in certain patients and may be a useful nonpharmacologic provocative screening test to aid in the diagnosis of this phenomenon.Abstract:
In this study we attempted to determine if the cold pressor test, a known sympathetic reflexogenic stimulus, could precipitate coronary artery spasm. Thirty-five patients undergoing coronary arteriography for evaluation of chest pain syndromes were given the cold pressor test. During 1 minute of cold pressor stimulation, aortic systolic pressure increased 18.1 ± 9.7 mm Hg (mean ± SD) and heart rate did not change significantly. Focal coronary artery spasm was provoked in seven patients, each of whom had an atheromatous plaque at the site of spasm. Four of six patients with a precatheterization clinical diagnosis of variant angina (group 1) had coronary artery spasm, and two of the four had associated ischemic manifestations. Of 14 patients in whom classic angina (group 2) was diagnosed before cardiac catheterization, two manifested focal coronary spasm. One of 15 patients thought to have atypical chest pain (group 3) manifested spasm. There were no significant differences in baseline variables (aortic systolic or diastolic pressure, heart rate, double product and left ventricular end-diastolic pressure) or hemodynamic response (aortic systolic pressure, heart rate or double product) to cold pressor stimulation between patients in each group and between those who manifested spasm and those who did not. Ventricular ectopy and ventricular tachycardia developed in one patient but were readily reversed with intravenous nitroglycerin. Quantitative angiography showed that the luminal diameter of normal coronary segments significantly decreased in each group of patients in response to cold pressor stimulation, but this response was most pronounced in the variant angina group (-12.7 ± 11.5% from control in group 1, −5.1 ± 10.2% in group 2, and −7.9 ± 9.6% in group 3; p < 0.001 for each group). Patients who are prone to coronary spasm may represent one extreme of a spectrum of reactivity to a coronary vasoconstrictive stimulus. The cold pressor test can provoke focal coronary artery spasm in certain patients and may be a useful nonpharmacologic provocative screening test to aid in the diagnosis of this phenomenon.read more
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ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: Executive summary and recommendations: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on the management of patients with unstable angina)
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TL;DR: The present guidelines supersede the 1994 guidelines and summarize both the evidence and expert opinion and provide final recommendations for both patient evaluation and therapy.
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ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction)...
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TL;DR: Angina/Non-ST-Elevation Myocardial Infarction : ACC/AHA 2007 Guidelines for the Management of Patients With Unstable ISSN: 1524-4539 Copyright © 2007 American Heart Association.
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2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Jeffrey L. Anderson,Cynthia D. Adams,Elliott M. Antman,Charles R. Bridges,Robert M. Califf,Donald E. Casey,William E. Chavey,Francis M. Fesmire,Judith S. Hochman,Thomas N. Levin,A. Michael Lincoff,Eric D. Peterson,Pierre Theroux,Nanette K. Wenger,R. Scott Wright,Hani Jneid,Steven M. Ettinger,Theodore G. Ganiats,George J. Philippides,Alice K. Jacobs,Jonathan L. Halperin,Nancy M. Albert,Mark A. Creager,David L. DeMets,Robert A. Guyton,Frederick G. Kushner,E. Magnus Ohman,William G. Stevenson,Clyde W. Yancy +28 more
TL;DR: This poster presents a poster presented at the 2016 American Academy of Thoracic Surgeons conference on “Cardiovascular Angiography and Interventions: Foundations of Cardiovascular and Pulmonary Rehabilitation,” presented in Los Angeles, USA.
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ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina).
Eugene Braunwald,Elliott M. Antman,John W. Beasley,Robert M. Califf,Melvin D. Cheitlin,Judith S. Hochman,Robert H. Jones,Dean J. Kereiakes,Joel Kupersmith,Thomas N. Levin,Carl J. Pepine,John W. Schaeffer,Earl E. Smith,David E Steward,Pierre Theroux,Raymond J. Gibbons,Joseph S. Alpert,Kim A. Eagle,David P. Faxon,Valentin Fuster,Timothy J. Gardner,Gabriel Gregoratos,Richard O. Russell,Sidney C. Smith +23 more
TL;DR: The purpose of These Guidelines is to provide a framework for future research into the pathogenesis of UA/NSTEMI and to promote awareness of the need for informed consent for diagnosis and treatment of acute coronary syndrome.
Journal ArticleDOI
Dilation of normal and constriction of atherosclerotic coronary arteries caused by the cold pressor test.
TL;DR: The response of normal coronary arteries to the CPT test is dilation, in part related to beta-adrenoreceptor stimulation and possibly flow-mediated endothelial dilation or alpha 2- adrenergic activity.
References
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Coronary arterial spasm in Prinzmetal angina. Documentation by coronary arteriography.
TL;DR: Coronary arteriography should be attempted, if possible, during clinical attacks of pain in patients with Prinzmetal angina, even those who have a focal atherosclerotic obstruction may have additional distal coronary arterial spasm.
Journal ArticleDOI
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The cold pressor test for measuring the reactibility of the blood pressure: Data concerning 571 normal and hypertensive subjects
Edgar A. Hines,George E. Brown +1 more
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Prinzmetal's variant form of angina as a manifestation of alpha-adrenergic receptor-mediated coronary artery spasm: Documentation by coronary arteriography
TL;DR: In four patients with Prinzmetal's variant form of angina, the attack was induced by the combined administration of epinephrine and propranolol and severe spasm of a large coronary artery mediated by alpha-adrenergic receptors is responsible for the attack.
Journal ArticleDOI
Ergonovine maleate provocative test for coronary arterial spasm.
Frederick A. Heupler,William L. Proudfit,Mehdi Razavi,Earl K. Shirey,Richard Greenstreet,William C. Sheldon +5 more
TL;DR: Coronary spasm can be implicated as a cause of myocardial infarction in patients with normal coronary arteriograms who also have Prinzmetal's variant angina and no major coronary obstructions, and ergonovine maleate test is a safe, sensitive and specific method for reproducing coronary spasm.