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Exertional angina pectoris caused by coronary arterial spasm: effects of various drugs
Insights
Exercise can induce coronary artery spasm, causing exertional angina. Calcium channel blockers like diltiazem and nifedipine effectively prevent this spasm, offering a new treatment avenue for affected patients.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Exertional angina is often associated with coronary artery disease.
- The role of coronary artery spasm in exercise-induced angina requires further elucidation.
Purpose of the Study:
- To investigate the induction of coronary artery spasm by exercise in patients with exertional angina.
- To evaluate the efficacy of various medications in preventing exercise-induced angina and coronary spasm.
Main Methods:
- Coronary arteriography was performed before, during, and after arm exercise-induced angina attacks in four patients.
- Patients received propranolol, diltiazem, nifedipine, or phentolamine to assess their effects on treadmill exercise-induced angina.
Main Results:
- Arm exercise induced coronary artery spasm in the affected coronary artery, correlating with myocardial ischemia.
- Nitroglycerin relieved the spasm and angina.
- Propranolol failed to suppress treadmill-induced angina in two patients.
- Diltiazem, nifedipine, and phentolamine effectively suppressed angina in all patients.
Conclusions:
- Exercise can induce coronary arterial spasm, leading to exertional angina in susceptible individuals.
- Calcium channel blockers (diltiazem, nifedipine) are effective in preventing exercise-induced coronary spasm and angina.
Abstract:
In four patients with exertional angina induced by arm exercise, coronary arteriograms taken before, during and after the attack demonstrated that spasm appeared in the large coronary artery supplying the area of myocardium shown to be ischemic in the electrocardiogram during the attack. The spasm disappeared with subsidence of the attack after administration of nitroglycerin. Anginal attacks induced by treadmill exercise were not suppressed by propranolol, 60 mg orally, in two of the four patients. However, such attacks were suppressed in all patients by oral administration of diltiazem (90 mg, four patients) or nifedipine (20 mg, three patients) or intramuscular injection of phentolamine (0.2 mg/kg body weight, three patients). It is concluded that coronary arterial spasm can be induced by exercise and can cause exertional angina in some patients. Diltiazem and nifedipine, calcium antagonistic drugs, prevent spasm.