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[Detection of coronary artery spasm by the methylergometrin test. Technic. Results. Indications]
Insights
Methylergometrine (Methergin) effectively diagnoses Prinzmetal angina by inducing coronary spasm. This diagnostic test shows high sensitivity and specificity, aiding in identifying patients who require treatment for resting angina.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Prinzmetal angina, a condition characterized by chest pain due to coronary artery spasm, requires accurate diagnosis.
- Coronary arteriography is a standard procedure for visualizing coronary arteries.
Purpose:
- To evaluate the efficacy of intravenous methylergometrine (Methergin) as a provocative test for diagnosing coronary artery spasm, particularly in patients with suspected Prinzmetal angina.
Summary:
- 118 patients undergoing coronary arteriography received 0.4 mg of methylergometrine intravenously.
- Continuous monitoring of electrocardiogram (ECG) and intraaortic pressure was performed post-injection.
- A positive test was defined by observed coronary spasm or ST-segment elevation (with or without pain).
- The test identified 13 of 14 Prinzmetal angina patients, demonstrating 93% sensitivity and 96-100% specificity.
- Three Prinzmetal angina patients showed spasm without ECG changes, highlighting the test's ability to detect subclinical spasm.
Impact:
- This diagnostic approach is indicated for patients with resting angina and those with "angiographically normal" coronary arteries but documented Prinzmetal angina.
- The methylergometrine test aids in identifying patients who may benefit from specific therapeutic strategies for coronary artery spasm.
- High sensitivity and specificity support its use in clinical settings for diagnosing coronary artery spasm and Prinzmetal angina.
Abstract:
Methylergometrine (Methergin) was given intravenously (0.4 mg) to 118 patients undergoing coronary arteriography. The electrocardiogramme and intraaortic pressure was continuously monitored whilst coronary arteriography was performed, 1,3, and 5 minutes after the injection of the ergot alkaloid. The test was positive if: 1) coronary spasm was observed; 2) if ST segment elevation was recorded with or without pain. Positive tests were obtained in 13 out of 14 patients with Prinzmetal angina. The test was negative in the other patients. However in 3 patients with Prinzmetal angina, the test produced typical coronary spasm without electrocardiographic changes. In Prinzmetal angina the sensitivity of this test was 93 p. 100 with a high specificity: 96-100 p. 100 depending on whether or not electrocardiographical changes associated with spasm are considered. Taking into account current therapeutic methods of treating Prinzmetal angina the indications of this test of coronary spasm are: 1) patients presenting with resting angina whatever the state of their coronary arteries; 2) patients with documented Prinzmetal angina with "angiographically normal" coronary arteries.