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[The use of ergonovine in the hemodynamics laboratory]
P Carvalho1, S Grossi, F Orzan
1Istituto di Medicina e Chirurgia Cardiovascolare, Università degli Studi di Torino.
Insights
Ergonovine maleate testing can provoke coronary artery spasm during angiography. This study found the ergonovine test to be positive in 11.2% of patients, aiding in diagnosing coronary artery spasm.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Pharmacology
Context:
- Coronary artery spasm is a significant cause of angina.
- Coronary arteriography is a standard diagnostic procedure.
- Ergonovine maleate is a provocative agent used to induce coronary spasm.
Purpose:
- To review the utility of ergonovine maleate as a provocative agent for inducing coronary spasm during coronary arteriography.
- To evaluate the diagnostic yield of the ergonovine test in patients with suspected coronary artery spasm.
Summary:
- The study reviewed 116 patients undergoing ergonovine testing between 1978 and 1991.
- Patients were categorized by symptoms including exertional angina, angina at rest, atypical chest pain, and previous myocardial infarction.
- The ergonovine test was considered positive based on significant coronary artery narrowing due to spasm, irrespective of angina or ECG changes, with 11.2% of tests being positive.
Impact:
- The findings highlight the role of ergonovine testing in diagnosing coronary artery spasm.
- This diagnostic approach can help identify the cause of chest pain in specific patient groups.
- Understanding the positive yield of this test aids in clinical decision-making for patients with suspected coronary artery disease.
Abstract:
In our department we have reviewed the use of ergonovine maleate as a provocative agent for inducing coronary spasm during coronary arteriography. From January 1978 to December 1991 the test has been performed in 116 patients. According to their symptoms, the patients were divided into 4 groups: (A) patients with exertional angina: 16 patients (13.8%), (B) patients with angina at rest: 64 patients (55.2%), (C) patients with atypical chest pain: 29 patients (25%), and (D) patients with previous myocardial infarct: 7 patients (6%). We have subdivided the patients with angina at rest, according to the electrocardiogram recorded during pain, into: (1) 16 patients with ST-segment elevation; (2) 14 patients with ST-segment depression or T wave inversion; (3) 5 patients with electrocardiogram unchanged during angina; (4) 29 patients with no electrocardiogram recorded during angina. In 67 patients (57.7%) the coronaries were normal, 17 patients (14.6%) had mild irregularities, 26 patients (22.4%) had non critical fixed obstructions (< or = 70%), and in 6 patients (3.5%) there were fixed coronary narrowings > or = 70%. The left ventricle was normal in 85 subjects (73.2%), hypo or akinetic in 31 (26.8%). After routine coronary angiography and ventriculography, ergonovine maleate, 0.05 up to 0.4 mg, was given intravenously. The ergonovine test was considered positive when a focal spasm narrowed a normal coronary artery, or one with a mild fixed obstruction (< or = 50%) to more than 70%, or when a 70% stenosis became occluded. The development of angina and/or electrocardiographic changes were not taken as a criteria of positivity. Thirteen tests (11.2%) were considered positive.(ABSTRACT TRUNCATED AT 250 WORDS)