[So-called coronary angiographic paradoxes]

The results of examination of 25 patients (18 with ischemic heart disease and 7 with cardialgia of other etiology) are discussed. The arteriolo-capillary bed of the coronary arteries was studied by intraarterial injection of albumin aggregates labelled with radioactive isotopes. A correlation was revealed between the degree of microcirculatory disorders and the results of electrocardiography. With increase in the degree of microcirculatory disorders, cicatricial changes in the left ventricular myocardium were found more frequently and a history of myocardial infarction (in 11 persons) and the development of left ventricular aneurysm (in 2 patients) were noted. Certain indices of integral function (EF, VcF, MNSER) and regional contractility (% delta r, L) of the left ventricle were determined in 14 patients. Among these parameters characterizing left ventricular function (EF, VCF, MNSER, % delta r, L), VCF, MNSER, and % delta r, L are most sensitive. No correlation was revealed between the state of the myocardial microcirculation bed and EF, VCF, and MNSER, but a definite correlation was found between it and % delta r, L (in the form of regional hypo- and hyperkinesia and paradoxical pulsation). Normal coronary arteriograms do not exclude the presence of ischemic heart disease and other primary diseases of the myocardium. Patients of this category should be examined more scrupulously to detect disorders of blood supply to the myocardium and function of the left ventricle.