Experience with ergonovine provocative testing for coronary arterial spasm

Area of Science:

• Cardiology
• Diagnostic Imaging

Background:

• Coronary arterial spasm is a cause of chest pain.
• The ergonovine provocative test is used to diagnose coronary arterial spasm.

Purpose of the Study:

• To evaluate the ergonovine provocative test for diagnosing coronary arterial spasm.
• To characterize the spectrum of responses to ergonovine administration.

Main Methods:

• Reviewed 41 patients undergoing ergonovine testing for chest pain.
• Administered incremental doses of ergonovine maleate (0.25-1.2 mg).
• Assessed changes in coronary arterial diameter via angiography.

Main Results:

• Coronary arterial diameter reduction varied, with 8 patients showing >50% reduction.
• Variant angina patients had complete occlusion; others showed diffuse or focal narrowing.
• Chest pain occurred frequently, but ST-segment changes were only seen with complete occlusion.

Conclusions:

• Ergonovine testing reveals a spectrum of coronary arterial spasm.
• Variant angina represents one end of this spectrum.
• Chest pain can occur with intermediate spasm without ECG changes.