Coronary arterial spasm in angina at rest associated with transient ST-segment changes
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Coronary arterial spasm is a key factor in angina at rest, causing varied ST-segment changes. This study demonstrates coronary vasospasm in patients experiencing chest pain, linking spasm location to specific ECG shifts.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Angina at rest (AAR) pathogenesis is complex.
- The role of coronary arterial spasm in AAR requires clarification.
Purpose of the Study:
- To investigate the role of coronary arterial spasm in the pathogenesis of angina at rest.
- To correlate coronary vasospasm findings with electrocardiogram (ECG) changes during chest pain.
Main Methods:
- Coronary arteriography performed in 40 patients with AAR.
- Arteriography conducted during spontaneous chest pain or after ergonovine maleate administration.
- Analysis of coronary vasospasm and its association with ST-segment elevation or depression.
Main Results:
- Coronary vasospasm was identified in 34 out of 40 patients.
- ST-segment elevation correlated with proximal or mid-left anterior descending artery occlusion.
- ST-segment depression was linked to diffuse narrowing or distal occlusion of the left anterior descending artery.
- Inferior ST-segment elevation was associated with spasm in the right or circumflex coronary arteries.
Conclusions:
- Coronary artery spasm can be demonstrated in patients with angina at rest and transient ST-segment changes.
- The location and severity of coronary spasm influence ischemic patterns and ECG manifestations.
- Coronary vasospasm is a significant contributor to the pathophysiology of angina at rest.
Abstract:
In order to clarify the role of coronary arterial spasm in the pathogenesis of angina at rest, coronary arteriography was perforned during spontaneous chest pain or following intravenous administration of ergonovine maleate in 40 patients with angina at rest. Coronary vasospasm was demonstrated in 23 patients with ST-segment elevation during chest pain (group I), in 7 with ST-segment depression (group II), and in 4 with both ST-segment depression and elevation (group III). Complete spastic occlusion of the proximal or of the midportion of the left anterior descending artery was always associated with ST-segment elevation in anterior leads. In contrast, transient ST-segment depression in anterior leads was associated with diffuse narrowing of the left anterior descending artery with slow progression of the contrast medium, or complete occlusion of a small branch or of the distal segment of the left anterior descending artery. ST-segment elevation in inferior leads was associated with complete spastic occlusion or with significant spastic narrowing of the right coronary artery or of the circumflex artery. We conclude that coronary spasm can be demonstrated in a selected cohort of patients with angina at rest associated with transient ST-segment changes. In some cases the site and the severity of the spasm may produce varying degrees of ischemia, thus determining the direction of the ST-segment shift.