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European Heart Journal 1989 10(10):903-909;
Copyright © 1989 by the European Society of Cardiology.
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© 1889 The European Society of Cardiology

Nocturnal angina in patients with fixed coronary stenosis. Increased coronary vasoconstrictive sensitivity with independence of pacing ischaemic threshold

J. FIGUERAS, J. CORTADELLAS, F. BALDA and J. CINCA

Unitat Coronaria, Hospital General Vall d'Hebron Barcelona, Spain

Received 24 October 1988; revised 17 March 1989; .

Correspondence to: Jaime Figueras MD, Unitat Coronaria, Hospital General Vall d'Hebron, Passeig Vall d'Hebron, s/n, 08035—Barcelona, Spain

Abstract

Atrial pacing and ergonovine tests were performed in 18 consecutive patients with unstable angina at rest and significant coronary artery stenosis (≥ 90% in ≥ one vessel in 16 patients). 13 of them also had exertional angina. 14 patients presented at least one positive response (≥1.0 mm ST-segment shift) to pacing, with a heart rate (144±11 vs 75±13 beats min–1, P<0.001) and double product (195±26 vs 108±32 x 10–2 P<0.001) significantly higher than during angina at rest. In the ten patients who presented nocturnal angina, the incidence of positive response to pacing and the pacing ischaemic threshold, tested on three different days, were similar to those seen in the remaining patients. In contrast, the ergonovine test was positive in all patients with nocturnal angina (100%), who required a low dose (0.28±0.2 mg), but it was positive in only four (50%) of those without nocturnal angina, who needed a higher dose (0.55±0.12 mg, P<0.005).

Therefore, in patients with severe coronary stenosis and exertional angina, spontaneous episodes, including nocturnal angina, are not related to increases in heart rate. The increased coronary vasoconstrictive sensitivity found in these patients, particularly those with nocturnal angina, was not dependent on the status of the coronary reserve, which strongly suggests that changes in coronary tone, focal or diffuse, are involved in the mechanisms of these ischaemic events.

Key Words: Coronary tone • nocturnal angina • ergonovine test • atrial pacing


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