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European Heart Journal 1990 11(Supplement B):58-64; doi:10.1093/eurheartj/11.suppl_B.58
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

Potential role of coronary vasoconstriction in ischaemic heart disease: effect of exercise

O. M. Hess*,, M. Büchi*, R. Kirkeeide**, P. Niederer{dagger}, M. Anliker{dagger}, K. L. Gould** and H. P. Krayenbühl*

* Department of Internal Medicine, Medical Policlinic, Cardiology, University Hospital
** Institute of Biomedical Engineering, University of Zürich
{dagger} Division of Cardiology, University of Texas Houston, U.S.A.

Address for correspondence: Otto M. Hess M.D., Medical Policlinic, Cardiology, University Hospital, Raemistrasse 100, 8091 Zürich, Switzerland

Coronary vasomotion plays an important role in the regulation of coronary perfusion at rest and during exercise. Normal coronary arteries show coronary vasodilation of the proximal (+20%) and distal (+40%) vessel segments during supine bicycle exercise. However, patients with coronary artery disease show exercise-induced vasoconstriction of the stenotic vessel segments. The exact mechanism of exercise-induced stenosis narrowing is not clear but might be related to a passive collapse of the disease-free vessel wall (Venturi mechanism), elevated plasma levels of circulating catecholamines, an insufficient production of the endothelium-derived vesorelaxing factor or increased platelet aggregation due to turbulent blood flow with release of thromboxane A2 and serotonin.

Various vasoactive drugs, such as nitroglycerin and calcium antagonists, prevent exercise-induced stenosis vasoconstriction. An additive effect on coronary vasodilation of the stenotic vessel segment was observed after combination of nitroglycerin with diltiazem. Thus, exercise-induced stenosis narrowing plays an important role in the pathophysiology of myocardial ischaemia during dynamic exercise. The antianginal effect of vasoactive substances can be explained—besides the effect on pre- and afterload—by a direct action on coronary stenosis vasomotion.

Key Words: Vasoconsriction • coronary circulaion • myocardial ischaemia • exercise


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