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European Heart Journal 1981 2(2):155-161;
Copyright © 1981 by the European Society of Cardiology.
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© 1981, by The European Society Of Cardiology

Variable threshold of exertional angina: a clue to a vasospastic component*

C. BRUNELLI, M. LAZZARI, I. SIMONETTI, A. L'ABBATE and A. MASERT{dagger}

CNR clinical Physiology Laboratory and Istituto di Patologia Medica I, University of Pisa Italy

Received 30 October 1980; .

Requests for reprints to: C. Brunelli, Istituto do fisiologia Clinica CNR. Via Sari 8, 56100 Pisa. Italy

Abstract

A patient with a history of exertional angina occurring at variable levels of effort underwent three consecutive exercise stress tests to evaluate his coronary reserve. The first test was negative, the second was positive with S-T segment depression, and the third showed S-Tsegment depression at the beginning of each stage with a return to normal at the end of each stage and S-T segment elevation in lead V2 at the maximal level of effort. Coronary arteriography during a stress test revealed incomplete spasm with asymptomatic S-T segment depression at the site of a 75% stenosis and the complete occlusion of the vessel at a higher level of effort associated with symptomatic S-T segment elevation. A similar electrocardio–graphic and angiographic pattern was observed both during ergonovine maleate injection and during a cold pressor test. Changes in coronary vasomotor tone may play an important role in anginal attacks occurring at a variable level of exertion and during cold exposure

Key Words: Coronary artery spasm • electrocardiographic stress testing • cold pressor test


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