Small-vessel vasospasm has been speculated upon as a possible cause of chest pain in patients with normal-appearing coronary angiograms. In this report, a patient who experienced typical chest pain during acetylcholine testing, which caused ST segment elevation without epicardial coronary spasm, is presented. This finding suggests that small-vessel vasospasm may be involved in the induction of myocardial ischemia in patients with normal epicardial coronary arteries.
Get full access to this article
View all access options for this article.
References
1.
Dwyer EM, Wiener L., Cox JW: Angina pectoris in patients with normal and abnormal coronary arteriograms: Hemodynamic and clinical aspects. Am J Cardiol23:639-646, 1969.
2.
Likoff W., Segal BL, Kasparian H.: Paradox of normal selective coronary arteriograms in patients considered to have unmistakable coronary heart disease. N Engl J Med276:1063-1066, 1967.
3.
Meller J., Goldsmith SJ, Rudin A., et al: Spectrum of exercise thallium-201 myocardial perfusion imaging in patients with chest pain and normal coronary angiograms. Am J Cardiol43:717-723, 1979.
4.
Opherk D., Zebe H., Weihe E., et al: Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms . Circulation63:817-825, 1981.
5.
Cannon RO III, Watson RM, Rosing DR, et al: Angina caused by reduced vasodilator reserve of the small coronary arteries. J Am Coll Cardiol1:1359-1373, 1983.
6.
Eliot RS, Bratt G.: The paradox of myocardial ischemia and necrosis in young women with normal coronary arteriograms: Relation to abnormal hemoglobin-oxygen dissociation . Am J Cardiol23:633-638, 1969.
7.
Kemp HG: Left ventricular function in patients with the anginal syndrome and normal coronary arteriograms. Am J Cardiol32:375-376, 1973.
8.
Richardson PJ , Livesley B., Oram S., et al: Angina pectoris with normal coronary arteries: Transvenous myocardial biopsy in diagnosis . Lancet2:677-680, 1974.
9.
Yasue H., Horio Y., Nakamura N., et al: Induction of coronary artery spasm by acetylcholine in patients with variant angina: Possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm. Circulation74:955-963, 1986.
10.
Ockene IS, Shay MJ, Alpert JS, et al: Unexplained chest pain in patients with normal coronary arteriograms: A follow-up study of functional status. N Engl J Med303:1249-1252, 1980.
11.
Selzer A., Langston M., Ruggeroli C., et al: Clinical syndrome of variant angina with normal coronary arteriograms . N Engl J Med295:1343-1347, 1976 .
12.
Erlebacher JA: Transmural myocardial infarction with "normal" coronary arteries. Am Heart J98:421-430, 1979.
13.
Kawakami K. , Shimada T., Nakayama K., et al: Angina pectoris due to possible vasospasm of small coronary arteries. Clin Cardiol14:775-777, 1991.
14.
Serota H., Kern MJ, Deligonul U., et al: Ergonovine-induced myocardial ischemia without epicardial coronary vasospasm: Evidence for ischemia produced by small-vessel vasoconstriction . Am Heart J121:1807-1809, 1991 .
15.
Kawachi Y., Tomoike H., Maruoka Y., et al: Selective hypercontraction caused by ergonovine in the canine coronary artery under conditions of induced atherosclerosis. Circulation69:441-450, 1984.
