cardiovascular-agents and Coronary-Vasospasm

Angina pectoris remains a significant burden despite advances in medical therapy and coronary revascularization. Many patients (up to 30%) with angina have normal coronary arteries, with coronary microvascular disease and/or coronary artery vasospasm being major drivers of the myocardial demand-supply mismatch. Even among patients revascularized for symptomatic epicardial coronary stenosis, recurrent angina remains highly prevalent. Medical therapy for angina currently centers around 2 disparate goals, viz secondary prevention of hard clinical outcomes and symptom control. Vasodilators, such as nitrates, have been first-line antianginal agents for decades, along with beta-blockers and calcium channel blockers. However, efficacy in symptoms control is heterogenous, depending on underlying mechanism(s) of angina in an individual patient, often necessitating multiple agents. Nicorandil (NCO) is an antianginal agent first discovered in the late 1970s with a uniquely dual mechanism of action. Like a typical nitrate, it mediates medium-large vessel vasodilation through nitric oxide. In addition, NCO has adenosine triphosphate (ATP)-dependent potassium channel agonist activity (K ATP ), mediating microvascular dilatation. Hence, it has proven effective in both coronary artery vasospasm and coronary microvascular disease, typically challenging patient populations. Moreover, emerging evidence suggests that cardiomyocyte protection against ischemia through ischemic preconditioning may be mediated through K ATP agonism. Finally, there is now fairly firm evidence in favor of NCO in terms of hard event reduction among patients with stable coronary artery disease, following myocardial infarction, and perhaps even among patients with congestive heart failure. This review aims to summarize the mechanism of action of NCO, its efficacy as an antianginal, and current evidence behind its impact on hard outcomes. Finally, we review other cardiac and emerging noncardiac indications for NCO use.

Topics: Angina Pectoris; Calcium Channel Blockers; Cardiovascular Agents; Coronary Vasospasm; Humans; Nicorandil; Nitrates; Vasodilator Agents

Myocardial infarction (MI) in the absence of obstructive coronary artery disease (MINOCA) is prevalent in around 5% of acute myocardial infarction (AMI) presentations. MINOCA is a heterogeneous entity with many different etiologies. It is important for health care providers to familiarize themselves with the disease process, presentation, and possible underlying causes in order to guide appropriate management strategies. In this article, the authors review the contemporary definition, etiologies and assessment, and management for AMI patients with MINOCA.

Topics: Aortic Dissection; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Coronary Artery Disease; Coronary Circulation; Coronary Vasospasm; Coronary Vessels; Humans; Myocardial Infarction; Myocarditis; Platelet Aggregation Inhibitors; Risk Factors; Severity of Illness Index; Takotsubo Cardiomyopathy; Thromboembolism

The spasm provocation tests of ergonovine and acetylcholine have been employed in the cardiac catheterization laboratory. Ergonovine acts through the serotogenic receptors, while acetylcholine acts through the muscarinic cholinergic receptors. Different mediators may have the potential to cause different coronary responses. However, there are few reports concerning the coronary response between ergonovine and acetylcholine in the same patients. Acetylcholine is supersensitive for females; spasm provoked by ergonovine is focal and proximal, whereas provoked spasm by acetylcholine is diffuse and distal. We should use both tests as supplementary in the clinic because ergonovine and acetylcholine have self-limitations to induce coronary spasms during daily life. The maximal pharmacological doses, administration methods, and the angiographical positive definition are remarkably different for each institution in the world. We recommend the pharmacological spasm provocation tests as Class I in the guidelines in patients with vasospastic angina throughout the world.

Topics: Acetylcholine; Cardiovascular Agents; Coronary Vasospasm; Ergonovine; Female; Heart; Heart Function Tests; Humans; Male; Spasm

Cardiotoxicity is a rare but serious complication of 5-fluorouracil therapy. Coronary vasospasm and, less frequently, acute myocarditis have been identified as underlying mechanisms. We report a case of severe toxicity in a relatively young and fit male patient being treated for metastatic colonic adenocarcinoma displaying characteristics that cannot be explained by either mechanism alone.

Topics: Adenocarcinoma; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Arrhythmias, Cardiac; Cardiomyopathy, Dilated; Cardiovascular Agents; Colonic Neoplasms; Coronary Vasospasm; Fluorouracil; Heart Diseases; Humans; Leucovorin; Liver Neoplasms; Male; Middle Aged; Myocarditis; Organoplatinum Compounds; Oxaliplatin; Treatment Outcome; Ventricular Dysfunction, Left

Topics: Acute Coronary Syndrome; Cardiovascular Agents; Collateral Circulation; Coronary Stenosis; Coronary Vasospasm; Diagnosis, Differential; Electrocardiography; Fibrinolytic Agents; Humans; Myocardial Infarction; Prognosis

Topics: Angioplasty, Balloon, Coronary; Arteriosclerosis; Cardiovascular Agents; Contraindications; Coronary Thrombosis; Coronary Vasospasm; Ergonovine; Female; Humans; Myocardial Infarction; Oxytocics; Pregnancy; Pregnancy Complications, Cardiovascular; Prognosis; Risk Factors

Topics: Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Vasospasm; Humans; Intra-Aortic Balloon Pumping; Intraoperative Complications; Perioperative Care; Postoperative Complications

The currently available antianginal drugs act by reduction of myocardial O2 requirement and/or by coronary vasodilatation. The choice between beta blockers, nitrates, calcium antagonists or their combination depends on the clinical presentation, coexisting disorders and specific factors in individual patients. In addition to symptomatic treatment, secondary prophylactic measures, such as aspirin and reduction of serum cholesterol, are also necessary to prevent progression of the underlying coronary artery disease. In this paper the comparative efficacy and the indications of the various types of antianginal drugs are discussed.

Topics: Angina Pectoris; Angina, Unstable; Calcium Channel Blockers; Cardiovascular Agents; Coronary Vasospasm; Humans; Isosorbide Dinitrate; Myocardial Infarction; Nitroglycerin; Platelet Aggregation Inhibitors; Vasodilator Agents

Myocardial infarction during pregnancy and puerperium is very rare. Increased awareness of its possible occurrence is important for diagnosis. We report on a 37-year-old woman without coronary risk factors who suffered an anterior septal infarction in the last trimester. Coronary angiography one month after normal delivery and two months after infarction revealed normal coronary arteries. Ventriculography showed anteroseptal akinesia. The assumed etiology of myocardial infarction appears to be coronary spasm. A history of vasospasm in other vascular beds, migraine and Raynaud's phenomenon support this hypothesis. The literature is reviewed with special emphasis on clinical picture, prognosis, etiology and management of myocardial infarction during pregnancy.

Topics: Adult; Cardiovascular Agents; Coronary Vasospasm; Female; Fetus; Heart Function Tests; Humans; Myocardial Infarction; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Factors

Coronary angioplasty is an accepted method of revascularization in selected patients with coronary artery disease. Immediately after a successful angioplasty, initial management concentrates on the detection and treatment of coronary artery spasm and acute vessel closure, should these complications occur. Once the patient is ambulatory, a formal assessment of the success of the procedure may be appropriate in some patients. Medical management is aimed at reducing the risk of coronary spasm and modifying those factors that may cause restenosis. During the next six months, coronary risk factor modification should be started while the patient is observed for symptoms that may suggest restenosis.

Topics: Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Disease; Coronary Vasospasm; Humans; Recurrence; Time Factors

We sought to determine whether a potent Rho-kinase inhibitor fasudil prevents the occurrence of myocardial ischemia in patients with microvascular angina attributable to coronary microvascular spasm.. Effective treatment of patients with angina who have normal coronary arteriograms (microvascular angina) has not yet been established. Rho-kinase-mediated calcium sensitization of the myosin light chain in smooth muscle cells has been implicated as substantially contributing to vascular hyperconstriction.. We studied consecutive 18 patients with angina and normal epicardial coronaries in whom intracoronary acetylcholine (ACh) induced myocardial ischemia (ischemic electrocardiographic changes, myocardial lactate production, or both) without angiographically demonstrable epicardial coronary vasospasm. All patients underwent a second ACh challenge test after pretreatment with either saline (n = 5) or fasudil (4.5 mg intracoronarily, n = 13).. Myocardial ischemia was reproducibly induced by ACh in the saline group. In contrast, 11 of the 13 patients pretreated with fasudil had no evidence of myocardial ischemia during the second infusion of ACh (p < 0.01). The lactate extraction ratio (median value [interquartile range]) during ACh infusion was improved by fasudil pretreatment, from -0.16 (-0.25 to 0.04) to 0.09 (0.05 to 0.18) (p = 0.0125).. Fasudil ameliorated myocardial ischemia in patients who were most likely having coronary microvascular spasm. The inhibition of Rho-kinase may be a novel therapeutic strategy for this group of patients with microvascular angina.

Topics: 1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine; Acetylcholine; Aged; Cardiovascular Agents; Coronary Circulation; Coronary Vasospasm; Enzyme Inhibitors; Female; Heart Function Tests; Humans; Infusions, Intra-Arterial; Intracellular Signaling Peptides and Proteins; Microvascular Angina; Middle Aged; Myocardial Ischemia; Protein Serine-Threonine Kinases; rho-Associated Kinases; Treatment Outcome; Vasodilator Agents

In pharmaceutical/clinical development, two-stage seamless adaptive designs are commonly considered. Such designs include a two-stage phase I/II or phase II/III adaptive trial that combines one phase IIb study for dose-finding or treatment selection and one phase III study for efficacy confirmation into a single study. At the end of stage 1, promising dose(s) will be selected based on pre-specified selection criteria. In practice, since there is little power with limited subjects available at interim, commonly considered selection criteria for critical decision-making include (i) conditional power, (ii) precision analysis, (iii) predictive probability of success, and (iv) probability of being the best dose or treatment. The selected promising dose(s) will then proceed to the next stage for efficacy confirmation. In this article, we introduce, compare, and evaluate these criteria. Simulation studies and a numeric example are given to illustrate those criteria. Besides, we attempt to address some concerns for the two-stage seamless adaptive clinical trial.

Topics: Cardiovascular Agents; Coronary Vasospasm; Dose-Response Relationship, Drug; Double-Blind Method; Endpoint Determination; Humans; Multicenter Studies as Topic; Probability; Randomized Controlled Trials as Topic

Topics: Adult; Cardiovascular Agents; Coronary Vasospasm; Diltiazem; Electrocardiography; Female; Humans

Previously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave).. The study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow-up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF.. Approximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.

Topics: Action Potentials; Adult; Aged; Asymptomatic Diseases; Cardiovascular Agents; Coronary Angiography; Coronary Vasospasm; Diagnosis, Differential; Electrocardiography, Ambulatory; Female; Heart Rate; Humans; Incidence; Japan; Male; Middle Aged; Predictive Value of Tests; Recurrence; Retrospective Studies; Time Factors; Treatment Outcome; Ventricular Fibrillation

Coronary artery spasm (CAS) is known to be a risk factor for cardiovascular events. However, there is limited data whether the multi-vessel and diffuse spasm (MVDS) is related to more adverse clinical outcomes compared to the Non-MVDS. The aim of this study is to evaluate the impact of the MVDS on clinical outcomes during a 3-year clinical follow-up period.A total 2797 patients underwent coronary angiography (CAG) with acetylcholine (ACH) provocation test from Nov 2004 to Oct 2010 were enrolled. It is a single-center, observational, prospective, all-comers registry designed to reflect the "real world" practic. The patients were divided into the 3 groups; the negative spasm (NS) group (n = 1188), the Non-MVDS group (n = 1081), and the MVDS group (n = 528). The incidence of major adverse cardiac events (MACE) and recurrent angina was evaluated up to 3 years. To minimize confounding factors, multivariable Cox-proportional hazards regression analysis was performed.In the 3-year clinical follow-up, the incidence of total death, myocardial infarction, de novo percutaneous coronary intervention (PCI), cerebrovascular accident and MACE were similar among the 3 groups. However, recurrent angina occurred more frequently in the MVDS group than in the NS group (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.27-3.02; P = .002). Recurrence angina between the MVDS group and the Non-MVDS group was not statistically significant (HR, 1.36; 95% CI, 0.91-2.03; P = .129).In this study, although the incidence of major adverse cardiovascular events were not different regardless of spasm type, the MVDS was associated with higher incidence of recurrent chest pain requiring repeat CAG during the 3-year follow-up period, suggesting more intensive optimal medical therapy with close clinical follow up would be necessary for this particular subset of patients.

Topics: Acetylcholine; Aged; Angina Pectoris; Cardiovascular Agents; Coronary Angiography; Coronary Vasospasm; Female; Humans; Incidence; Male; Middle Aged; Myocardial Infarction; Prognosis; Registries; Republic of Korea; Risk Factors; Time

Coronary artery spasm (CAS) could cause serious lethal ventricular arrhythmias. While implantable cardioverter defibrillators (ICDs) have been recommend for secondary prevention of sudden cardiac death related to lethal ventricular arrhythmias. However, in resuscitated sudden cardiac death caused by CAS, the effect of ICD is still not well clear.. A 60-year-old male presented with 2 episodes of syncope. Coronary angiography showed normal coronary arteries. Twenty-four hour Holter electrocardiograms revealed that there were repeatedly transient marked ST segment elevation in the all leads except avR lead, junctional rhythm, and subsequently nonsustained ventricular tachycardia.. Ischemic-induced lethal ventricular arrhythmias caused by CAS.. Both calcium channel blocker (diltiazem, 180 mg twice daily) and nitrate (isosorbide dinitrate 40 mg twice daily) were initially administrated, and ICD was subsequently implanted as a secondary prevention.. In the early stage of CAS, ICD therapy terminated the lethal ventricular arrhythmias. Conversely, after the administration of epinephrine, ICD therapy, even combined with external defibrillation, failed in resuscitating sudden cardiac death.. For the sudden cardiac death related to lethal ventricular arrhythmias caused by CAS, ICD therapy is an efficient secondary prevention base on administrating coronary vasodilators. Furthermore, administration of epinephrine should be avoided during cardiorespiratory resuscitation of sudden cardiac death caused by CAS.

Topics: Arrhythmias, Cardiac; Cardiovascular Agents; Coronary Vasospasm; Death, Sudden, Cardiac; Defibrillators, Implantable; Fatal Outcome; Humans; Male; Middle Aged; Myocardial Ischemia

Epicardial adipose tissue (EAT) is the ectopic visceral fat surrounding the heart, which plays an important role in atherosclerosis of the coronary arteries via endothelial damage. Several studies have also suggested that vasospasm with angina (VSA) causes endothelial dysfunction in the coronary arteries. The aim of this study was to evaluate the thickness of EAT in the anterior interventricular groove (EAT-AIG) using echocardiography in patients who had no obstructive coronary artery disease and were suspected of having VSA.. Sixty-five patients who underwent intracoronary acetylcholine provocation testing for clinical indications were prospectively enrolled. VSA was diagnosed by coronary artery stenosis increase of >90% and the presentation of chest pain with ischemic changes on electrocardiography.. Subjects were divided into two groups, with and without significant coronary spasm (VSA group, 30 patients; non-VSA group, 35 patients), consistent with acetylcholine provocation testing. EAT-AIG thickness was significantly greater in the VSA group than in the non-VSA group (8.2 ± 2.7 vs 6.1 ± 2.5 mm, P = .002). By receiver operating characteristic analysis, EAT-AIG thickness had a high C statistic (area under the curve = 0.81, P < .001) after adjustment for conventional risk factors (smoking, diabetes mellitus, and dyslipidemia). EAT-AIG thickness had incremental diagnostic value over other conventional risk factors (area under the curve = 0.81 vs 0.64, P for comparison = .020).. EAT-AIG thickness, which is noninvasively and easily measured using transthoracic echocardiography, can be one of multiple clinical variables associated with VSA.

Topics: Acetylcholine; Adipose Tissue; Aged; Cardiovascular Agents; Coronary Artery Disease; Coronary Vasospasm; Echocardiography; Female; Hospitals, University; Humans; Male; Middle Aged; Pericardium; Predictive Value of Tests; Retrospective Studies; Risk Factors; Sensitivity and Specificity

Patients with microvascular angina are characterized by angina pectoris with proof of myocardial ischemia in the absence of any relevant epicardial stenosis and without myocardial disease (type 1 coronary microvascular dysfunction according to Crea and Camici). Structural and functional alterations of the coronary microvessels (diameter < 500 µm) are the reason for this phenomenon. Frequently such alterations are associated with cardiovascular risk factors. Patients with angina pectoris without epicardial stenoses represent for 10 - 50 % of all patients undergoing coronary angiography depending on the clinical presentation. Diagnostic approaches include non-invasive (e. g. combination of coronary CT-angiography and positron emission tomography/echo Doppler-based coronary flow reserve measurements) as well as invasive procedures (coronary flow reserve measurements in response to adenosine, intracoronary acetylcholine testing). Pharmacological treatment of these patients is often challenging and should be based on the characterization of the underlying mechanisms. Moreover, strict risk factor control and individually titrated combinations of antianginal substances (e. g. beta blockers, calcium channel blockers, nitrates, ranolazine, ivabradine etc.) are recommended.

Topics: Adrenergic beta-Antagonists; Calcium Channel Blockers; Cardiovascular Agents; Coronary Vasospasm; Coronary Vessels; Humans; Implantable Neurostimulators; Microvascular Angina; Myocardial Ischemia; Physical Conditioning, Human; Risk Factors; Sodium Channel Blockers

Calcium channel blockers diltiazem and nitrate have been used as selective coronary vasodilators for patients with significant coronary artery spasm (CAS). However, no study has compared the efficacy of diltiazem alone versus diltiazem with nitrate for long-term clinical outcomes in patients with CAS.. A total of 2741 consecutive patients without significant coronary artery disease with positive CAS by acetylcholine (Ach) provocation test between November 2004 and May 2014 were enrolled. Significant CAS was defined as a narrowing of >70% by incremental intracoronary injection of 20, 50, and 100 μg of Ach into the left coronary artery. Patients were assigned to either the diltiazem group (n=842) or the dual group (diltiazem with nitrate, n=1899) at physician discretion. To adjust for potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM analysis, two well-balanced groups (811 pairs, n=1622, C-statistic=0.708) were generated.. At 5 years, there were similar incidences in primary endpoints, including mortality, myocardial infarction, revascularization, and recurrent angina requiring repeat coronary angiography between the two groups. Diltiazem alone was not an independent predictor for major adverse cardiovascular events or recurrent angina requiring repeat coronary angiography.. Despite the expected improvement of endothelial function and the relief of CAS, the combination of diltiazem and nitrate treatment was not superior to diltiazem alone in reducing mortality and cardiovascular events up to 5 years in patients with significant CAS.

Topics: Acetylcholine; Aged; Angina Pectoris; Calcium Channel Blockers; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Coronary Vasospasm; Diltiazem; Drug Therapy, Combination; Female; Humans; Incidence; Male; Middle Aged; Myocardial Infarction; Nitrates; Propensity Score; Time Factors; Vasodilator Agents

Topics: Angina Pectoris, Variant; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Coronary Stenosis; Coronary Vasospasm; Drug-Eluting Stents; Everolimus; Humans; Male; Middle Aged; Prosthesis Design; Sirolimus; Time Factors; Treatment Outcome; Vasodilator Agents

Calcium channel blockers have been used in the treatment of coronary artery spasm for many years. However, there is insufficient knowledge about their application to treat atrioventricular block caused by coronary spasm. Clinical data of five patients who were diagnosed with coronary spasm caused by atrioventricular block and treated with calcium channel blockers were retrospectively assessed. The patients had varying degrees of atrioventricular block (confirmed by Holter ECG) and myocardial ischemia-like ST-T changes. Two patients were II type I AVB, two patients II type II AVB, and the remaining one patient was III AVB. All patients were all diagnosed with right coronary artery spasm by coronary angiography. The patients were treated with calcium channel blockers. No patient reported recurrence of chest pain or chest discomfort. On Holter ECG monitoring, no significant myocardial ischemia or atrioventricular block was seen. In conclusion, calcium channel blockers are effective and safe in the treatment of atrioventricular block caused by coronary spasm.

Topics: Atrioventricular Block; Calcium Channel Blockers; Cardiovascular Agents; Coronary Angiography; Coronary Vasospasm; Diltiazem; Female; Humans; Male; Middle Aged

Topics: Acute Coronary Syndrome; Calcium Channel Blockers; Cardiopulmonary Resuscitation; Cardiovascular Agents; Coronary Angiography; Coronary Vasospasm; Coronary Vessels; Drug-Eluting Stents; Electrocardiography; Everolimus; Heart Arrest; Humans; Male; Middle Aged; Nitroglycerin; Percutaneous Coronary Intervention; Recurrence; Treatment Outcome

Coronary endothelial dysfunction is thought to underlie the development of coronary artery spasms. Malondialdehyde-modified low-density lipoprotein (MDA-LDL) was suggested as a marker of endothelial damage. This study investigated the diagnostic impact of MDA-LDL on ergonovine-induced coronary spasms.. We included 152 patients with suspected coronary spastic angina. MDA-LDL levels were measured before an ergonovine provocation test. Coronary spasm was defined as total or subtotal occlusion, compared to the relaxed state after nitroglycerin, associated with ischemic ECG changes and concurrent chest pain. Changes in vessel diameter in response to ergonovine were evaluated with quantitative coronary angiography.. Coronary spasms were observed in 41 patients (27%). MDA-LDL levels were significantly higher in patients with spasms compared to those without spasms (139.9 ± 45.9 U/L vs. 109.6 ± 36.6 U/L, p<0.01). Univariate logistic regression analyses indicated significant relationships between coronary spasms and MDA-LDL (per 10 U/L, odds ratio (OR): 1.20; p<0.01), high-density lipoprotein (per 10 mg/dL, OR: 0.76; p=0.03), smoking (OR: 3.04; p<0.01), and male gender (OR: 3.51; p<0.01). In the multivariate model, MDA-LDL (per 10 U/L, OR: 1.17; p<0.01) remained a significant predictor of coronary spasm. Regression analysis showed a positive correlation between MDA-LDL levels and coronary luminal diameter changes induced by ergonovine (r=0.57, p<0.01). The optimal MDA-LDL threshold for predicting coronary spasm was 121.3 U/L, identified with a receiver operating characteristic curve.. Increased circulating MDA-LDL levels were associated with ergonovine-induced coronary artery spasm.

Topics: Aged; Angina Pectoris; Cardiovascular Agents; Coronary Angiography; Coronary Vasospasm; Coronary Vessels; Endothelium, Vascular; Ergonovine; Female; Humans; Lipoproteins, LDL; Male; Malondialdehyde; Middle Aged; Nitroglycerin; Statistics as Topic

Topics: Cardiovascular Agents; Coronary Vasospasm; Diltiazem; Heart Arrest; Heart Block; Humans; Male; Middle Aged

In cases of coronary artery spasm, life-threatening ventricular arrhythmias are possible and can lead to sudden cardiac death. Treatment for this condition includes implantable cardioverter defibrillators, but their effectiveness in patients who present with ventricular fibrillation is debated. Our patient presented with intractable ventricular fibrillation episodes that triggered shocks from her implanted defibrillator. At 2 years of follow-up, we placed her on 200 mg/day of oral amiodarone, after identifying short-coupled premature contractions as the trigger for the ventricular fibrillation. In the 2 years following initiation of this drug therapy, the patient had no further fibrillation episodes.

Topics: Cardiovascular Agents; Coronary Vasospasm; Defibrillators, Implantable; Diagnosis, Differential; Diltiazem; Echocardiography; Electrocardiography; Female; Humans; Isosorbide Dinitrate; Middle Aged; Nicorandil; Recurrence; Treatment Outcome; Ventricular Fibrillation

Although spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, it should be considered during the evaluation of patients who have chest pain. Coronary vasospasm can lead to spontaneous dissection. The dopamine agonist cabergoline is known to cause digital vasospasm. Herein, we report a case of spontaneous right coronary artery dissection in a 43-year-old woman who was taking cabergoline as therapy for prolactinoma. To our knowledge, this is the first report of an apparent relationship between cabergoline therapy and spontaneous coronary artery dissection. The possible association of cabergoline with coronary artery spasm and dissection should be considered in patients who present with chest pain while taking this medication.

Topics: Adult; Angina Pectoris; Antineoplastic Agents, Hormonal; Aortic Dissection; Cabergoline; Cardiovascular Agents; Coronary Aneurysm; Coronary Angiography; Coronary Vasospasm; Ergolines; Female; Humans; Pituitary Neoplasms; Predictive Value of Tests; Prolactinoma; Recurrence; Risk Factors; Time Factors; Treatment Outcome

We report a case of capecitabine-induced cardiotoxicity (effort angina) in a woman with metastatic breast carcinoma. Due to cancer progression, rechallenge of therapy with capecitabine was attempted, using several strategies in order to prevent cardiotoxicity. The most (even if not fully) effective strategy was reducing capecitabine dosage together with nitrates, calcium-channel blockers and trimetazidine therapy.

Topics: Angina Pectoris; Antimetabolites, Antineoplastic; Breast Neoplasms; Capecitabine; Cardiovascular Agents; Coronary Vasospasm; Deoxycytidine; Echocardiography, Doppler, Color; Echocardiography, Doppler, Pulsed; Electrocardiography; Female; Fluorouracil; Humans; Middle Aged

Topics: Aged; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass, Off-Pump; Coronary Vasospasm; Coronary Vessels; Diltiazem; Electrocardiography; Female; Follow-Up Studies; Humans; Postoperative Complications; Ultrasonography

Patients with persistent chest pain and no obstructive coronary artery disease are often labeled as having noncardiac pain and not offered further cardiologic testing or treatment. Diagnostic uncertainty for persistent chest pain is associated with adverse quality of life, morbidity, and health care costs. Two underdiagnosed cardiac causes for persistent chest pain include microvascular coronary disease and abnormal cardiac nociception. Microvascular coronary disease is associated with an increased risk of adverse cardiovascular events such as myocardial infarction, congestive heart failure, and sudden cardiac death, and treatment directed at improving endothelial function can improve outcomes. Abnormal cardiac nociception is also a cause for persistent chest pain caused by heightened coronary pain perception. Coronary reactivity testing allows for direct measurement of blood flow characteristics in response to vasoactive agents for the diagnoses of microvascular coronary disease and can be a useful tool to differentiate causes of chest pain. Coronary reactivity testing is an invasive method for assessing coronary vascular function, with current evidence suggesting that its associated risk is relatively low compared with the adverse prognosis associated with microvascular coronary dysfunction. Accurate diagnosis in patients with persistent chest pain and normal coronary arteries can be challenging and deserves adequate investigation in light of the associated morbidity, mortality, and health care costs.

Topics: Adult; Blood Flow Velocity; Cardiovascular Agents; Chest Pain; Coronary Circulation; Coronary Vasospasm; Diagnosis, Differential; Diagnostic Techniques, Cardiovascular; Female; Humans; Imipramine; Microvascular Angina; Middle Aged; Nociceptors; Pain Measurement; Radiography, Interventional; Transcutaneous Electric Nerve Stimulation; Vasodilator Agents

We describe two cases of severe, multivessel coronary vasospasm that occurred a few months after placement of sirolimus-eluting stents in patients with severe coronary disease, and involved segments not significantly atheromatous and not previously treated. The literature suggests that biocellular interference with the endothelial equilibrium on the part of drugs eluted from a stent poses a serious risk of tardive and widespread postangioplasty coronary spasm in comparison with the use of a bare-metal stent.

Topics: Angina Pectoris; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Coronary Stenosis; Coronary Vasospasm; Drug-Eluting Stents; Humans; Intra-Aortic Balloon Pumping; Male; Middle Aged; Prosthesis Design; Severity of Illness Index; Sirolimus; Time Factors; Treatment Outcome; Vasodilator Agents

A 60-year-old man who had serious chest and arm pain died suddenly during hospitalization. He suffered from coronary vasospastic angina complicated by a fatal acute fulminant-type of myocarditis associated with Churg-Strauss syndrome (CSS). The diagnosis at autopsy was acute progressive eosinophilic myocarditis associated with CSS.

Topics: Angina Pectoris; Autopsy; Cardiovascular Agents; Churg-Strauss Syndrome; Coronary Angiography; Coronary Vasospasm; Death, Sudden, Cardiac; Electrocardiography; Eosinophilia; Fatal Outcome; Humans; Male; Middle Aged; Myocarditis

This study sought to determine vasomotor functional responses of conduit coronary artery distal to bare-metal stents (BMS), polymer-only stents (POLY), and sirolimus-eluting stents (SES) in a clinically relevant animal model.. Drug-eluting stents (DES) reduce in-stent restenosis, and also affect neointima formation and vascular remodeling in downstream coronary segments. Whether distal artery vasomotor function is also influenced by DES has not been determined.. Pigs (n = 12) received coronary stent implants, and hearts were harvested at 1 month. Arterial segments >or=15 mm distal to stents were excised and studied in an organ-chamber apparatus. Endothelium-dependent and endothelium-independent relaxation and contraction to classical agonists were measured.. The SES showed increased lumen area and reduced neointima; abnormal vasomotor function of conduit arteries distal to SES also was observed. Contraction to endothelin-1 was significantly enhanced for SES compared with both BMS and POLY. Endothelium-dependent relaxation to a maximal dose of substance P was attenuated for SES compared with both BMS and POLY (46 +/- 6% vs. 71 +/- 3% and 78 +/- 3%, respectively, p < 0.001). Endothelium-independent relaxation to sodium nitroprusside was potentiated for SES, compared with BMS and POLY (100 +/- 5% vs. 69 +/- 7% and 77 +/- 5%, respectively, p = 0.02).. Stent-based local delivery of sirolimus profoundly inhibited neointima formation but caused vasomotor dysfunction in distal conduit vessel segments. These observations suggest that distal coronary vasospasm may be more readily evoked in the presence of DES and contribute to pathophysiological sequela.

Topics: Angioplasty, Balloon, Coronary; Animals; Cardiovascular Agents; Coronary Vasospasm; Coronary Vessels; Dose-Response Relationship, Drug; Drug-Eluting Stents; Female; Male; Metals; Models, Animal; Prosthesis Design; Sirolimus; Stents; Sus scrofa; Thrombosis; Time Factors; Vasoconstriction; Vasoconstrictor Agents; Vasodilation; Vasodilator Agents

Topics: Angioplasty, Balloon, Coronary; Animals; Cardiovascular Agents; Coronary Vasospasm; Coronary Vessels; Drug-Eluting Stents; Models, Animal; Myocardium; Sirolimus; Swine

Topics: Administration, Cutaneous; Administration, Oral; Angina Pectoris, Variant; Aspirin; Cardiovascular Agents; Chest Pain; Coronary Angiography; Coronary Vasospasm; Diltiazem; Drug Therapy, Combination; Electrocardiography; Follow-Up Studies; Humans; Male; Middle Aged; Nitrates; Platelet Aggregation Inhibitors; Time Factors

Topics: Acetylcholine; Angina Pectoris; Bundle-Branch Block; Calcium Channel Blockers; Cardiovascular Agents; Coronary Vasospasm; Death, Sudden, Cardiac; Defibrillators, Implantable; Electrocardiography; Humans; Myocardial Ischemia; Syncope; Ventricular Fibrillation

Two patients with life-threatening episodes of ventricular fibrillation (VF) showed typical ST elevation in V1-V3 leads. Both had spontaneous clinical episodes of resting angina. Intracoronary injection of acetylcholine provoked coronary vasospasm and ST elevation was the same as Brugada-type ST elevation in 1 case but not in the other. Calcium channel antagonist was prescribed to prevent coronary vasospasm but Brugada-type ST elevation and the occurrence of VF could not be prevented. The symptoms accompanied both cases. Considering these cases, the pathogenesis of Brugada syndrome should differ from that of coronary vasospasm because it could not be prevented by calcium channel antagonist.

Topics: Acetylcholine; Amlodipine; Calcium Channel Blockers; Cardiovascular Agents; Coronary Vasospasm; Defibrillators, Implantable; Diltiazem; Electric Countershock; Electrocardiography; Fatal Outcome; Heart Function Tests; Humans; Male; Middle Aged; Myocardial Ischemia; Syncope; Ventricular Fibrillation

Topics: Cardiovascular Agents; Comorbidity; Coronary Artery Disease; Coronary Vasospasm; Disease Progression; Female; Follow-Up Studies; Humans; Incidence; Leukocyte Count; Male; Middle Aged; Myocardial Infarction; Prognosis; Survival Rate; Taiwan

Coronary artery spasm has been shown to play an important role in the pathogenesis of not only variant angina but also various arrhythmias. We present a case report of coronary vasospasm-induced arrhythmia and review the prevalence, mechanism, prognosis and management of this problem.

Topics: Aged; Angina Pectoris, Variant; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Vasospasm; Female; Humans; Prognosis; Stents; Tachycardia, Ventricular

We present a 53-year-old male with recurrent episodes of vasospastic angina and serious complications of coronary artery spasm including ventricular fibrillation and myocardial infarction, who was treated with coronary stenting at the site of ergonovine-induced coronary vasospasm where the coronary artery appeared angiographically normal, i.e., without evidence of atherosclerotic lesion.

Topics: Cardiovascular Agents; Coronary Angiography; Coronary Vasospasm; Ergonovine; Humans; Male; Microvascular Angina; Middle Aged; Myocardial Infarction; Prosthesis Implantation; Recurrence; Stents; Treatment Outcome; Ventricular Fibrillation

The goal of this study was to assess the prognostic value of ergonovine echocardiography (Erg Echo) for diagnosis of coronary vasospasm (CVS) in patients without significant fixed coronary stenosis.. Medical records of 650 patients who underwent Erg Echo were reviewed. Before Erg Echo, absence of significant fixed coronary stenosis was confirmed by invasive coronary angiography (CAG) in 316 patients (49%) or by noninvasive confirmation of negative treadmill or normal myocardial perfusion scan in 334 patients (51%). The cardiac events after Erg Echo were tabulated and these included cardiac death, myocardial infarction (MI), readmission due to intractable chest pain.. The average age was 54 +/- 10 years, with 223 women and 427 men. Erg Echo was positive in 237 patients (36%), for whom long-acting calcium channel blocker and nitrates were prescribed. During follow-up (46 +/- 23 months), cardiac events developed in 13% (30 of 237) of the positive Erg Echo group and 3% (14 of 413) of the negative Erg Echo group (P <.001). Incidence of cardiac death was higher in the positive Erg Echo group (3.4% vs 0.7%, P =.022). The 5-year survival rate (93% +/- 3% vs 99% +/- 1%, P =.013) and event-free survival rate (94% +/- 2% vs 77% +/- 6%, P <.001) were significantly lower in the positive Erg Echo group. Smoking (hazards ratio 6.3; 95% CI 1.7-23.5) and multivessel spasm (hazards ratio 37.2, 95% CI, 8.1 to 170.4) were independent factors associated with cardiac death and/or MI.. Erg Echo for noninvasive diagnosis of CVS in the differential diagnosis of chest pain provides useful prognostic information for patients without significant fixed coronary stenosis and can play a role as a cost-effective diagnostic strategy in these selected patients.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Coronary Stenosis; Coronary Vasospasm; Echocardiography, Stress; Ergonovine; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prognosis; Retrospective Studies; Statistics as Topic

Topics: Accidents, Home; Adult; Anticoagulants; Antithrombin III Deficiency; Arginine; Burns; Cardiovascular Agents; Coronary Vasospasm; Debridement; Drug Therapy, Combination; Explosions; Humans; Male; Pipecolic Acids; Sulfonamides; Ventricular Dysfunction, Left; Warfarin

Endothelial dysfunction and effectiveness of treatment of calcium antagonists are suggestive of coronary artery spasm as an underlying disorder in dilated cardiomyopathy (DCM). The aim of this study is to determine whether or not the epicardial coronary artery spasm can induce severe cardiac dysfunction like DCM. Thirty-four consecutive patients with angiographically normal coronary arteries and diffuse left ventricular hypokinesis whose causes had been unknown underwent acetylcholine provocation test and left ventricular biopsy. Eight patients were excluded according to the clinical and laboratory data and biopsy findings suggesting myocarditis or other systemic diseases. According to the results of the acetylcholine provocation test, 17 patients were finally diagnosed as having DCM, and nine patients (35% of the study patients), who had acetylcholine-induced diffuse and multivessel coronary spasm, were diagnosed as having DCM-like vasospastic angina pectoris (VSA). Clinical and cardiac catheterization data including hemodynamics and biopsy findings were similar between the two groups except that left ventricular end-systolic volume was significantly greater in DCM than in DCM-like VSA. After the acetylcholine provocation test, DCM patients received both a beta blocker and an angiotensin-converting enzyme inhibitor, and DCM-like VSA patients received antianginal drugs. In echocardiographic findings at predischarge and those after 6-month drug treatment, both DCM-lke VSA and DCM showed significant reduction in end-diastolic and end-systolic diameters and significant increase in fractional shortening and ejection fraction, whereas changes in ejection fraction and fractional shortening were significantly greater in DCM-like VSA than those in DCM. Epicardial coronary artery spasm can induce diffuse and severe left ventricular dysfunction like DCM in VSA. Although antianginal drugs markedly improve left ventricular function of these patients, only the acetylcholine provocation test can identify DCM-like VSA.

Topics: Acetylcholine; Adult; Aged; Biopsy; Cardiac Catheterization; Cardiomyopathy, Dilated; Cardiovascular Agents; Coronary Angiography; Coronary Vasospasm; Endothelium, Vascular; Female; Heart Ventricles; Hemodynamics; Humans; Male; Middle Aged; Severity of Illness Index; Ventricular Dysfunction, Left

Although the long-term survival of patients suffering from coronary spasm is usually excellent, serious complications can develop, such as disabling pain, myocardial infarction, ventricular tachyarrhythmias, atrioventricular block and sudden cardiac death. A 40-year-old man who had intractable chest pain from coronary artery spasm suffered ventricular fibrillation and an acute anterior myocardial infarction upon first admission. The patient underwent a coronary angiogram, which revealed a spontaneous focal spasm at the proximal left anterior descending coronary artery (LAD). He was treated by the combination of nitrate and calcium channel blocker, but continued to complain of severe chest pain despite intensive medical therapy and he had to be treated in the emergency room 5 times during an 8-month follow-up period. An ergonovine coronary angiogram was performed and an intracoronary ultrasound examination, which revealed a focal spasm at the same site of the proximal LAD with a small amount of localized eccentric atheromatous plaque. A coronary artery stent was placed in the proximal LAD and his symptoms resolved. A follow-up coronary angiogram was performed 3 years after stenting and the stent remained patent without any in-stent restenosis or spasm.

Topics: Adult; Amlodipine; Aspirin; Calcium Channel Blockers; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Coronary Vasospasm; Diltiazem; Doxazosin; Drug Resistance; Drug Therapy, Combination; Ergonovine; Humans; Isosorbide Dinitrate; Male; Myocardial Infarction; Nicorandil; Nitrates; Pyridines; Stents; Ticlopidine; Ventricular Fibrillation

Long-term nitrate therapy for ischemic heart disease may cause drug tolerance which diminishes its beneficial effects; consequently, intermittent administration of nitrates is recommended. With this regimen, however, the potential occurrence of rebound angina during the nitrate-free intervals is a source of concern.. We carried out a retrospective study of 606 patients to determine whether rebound angina occurred when conventional continuous nitrate administration was replaced by intermittent administration as part of a long-term therapy protocol for prior myocardial infarction. The subjects were receiving treatment for myocardial infarction and included 293 patients treated with nitrates (Nitrate group) and 313 patients who were not (No-nitrate group). The former included 186 patients who received intermittent nitrate administration (Intermittent group) and 107 patients who received continuous administration (Continuous group). The mean period of observation was 4.3 +/- 1.6 months.. There were no cases of rebound angina in the Intermittent group. Cardiac events occurred in one case in the No-nitrate group (0.3%), in 4 cases in the Continuous group (3.7%) and in 2 cases in the Intermittent group (1.1%). The incidence of cardiac events was thus significantly increased in the Continuous group compared to the No-nitrate group (p < 0.05; odds ratio 9.06; 95% CI 1.41-58.28). The Intermittent group did not significantly differ from the No-nitrate group in the incidence of cardiac events.. It is concluded that intermittent administration of nitrates does not cause rebound angina and is therefore safe. A randomized controlled trial is needed to find the long-term effect on cardiac events.

Topics: Administration, Cutaneous; Administration, Oral; Aged; Angina Pectoris; Cardiovascular Agents; Coronary Vasospasm; Delayed-Action Preparations; Disease-Free Survival; Drug Administration Schedule; Drug Therapy, Combination; Drug Tolerance; Exercise Tolerance; Female; Follow-Up Studies; Heart Failure; Humans; Isosorbide Dinitrate; Male; Middle Aged; Myocardial Infarction; Nitroglycerin; Recurrence; Retrospective Studies; Treatment Outcome

An electrophysiological study and a provocative test of coronary artery spasm was attempted in a 68-year-old man who was having syncopal attacks and chest pain. His electrocardiogram had the characteristics of Brugada syndrome and ventricular fibrillation (VF) was induced by programmed electrical stimulation. ST-segment elevation became exaggerated by procainamide, which could not prevent the induction of VF. Coronary angiography revealed no stenotic lesions, and spasm in the left coronary artery was induced by intracoronary administration of acetylcholine with similar chest pain to that experienced before. Under treatment with diltiazem and flecainide, which suppressed the induction of VF, the patient experienced no recurrence of symptoms despite persistent ST-segment elevation. No previous reports have described coronary spasm associated with Brugada-type ECG abnormalities, and patients with syncope should be evaluated carefully.

Topics: Acetylcholine; Aged; Anti-Arrhythmia Agents; Calcium Channel Blockers; Cardiovascular Agents; Chest Pain; Coronary Angiography; Coronary Vasospasm; Diagnosis, Differential; Diltiazem; Electric Stimulation; Electrocardiography; Electrophysiology; Flecainide; Humans; Male; Syncope; Syndrome; Vasodilator Agents; Ventricular Fibrillation

Chest pain in patients with hypertrophic cardiomyopathy seems to be caused by relative myocardial ischemia due to the left ventricular outflow pressure gradient and myocardial hypertrophy. However, in 2 cases of hypertrophic cardiomyopathy chest pain was associated with coronary vasospasm. Thus, chest pain in these cases was decreased not by a beta-blocker but by isosorbide dinitrate and a calcium antagonist. Because beta-blockers are commonly used for hypertrophic obstructive cardiomyopathy and chest pain may be aggravated by beta-blockers in patients with coronary vasospasm, a combination of beta-blocker, isosorbide dinitrate and calcium antagonist was necessary for this hypertrophic cardiomyopathy with variant angina.

Topics: Adrenergic beta-Antagonists; Aged; Angina Pectoris, Variant; Calcium Channel Blockers; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Coronary Vasospasm; Diltiazem; Drug Therapy, Combination; Electrocardiography; Humans; Isosorbide Dinitrate; Male; Middle Aged

It has been well documented that the use of the internal thoracic artery yields better long-term patency rates than saphenous vein grafts for coronary artery bypass grafting. This knowledge has prompted surgeons to use other arterial conduits such as the radial artery.. Between April 1994 and January 1996, radial artery grafts were used in 83 patients (mean age, 54.6 years) undergoing myocardial revascularization. All patients received diltiazem, 80 mg orally three times daily. Angiographic studies were performed in the early post-operative period in 61 patients, and 6 to 19 months later in 12 patients.. There were four hospital deaths (4.8%), none of them due to cardiac causes. Perioperative myocardial infarction was observed in 3 patients, 1 related to a radial artery graft occlusion. Of 61 grafts studied early, 59 were patent (96.7%), but two grafts showed diffuse spasm. Twelve patients had a second angiogram after a mean interval of 8.7 months, and all grafts were patent. One patient who had a diffuse spasm at the early study had recurrent symptoms, and repeat angiogram showed further narrowing of the graft (string sign).. Our results suggest that with proper care, the radial artery may be used for coronary artery bypass grafting with good early results. Long-term follow-up and angiography studies will be needed to establish the merit of the radial artery as a graft for coronary artery operations.

Topics: Administration, Oral; Adult; Aged; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Vasospasm; Diltiazem; Female; Follow-Up Studies; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Radial Artery; Recurrence; Survival Rate; Vascular Patency; Vasoconstriction; Vasodilator Agents

Topics: Adult; Cardiovascular Agents; Coronary Vasospasm; Ergonovine; Female; Humans; Male; Middle Aged

A total of 349 patients with vasospastic angina were followed in eight centers in Japan for a period of 3.4 +/- 0.1 years (mean +/- SE). Ninety-eight percent of patients were treated with calcium blockers. Twenty-one episodes of myocardial infarction occurred in 18 patients (5%), including two fatal myocardial infarctions. The rate of myocardial infarction was higher (p less than .01) in patients with a fixed stenosis of 90% or greater than in patients with a fixed stenosis of less than 90% or normal coronary arteries. Myocardial infarctions occurred predominantly during hospital stays or at a time when the frequency of vasospastic angina increased. There were five sudden deaths (2%). Only one patient suffering sudden death had a fixed stenosis of 75% or greater. Serious arrhythmias were noted in 49 patients (14%). The risk of arrhythmias did not depend on the presence of a fixed stenosis of 75% or greater. These results suggest that cardiac events are rather infrequent in Japanese patients with vasospastic angina who are receiving treatment with calcium blockers and that the presence of a severe fixed stenosis markedly increases the risk of myocardial infarction but not the risk of arrhythmias.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Arrhythmias, Cardiac; Calcium Channel Blockers; Cardiovascular Agents; Coronary Vasospasm; Death, Sudden; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Japan; Male; Middle Aged; Myocardial Infarction; Risk

If myocardial ischemia always results from an imbalance between the needs and supplies in oxygen of the myocardium cells, the physiopathology of this process seems today infinitely more complex than the mere diminution or interruption of the output in a coronary artery. The extension of atheromatous lesions, the platelets aggregation, thrombosis, the coronary spasm, the release of products from the arachidonic cascade, the reactivity of the vascular endothelium, the profibrinolytic activity of the tissues are many of the intricate factors inducing myocardial ischemia. Cellular alterations, of which some are triggered by the release of oxygenated free radicals, lead then to an irreversible necrosis. The medications used until now in the treatment of angina are oxygen scavengers and research goes on in this direction with vaso-dilators beta-blockers, prolonged action nitro-compounds (nicorandil) or nitro-compounds with an action reinforced by N-acetyl-cysteine, bradycardiac derivates of alinidine and the new calcium antagonists dihydropyridine. However, the new physiopathological concepts of ischemia have opened new directions for the research: products which modify the arachidonic cascade by increase of synthesis or release of PGI2 (nafazatrom, defibrotide), by inhibition of TXA2 synthesis or blocking of TXA2 receptors, and similar products of PGI2 (iloprost); thrombolytic agents more specific of thrombin (PTA) or fibrinolysis activators (defibrotide), and anticoagulants with extended action; chelating agents of oxygenated free radicals (peroxide dismutase, catalase, peroxidase) or xanthine oxidase inhibitors; platelets anti-aggregates like ticlopidine which blocks the platelets receptors to fibrinogen, or inhibitors of the synthesis of pro-aggregating agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adrenergic beta-Antagonists; Animals; Calcium Channel Blockers; Cardiovascular Agents; Chelating Agents; Coronary Disease; Coronary Vasospasm; Epoprostenol; Fibrinolytic Agents; Humans; Nitrites; Platelet Aggregation; Thromboxane A2