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May 1981

Coronary VasospasmObservations Linking the Clinical Spectrum of Ischemic Heart Disease to the Dynamic Pathology of Coronary Atherosclerosis

Author Affiliations

From the Department of Medicine, Cardiology Section, Wadsworth Veterans Administration Hospital, and UCLA School of Medicine, Los Angeles.

Arch Intern Med. 1981;141(6):716-722. doi:10.1001/archinte.1981.00340060024008

• Patients with angina, myocardial infarction, and sudden death almost always have demonstrable coronary atherosclerosis. Furthermore, there is mounting evidence that coronary artery "spasm" is a contributing feature of these different coronary ischemic syndromes. Using quantitative angiography and two modes of α-adrenergic stimulation in patients with spontaneous rest angina, vasomotor hyperreactivity was shown to be localized only to the region of a preexisting coronary atheroma. These observations support the hypothesis that a dynamic interaction between the histopathologic features of coronary atherosclerosis and "normal" amounts of coronary smooth-muscle shortening accounts for the clinical features in the great majority of cases in the spectrum of ischemic heart disease. There are various mechanisms of smooth-muscle shortening in an arterial stenosis, each with different therapeutic implications.

(Arch Intern Med 1981;141:716-722)