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

Hess, O. M. ; Büchi, M. ; Kirkeeide, R. ; Niederer, P. ; Anliker, M. ; Gould, K. L. ; Krayenbühl, H. P.

In: European Heart Journal, 1990, vol. 11, p. 58-64

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    Title
    • Potential role of coronary vasoconstriction in ischaemic heart disease: effect of exercise
    Author
    • Hess, O. M.. Department of Internal Medicine, Medical Policlinic, Cardiology, University Hospital
    • Büchi, M.. Department of Internal Medicine, Medical Policlinic, Cardiology, University Hospital
    • Kirkeeide, R.. Institute of Biomedical Engineering, University of Zürich
    • Niederer, P.. Division of Cardiology, University of Texas Houston, U.S.A.
    • Anliker, M.. Division of Cardiology, University of Texas Houston, U.S.A.
    • Gould, K. L.. Institute of Biomedical Engineering, University of Zürich
    • Krayenbühl, H. P.. Department of Internal Medicine, Medical Policlinic, Cardiology, University Hospital
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:300835
    Summary
    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