Open AccessReflex Increase in Coronary Vascular Resistance in Patients with Ischemic Heart Disease
Author(s) -
Gilbert H. Mudge,
William Grossman,
Roger M. Mills,
Michael Lesch,
Eugene Braunwald
Publication year - 1976
Publication title -
new england journal of medicine/the new england journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 19.889
H-Index - 1030
eISSN - 1533-4406
pISSN - 0028-4793
DOI - 10.1056/nejm197612092952401
Subject(s) - medicine , cardiology , cold pressor test , vascular resistance , angina , phentolamine , vasoconstriction , blood pressure , coronary arteries , coronary circulation , coronary flow reserve , coronary atherosclerosis , vascular disease , ischemia , coronary artery disease , myocardial infarction , blood flow , heart rate , artery , stimulation
To assess possible coronary vasoconstriction in patients with ischemic heart disease, we measured coronary vascular resistance in 12 patients with normal hearts and 12 with coronary disease before and during the initial 50 seconds of cold pressor test, a stimulus known to produce systemic vasoconstriction. Control coronary vascular resistance was similar in the two groups, and although it did not change in patients with normal vessels, it rose by 27 per cent (P less than 0.005) in the group with coronary disease during the cold pressor test. In three of 12 patients with coronary disease coronary flow actually declined despite an increase in arterial pressure; in four, angina was precipitated. Phentolamine abolished increases in arterial pressure and coronary vascular resistance during the test in three patients with coronary disease. Adrenergically mediated coronary vascular tone may be an important determinant of coronary blood flow and may contribute to ischemia in patients with coronary disease.