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

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Circulation. 1986;74:955-963

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ARTICLES

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

H Yasue, Y Horio, N Nakamura, H Fujii, N Imoto, R Sonoda, K Kugiyama, K Obata, Y Morikami and T Kimura

We injected acetylcholine (ACh), the neurotransmitter of the parasympathetic nervous system, into the coronary arteries of 28 patients with variant angina. Injection of 10 to 80 micrograms ACh into the coronary artery responsible for the attack induced spasm together with chest pain and ST segment elevation or depression on the electrocardiogram in 30 of the 32 arteries of the 25 of the 27 patients. The injection of 20 to 100 micrograms ACh into the coronary artery not responsible for the attack in 18 patients resulted in various degrees of constriction in most of them, but no spasm in any of them. After intravenous injection of 1.0 to 1.5 mg atropine sulfate, the injection of ACh into the coronary artery responsible for the attack did not induce spasm or attack in any of the nine coronary arteries injected in eight patients. We conclude that the intracoronary injection of ACh induces coronary spasm and attack in patients with variant angina and that the activity of the parasympathetic nervous system may play a role in the pathogenesis of coronary spasm. We also conclude that the intracoronary injection of ACh is a useful test for provocation of coronary spasm.

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				Authors/Task Force Members, K. Fox, M. A. A. Garcia, D. Ardissino, P. Buszman, P. G. Camici, F. Crea, C. Daly, G. De Backer, P. Hjemdahl, et al. Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology Eur. Heart J., June 1, 2006; 27(11): 1341 - 1381. [Full Text] [PDF]

				O. Manfrini, G. Bazzocchi, A. Luati, A. Borghi, P. Monari, and R. Bugiardini Coronary spasm reflects inputs from adjacent esophageal system Am J Physiol Heart Circ Physiol, May 1, 2006; 290(5): H2085 - H2091. [Abstract] [Full Text] [PDF]

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				H. Soejima, A. Irie, S. Miyamoto, I. Kajiwara, S. Kojima, J. Hokamaki, T. Sakamoto, T. Tanaka, M. Yoshimura, Y. Nishimura, et al. Preference Toward a T-Helper Type 1 Response in Patients With Coronary Spastic Angina Circulation, May 6, 2003; 107(17): 2196 - 2200. [Abstract] [Full Text] [PDF]

				Y. Abe, M. Kondo, R. Matsuoka, M. Araki, K. Dohyama, and H. Tanio Assessment of clinical features in transient left ventricular apical ballooning J. Am. Coll. Cardiol., March 5, 2003; 41(5): 737 - 742. [Abstract] [Full Text] [PDF]

				S. S. Choi, Y.-J. Lim, J.-H. Bahk, S.-H. Do, and B.-M. Ham Coronary artery spasm induced by carotid sinus stimulation during neck surgery Br. J. Anaesth., March 1, 2003; 90(3): 391 - 394. [Abstract] [Full Text] [PDF]

				T. Noda, W. Shimizu, A. Taguchi, K. Satomi, K. Suyama, T. Kurita, N. Aihara, and S. Kamakura ST-segment elevation and ventricular fibrillation without coronary spasm by intracoronary injection of acetylcholine and/or ergonovine maleate in patients with Brugada syndrome J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1841 - 1847. [Abstract] [Full Text] [PDF]

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				H. Ogawa, Y. Mizuno, S. Ohkawara, K. Tsujita, Y. Ando, M. Yoshinaga, and H. Yasue Cardiac Amyloidosis Presenting as Microvascular Angina: A Case Report Angiology, April 1, 2001; 52(4): 273 - 278. [Abstract] [PDF]

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				H. Ogawa, H. Soejima, K. Takazoe, S. Miyamoto, I. Kajiwara, H. Shimomura, T. Sakamoto, M. Yoshimura, K. Kugiyama, M. Kimura, et al. Increased Autoantibodies Against Oxidized Low-Density Lipoprotein in Coronary Circulation in Patients with Coronary Spastic Angina Angiology, March 1, 2001; 52(3): 167 - 174. [Abstract] [PDF]

				S. Sueda, H. Fukuda, K. Watanabe, N. Ochi, H. Kawada, Y. Hayashi, and T. Uraoka Usefulness of Accelerated Exercise Following Mild Hyperventilation for the Induction of Coronary Artery Spasm : Comparison With an Acetylcholine Test Chest, January 1, 2001; 119(1): 155 - 162. [Abstract] [Full Text] [PDF]

				M. Suzuki, T. Yoshii, T. Ohtsuka, O. Sasaki, Y. Hara, T. Okura, Y. Shigematsu, M. Hamada, and K. Hiwada Coronary Spastic Angina Induced by Anticholinesterase Medication for Myasthenia Gravis: A Case Report Angiology, December 1, 2000; 51(12): 1031 - 1034. [Abstract] [PDF]

				K. Nagao, N. Hayashi, K. Kanmatsuse, K. Arima, J. Ohtsuki, K. Kikushima, and I. Watanabe Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital J. Am. Coll. Cardiol., September 1, 2000; 36(3): 776 - 783. [Abstract] [Full Text] [PDF]

				E. Braunwald, E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, D. Kereiakes, J. Kupersmith, T. N. Levin, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina) J. Am. Coll. Cardiol., September 1, 2000; 36(3): 970 - 1062. [Full Text] [PDF]

				M K DAVIES and A HOLLMAN Hypertension Heart, July 1, 2000; 84(1): 2 - 2. [Full Text]

				K. Kugiyama, Y. Ota, H. Kawano, H. Soejima, H. Ogawa, S. Sugiyama, H. Doi, and H. Yasue Increase in plasma levels of secretory type II phospholipase A2 in patients with coronary spastic angina Cardiovasc Res, July 1, 2000; 47(1): 159 - 165. [Abstract] [Full Text] [PDF]

				J.-K. Song, S.-W. Park, D.-H. Kang, M.-K. Hong, J.-J. Kim, C.-W. Lee, and S.-J. Park Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1850 - 1856. [Abstract] [Full Text] [PDF]

				O. Hirashima, H. Kawano, T. Motoyama, N. Hirai, M. Ohgushi, K. Kugiyama, H. Ogawa, and H. Yasue Improvement of endothelial function and insulin sensitivity with vitamin C in patients with coronary spastic angina: Possible role of reactive oxygen species J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1860 - 1866. [Abstract] [Full Text] [PDF]

				K. Kodama, Y. Shigematsu, M. Hamada, K. Hiwada, Y. Kazatani, K. Matsuzaki, and E. Murakami The Effect of Coronary Vasospasm on the Direction of ST-Segment Deviation in Patients With Both Hypertrophic Cardiomyopathy and Vasospastic Angina Chest, May 1, 2000; 117(5): 1300 - 1308. [Abstract] [Full Text] [PDF]

				T. Tokudome, K. Mizushige, K. Ohmori, K. Watanabe, Y. Takagi, Y. Takano, H. Matsuo, and K. Mizushige Neurogenic Regulation of Basal Tone of Coronary Artery with Mild Atherosclerosis in Humans: Observation Using Two-Dimensional Intravascular Ultrasound Angiology, December 1, 1999; 50(12): 989 - 996. [Abstract] [PDF]

				M Takusagawa, S Komori, K Umetani, T Ishihara, T Sawanobori, I Kohno, S Sano, D Yin, H Ijiri, and K Tamura Alterations of autonomic nervous activity in recurrence of variant angina Heart, July 1, 1999; 82(1): 75 - 81. [Abstract] [Full Text] [PDF]

				M. Nakayama, H. Yasue, M. Yoshimura, Y. Shimasaki, K. Kugiyama, H. Ogawa, T. Motoyama, Y. Saito, Y. Ogawa, Y. Miyamoto, et al. T-786->C Mutation in the 5'-Flanking Region of the Endothelial Nitric Oxide Synthase Gene Is Associated With Coronary Spasm Circulation, June 8, 1999; 99(22): 2864 - 2870. [Abstract] [Full Text] [PDF]

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